Archived: Kingsfield Care Centre

Updated 2 December 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 26 and 29 September 2017. The first day of the inspection was unannounced and the second was announced. On day one of the inspection the inspection team consisted of one inspector, a nurse specialist and two experts by experience. The experts-by-experience had backgrounds in caring for elderly people. Day two of the inspection was carried out by one inspector.

Before the inspection, we checked the Provider Information Return (PIR). The PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We looked at previous inspection reports and notifications about important events that had taken place at the service, which the provider is required to tell us by law. We checked that the provider had followed their action plan and to confirm that they now met legal requirements.

We observed the care provided for people. We spoke with 22 people and seven relatives about their experience of the service. We spoke with eleven staff including the acting manager, the area manager, the operational support manager, the quality development manager, one registered mental health nurse, two registered general agency nurses, the dementia lead, one senior care worker and two care workers. After the inspection, three relatives contacted us to give their views about the service. We received feedback about the service from three health and social care professionals.

We looked at records held by the provider and care records held in the service. This included seven care plan daily notes; safeguarding, medicines and complaints policies; the recruitment records of the six newly recruited staff employed at the service; the staff training programme; medicines management; complaints and compliments; meetings minutes; and health, safety and quality audits. The provider sent us other information about the maintenance of equipment, DoLS applications and fire safety after the inspection. This was received in a timely manner.

Updated 2 December 2017

The inspection was carried out on the 26 and 29 September 2017. The first day of the inspection was unannounced and the second was announced.

The service provided modern, purpose built accommodation. Staff provided personal and nursing care for up to 90 older people. The accommodation spanned three floors and offered various room size options for people. Bedrooms had on-suite facilities. There were plenty of communal areas and lifts were available for people to travel between floors. There were 56 people living in the service when we inspected, 39 people were accommodated in part of the service which was designed for people who needed nursing care or were living with developed dementia. The other parts of the service provided residential accommodation and nursing care to 17 people living with non-complex dementia. Nursing staff and care staff assisted people to manage chronic and longer-term health issues associated with ageing or after an accident or illness.

We carried out our last announced comprehensive inspection of this service on 25, 26 and 27 July 2016. Breaches of legal requirements were found. Accurate and complete records were not being kept, staff were not deployed in sufficient numbers and staff had not been receiving supervision. We also made a recommendation about the levels of staff training for end of life care. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches of Regulation 17 and Regulation 18 of the Health and Social Care Act Regulated Activities Regulations 2014, Good Governance and Fit and proper persons employed. The provider sent us an action plan, this told us they had already taken action and were now meeting the regulation. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Kingsfield Care Centre on our website at www.cqc.org.uk.

There was not a registered manager employed at the service. The person who had been registered left the service on 15 September 2017. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. However, the provider was in the process of employing a manager. At the time of this inspection the service was being managed by the deputy manager (Acting manager).

At this inspection we found that some improvements had been made. Staff had been keeping up to date and accurate records of the care provided to people. Recruitment of new nursing and care staff had taken place, but the new staff had only just started their induction. However, the majority of people who gave us feedback about the service told us their experiences of the care and the management continued to be poor. Concerns remained about the stability of the management structures in the service and the consistent deployment of regular qualified nursing staff. At the time of this inspection the local authority in Kent had issued a safeguarding and poor practice warning against Kingfield Care Centre. This meant that the service still required improvement. We have made a recommendation about this.

The provider understood the challenges and issues faced by the service and had taken steps to improve people’s experiences of the care. However, the provider needed to do more to improve the outcomes for people in the service.

Staff received training that related to the needs of the people they were caring for. During the inspection all three of the nurses leading the day staff were agency nurses. The acting manager told us that five new nurses had been recruited and four new nurses had started their induction on the first day of our inspection.

The provider had a system in place to assess people’s needs and to work out the required staffing levels. However, we could not fully assess the staffing levels impact on the service because the provider was still in the process of recruiting and training staff and there were 24 vacant rooms in the service, which was not running at full capacity.

The leadership in the services had not been stable. People, their relatives and external health and social care professionals could not always tell us that they experienced well-led safe care.

Staff supervisions had improved, but were not consistent having been affected by large movements of staff out of and into the service. We could not fully assess if the current management structure in the service could effectively sustain staff meetings and supervisions with a designated line manager to discuss their work performance. We have made a recommendation about this.

There were systems in place to monitor the quality of the service, which included gaining the views of people and their relatives. People felt confident to raise a concern or complaint, but were not always sure their concerns would be acted on.

All staff understood their responsibilities to protect people from harm and were encouraged and supported to raise any concerns.

Records about the care people had received were now up to date and completed.

Agency nursing staff had the skills and experience to advise care staff and to meet people’s needs. The acting manager provided nurses with clinical training and development.

The provider and acting manager had contingency plans in place to reduce the impact on people’s care from foreseeable emergencies. Equipment and the environment were maintained, checked and tested to minimise the risks of potential harm.

There were policies in place for the safe administration of medicines. Nurses and accredited staff were trained in the safe administration of medicines, gained people’s consent before giving a person their medicines and appropriate records were kept.

People's care plans and risk assessments contained information about their personal history and support needs that enabled staff to support them safely. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or make sure people were protected from harm. Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced.

The environment was clean and some of the design features benefitted people living with dementia including themed areas and signage. The service planned to make further provision to improve outcomes for people living with dementia.

People had their health and nutritional needs assessed and monitored and referrals were made to health professionals when their needs changed. People were offered a choice at mealtimes which took into consideration their dietary requirements.

New staff received an induction which included shadowing existing staff. They were provided with a regular programme of training in areas essential to their role. Staff had received training in the Mental Capacity Act 2005 and understood its main principles. CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The acting manager had submitted and monitored DoLS applications so that people were not deprived of their liberty unlawfully.

Staff communicated with people in a kind manner and treated them with compassion, dignity and respect. Staff had developed positive and valued relationships with people and their family members.

A plan of care was developed for each person to guide staff on how to support people’s individual needs. Information had been gained about people’s likes, and what was important to them. These were regularly reviewed so that they contained the right information for staff to be able to support people.

People were offered a range of activities which included sensory activities that took into consideration the needs of people living with dementia.