Kings Lodge

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question Good. At this assessment the rating has changed to Requires Improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The service was in breach of legal regulation in relation to governance at the service as care plans were not contemporaneous, audits did not always identify shortfalls and actions following incidents were not always following safe practices.

This service scored 61 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Management had a shared vision, strategy and culture and people felt the care they received was good.

On the whole the feedback we received from people, relatives and staff was positive. People told us, “Staff are good. I didn’t choose to be here, but they have it well organised”, “I don’t have a lot to do with the managers, but they are very nice”, “It’s nice here – lovely. (Staff) are so lovely. I don’t know who the managers are”, “I’m very settled and happy here. It’s a good place to be. The manager is a really nice, helpful lady” and “It’s safe and cosy in here. That’s what I like. I like feeling safe.” We also observed good banter between staff and some people and there was clearly affection for people.

Relatives commented, “She (person) knows her surroundings, she is comfortable, she knows the nurses”, [Registered manager name] is not too bad. Staff have been lovely, easy to talk to and understanding”, “It’s magnificent. I always get a welcome by the staff. There is really good communication. He is well looked after”, “Mum is really well looked after. The communication is very good. She is always up, looking neat and well dressed and her hair is done. I am happy with the care she is getting here.” In addition, staff told us, “We do see her about (registered manager) and she is very nice, and you can approach her and she asks if we like our job. As a general rule, everybody’s really nice here.”

Management had the skills, knowledge, experience and credibility to lead effectively. However we did identify areas where improvements were required.

Accidents, incidents and safeguarding concerns were recorded, this included statutory notifications made to the CQC. A notification is the action that a provider is legally bound to take to tell us about changes to their regulated services or notifiable incidents that have taken place in them. We identified where there had been an error with this process but the registered manager took immediate action to rectify this oversight.

We found management were responsive as we identified some shortfalls during our visit which we have reported in the key question of Safe. Once these issues were raised with management, they were addressed immediately or shortly after our visit. We also found our request for documentation after our site visit was met, as management sent us everything within the required timescale.

We heard from staff that they felt fully supported by management. They told us, “Absolutely I have the support”, “Manager always comes in at the start of the day to greet everyone, see residents and staff” and “Managers frequently pop into the unit to see how everyone is, nurses are helpful and will assist in emergencies/call outs promptly and are available, teamwork is good.”

Management fostered a positive culture where people felt they could speak up and their voice would be heard.

People, relatives and staff felt comfortable in raising suggestions or concerns. Resident and relatives’ meetings were also held to support this. Staff meetings were also held regularly to help encourage staff’s contribution towards the running of the service. One person said, “If I had any problems, I think I could tell anyone here.” A relative told us, “I would speak to the manager if I needed to but have never had the need” and staff said, “Able to speak up. We just go to her (the manager) office if we need to” “Suggestions are most welcome” and “I feel free to talk to the manager. We need to work as a team.” Staff said they had regular supervisions and support to speak up if needed.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

Staff we spoke with felt supported and valued. They had no concerns around how the provider treated them. One said the managers helped them with learning and improving their language skills which they appreciated. Another said, “I feel respected and valued and there is a good understanding of equality and diversity in the service.” Other staff were recruited from overseas.

The deputy manager told us, “Everyone has the same support and supervision. There is no discrimination.”

Management did not always have clear responsibilities, roles, systems of accountability or good governance.

We reviewed the care plans of 21 people and found some of these contained generic or contradictory information, meaning there was the potential risk that staff might not know what care the person required. This was despite governance arrangements in place to review and audit care plans.

One person’s continence care plan recorded, ‘I have occasional urinary accidents or am catheter dependent’, it then went on to say, ‘I am continent, or have a catheter’. This meant it was not clear whether the person had a catheter or not. This same person’s pain care plan stated, ‘I have minimal pain/fatigue’ but also said, ‘I have chronic pain’. Throughout this person’s care plan, it was recorded that they were type 2 diabetic. In their nutritional assessment, it stated this was diet controlled, but in their medical record, it stated it was to be controlled with insulin.

A second person had a self-administration care plan for medicines, but in their capacity assessment, it stated, ‘[person’s name] is unable to administer her own medication’. Further in their care plan, it stated this person could not always communicate discomfort or the need to be turned, yet we had been told this person was able to communicate well and did not need repositioning.

Another person’s care plan recorded they were at low risk of malnutrition but later stated they were at ‘very high risk’. The person had lost 17kg of weight over a period of time and yet their skin integrity recorded ‘unknown’ to the question of whether the person had lost weight.

We also identified in a further person’s mobility care plan that it said they were able to weight bear but on the front page of their care plan it stated the occupational therapist advised only using a hoist due to muscle weakness.

Although management used a dependency tool to calculate staffing levels, staff deployment was not sufficiently monitored to ensure it met people’s needs across all areas of the service. For example, 1 person required extensive 1:1 support and at times 2 staff for personal care, as confirmed by their daily records from 10 to 25 November, yet their dependency level was recorded as ‘medium’. We also observed delays in care, including 1 person waiting over 15 minutes for a cup of tea and another not receiving timely support to use the toilet. These issues were particularly evident in 1 area of the service, indicating that pinch-times and staff deployment were not being effectively monitored or adjusted.

Although regular audits were completed in relation to infection control, health and safety, medicines and call bell response times, these did not always pick up areas that required addressing. For example, the inappropriate storage of controlled drugs.

We also found some gaps in best practice indicating some staff may need additional training. For example, management told us the incontinence pads stacked in the sluice room were down to a new staff member, indicating a need for further induction or training. In addition, we also observed practices that did not reflect a dignified or compassionate approach by staff. This included staff calling out meal options at lunchtime rather than appreciating people’s communication needs, a staff member saying to 1 person, “Shall I show you?” but never doing so, and a staff member standing over a person who was distressed instead of sitting with them to provide reassurance.

Finally, 1 relative told us (of activities), “They never ask [person’s name]. It’s always the same 4 people. The easy ones.” We carried out an analysis of 3 months of activity records and found that this somewhat supported this comment. The offer of activities was inconsistent, with little evidence that people were not attending many activities that they had been offered but had declined.

This demonstrated that although management systems existed, they were not effective.

Staff understood their duty to collaborate and work in partnership, so services worked seamlessly for people.

Staff worked with local health and social care professionals to help support people’s care. This included the diabetes nurse, tissue viability nurse, GP practice, local pharmacy, physiotherapists, the occupational therapist and speech and language therapy team. The deputy manager told us, “We had a good networking event on Friday where social workers came from the local area. We are going to introduce these every couple of months.” They went on to say, “A solicitor came in to talk about power of attorney for relatives.”

In addition, people had the opportunity to go out on mini-bus trips and local schools and nurseries came into the service. A church service was held once a month for those who had a faith.

Although management focused on continuous learning, innovation and improvement across the organisation, they did not always ensure that actions taken were in line with best practice.

Following a recent serious incident, management had held supervisions with staff, arranged training, and purchased some preventative choking equipment to be held by clinical staff. However, although the training was cancelled before it was delivered to staff, management had already distributed the preventive choking device kits to the nurses. This meant there was equipment in the clinical rooms which staff told us they did not know how to use. Additionally, the equipment was not endorsed by the Resuscitation Council UK. This meant, in the event of a person choking, they may not receive the most appropriate intervention from staff.

Other lessons had been learnt by management and the learning shared with staff. This was done through the regular staff meetings held by management.