During August and September 2016, we received a significant number of concerns about staffing levels and care provision at Kingfisher Lodge. This information of concern was received from people’s relatives, staff and from healthcare professionals who had visited the service. As a result of this information, we undertook an unannounced inspection of Kingfisher Lodge on 19 September 2016.
When the service was last inspected in November 2014, we found the provider had failed to ensure there were adequate staffing levels to meet the needs of people at the service. The provider wrote to us in February 2015 and told us how they would achieve compliance with this regulation. During this inspection, we found the provider has not ensured staffing levels were adequate to meet the needs of the people at the service.
Kingfisher Lodge provides accommodation for people who require nursing or personal care to a maximum of 60 people. At the time of our inspection in September 2016, 47 people were living at the service. The service is split over two floors, with Chaffinch unit on the lower floor and Lark unit on the upper floor. Lark Unit primarily supports people living with a dementia type illness.
A registered manager was not in post at the time of 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. A general manager had assumed post in May 2016 and was currently undertaking the registration process with us to become the registered manager.
Following this inspection in September 2016, we wrote to the provider to outline the immediate concerns we identified and requested that an urgent action plan to address our concerns was produced. The provider responded to us within the requested timeframe. They acknowledged the seriousness of the concerns we had raised and the impact they were having on the quality of care provided to some people. We have since responded to the provider and requested they send reports to us at specified frequencies. These reports relate to the current staffing levels at the service in order to demonstrate to us that the service is able to meet people’s assessed needs.
The provider had not ensured there was enough staff on duty to consistently meet people’s needs. This placed people at the service at risk of not having their assessed needs met. Medicines were not always managed safely and medicine recording omissions made it unclear if people had received their medicines as prescribed. There were no effective systems in operation that ensured accidents and incidents were reviewed to reduce the risk of recurrence and risks to people. People were placed at risk through poor cross infection prevention practice.
There were insufficient systems to show that the service had met the Deprivation of Liberty Safeguard (DoLS). DoLS is a framework to approve the deprivation of liberty for a person when they lack the mental capacity to consent to treatment or care and need protecting from harm. There was no evidence that the service understood the conditions attached to people’s DoLS or how they were being implemented. In addition to this, the provider was not consistently providing care in line with people’s consent and with mental capacity legislation.
Staff at the service were caring and people and their relatives spoke very highly about the caring nature of staff. We made positive observations of care provision, however we also received information from people and made observations of how staff were unable to be consistently caring through inadequate staffing numbers. People’s clinical needs were not consistently met in relation to pressure ulcers and diabetes care. In addition we found that where people required pressure relieving mattresses to meet their needs, there was no effective system to ensure these were correctly set which placed people at risk.
There were governance systems provided, however these had not always been effectively used. There were inconsistencies between Chaffinch and Lark units and no management systems in operation that identified this. People, staff and their relatives gave mixed feedback on the management of the service. Although we noted the service had received regional support from the provider, this was not consistent. Prior to the inspection the provider had failed to ensure people’s health, safety and welfare needs were met by failing to ensure sufficient management arrangements were in place during a pre-planned absence of both regular managers.
People and their relatives spoke positively about the staff at the service. Most wished to stress that although they were giving us information about negative experiences at the service, they felt the staff were very caring.
The service had safe recruitment procedures. The environment was risk assessed and there were regular systems to ensure the equipment within it were serviced and functional. Staff were supported through a training programme and supervision was completed. It was noted that supervision completion was low but the manager told us this was being addressed.
People were supported with their nutritional needs and people had access to healthcare professionals when required. There was a complaints procedure in operation however we saw the responses were inconsistent.
We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.
For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.