Kingsway Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to infection prevention and control and premises safety, risk management and staffing.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always have a proactive and positive culture of safety based on openness and honesty. Lessons were not always learned to continually identify and embed good practice. During our assessment we found issues with the premises, infection prevention and control, risk management and care records which had not been identified or addressed by the provider.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. Healthcare partners spoke positively about how staff worked with them to maintain safe systems of care. One healthcare partner told us, “I feel having this working relationship enables us to work together to get the best patient care for the patients.”

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately. Staff received safeguarding training and said they would immediately report any concerns they had. One member of staff said, “I feel able to raise concerns, and management takes these seriously.” People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). The provider and staff followed the principles of the MCA and DoLS.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. For example, some risk assessments lacked information on risks to people and how these could be managed to keep people safe.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care. For example, emergency alarms in bathrooms were not always accessible and external areas were not kept clear of trip and fire risk hazards. We also saw that safety check records did not always record what had been reviewed to ensure the premises were safe to use.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. Not all staff had received supervisions in line with the provider’s own policy, and staff told us these were not always effective at supporting them in their roles. We also saw gaps in the recruitment records of some staff, which meant recruitment processes were not always safe.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly. Some areas of the home were dirty, and personal protective equipment was not always in place for staff to use.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened. Records showed that people received their medicines when needed, and that they were safely and securely stored.