The inspection took place on 26 September 2018 and it was unannounced.
Kings Lodge is a new home providing residential care for older people including those living with dementia. The care home has been opened just over a year. The building is designed to accommodate and care for up to 64 people in four different units. At the time of the inspection there were 19 people living there, 13 of whom were living with dementia.
People in residential care homes receive accommodation and personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
There was no registered manager in post at the time of the inspection. 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.
The registered manager had resigned recently and the provider was taking the necessary steps to recruit to the role. The registered provider was present for the inspection. They had a dual role as they also managed another care home but were spending two days a week at Kings Lodge. There were other staff who were currently taking on addition management tasks who were also present on the day of inspection.
There had been some upheaval recently with the loss of senior staff at the home. The provider was aware of the need to support the workforce, and give clear leadership. Whilst aspects of the care were good, there was a recognition that improvements were still needed and staff needed support to make the necessary changes.
There was some inconsistency in the way that people’s consent for care was agreed which was not meeting the legal requirements of the Mental Capacity Act.
Whilst there was sufficient staff on the day we visited, there was some evidence that staffing levels had been stretched in the past. We have made a recommendation about the need for the provider to continually review staffing, based on the needs of the people as the service grows.
Some improvements were needed to ensure the facilities and furniture were always suitable to meet the physical and specialist needs of the people who lived there. Some people were kept waiting to have their lunch served. We have made recommendations to the provider.
People’s wishes for the end of their lives were not always documented or clear. Some care plans were not signed off as agreed with the person. Daytime activities for people, and opportunities to access the community was being improved by the provider. The involvement of people, relatives and staff in the service was still being developed and further engagement was needed.
People were kept safe from harm. The risks to people’s safety were assessed and staff knew of the actions they should take. People were protected from the spread of infections through the safe practices of staff.
The environment people lived in was kept very clean. People received their medicines on time and from staff who were trained and understood the medicines administration. Staff were aware of their responsibilities to protect people from abuse.
Accidents and incidents, including any falls that people experienced, were recorded and monitored including trends. Lessons had been learnt from a recent safeguarding incident and processes were updated.
People’s physical, psychological and social needs had been assessed before they moved into the service. People had enough to eat and drink throughout the day. Choices were provided and their nutritional needs were being met.
People’s health was maintained and they had access to specialist services when needed.
People were treated with kindness, respect, and compassion. They felt they were listened to and their emotional needs were being met. People made day to day decisions about their care. Privacy was always maintained. Staff made sure they spent one to one time with people and engaged with them personally.
There was a complaints process in place, though people said they had no reason to use this.
The service had developed partnerships with other agencies and had an ambition to do more.
The service had experienced a time of uncertainty and the provider was supporting staff during a period of change. There was evidence that the provider was already acting to improve and create a good basis for growth.
During this inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also made three recommendations to the registered provider.
You can see what action we told the provider to take at the back of the full version of this report.