Background to this inspection
Updated
17 February 2021
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The first site visit was carried out by two inspectors, and the second by one inspector. An assistant inspector worked remotely and spoke with people’s relatives.
Service and service type
Kingsgate is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The owner of the service was the registered provider. This means that they are legally responsible for how the service is run and for the quality and safety of the care provided. There was also a manager in post who oversaw the day to day running of the service.
Notice of inspection
This inspection was unannounced.
We carried out a focused inspection to review the key questions of safe and well-led only.
Inspection activity started on 1 December 2020 and ended on 29 December 2020. We visited the service on 1 December 2020 and 8 December 2020.
What we did before the inspection
We reviewed the information we had received about the service since the last inspection. We sought feedback from the local authority about the service.
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give us key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
We used all of this information to plan our inspection.
During the inspection
During the inspection we spoke with two people who lived in the service. We also spoke with the provider, the manager, three members of care staff and a member of maintenance staff. During the visit, we also observed the care and support people received.
We reviewed a range of records. These included the care records for four people, and the medicines records for four people. We also reviewed a variety of records relating to the management of the service. These included policies and procedures, incidents, training records, quality monitoring audits and maintenance records for the premises.
After the inspection
We had further contact with the provider, the manager, and deputy manager to assess and validate the information we reviewed.
Updated
17 February 2021
About the service
Kingsgate is a residential care home providing personal care to people aged 65 and over at the time of the inspection. On the day of our first visit there were 24 people living in the service with one person in hospital. When we visited on the second day, 22 people were living in the service and three people were in hospital. The service can support up to 33 people.
Kingsgate is comprised of three large terraced houses and is set across three floors. People share bathing facilities and there are a number of communal lounges and a large dining room.
People’s experience of using this service and what we found
At this inspection we found the provider had not taken any action to address the concerns found at the previous inspections in March 2019, and January 2020. At this inspection in December 2020, we found continued breaches of three of the regulations.
Management of risks within the environment and to people’s individual needs were poorly managed. Serious risks within the environment which posed a risk of harm to people were not identified, and appropriately managed. Risk assessments in relation to behaviour that challenges were not in place.
Records of accidents and incidents were not detailed, nor consistently recorded. Opportunities to learn from incidents were missed due to the lack of thorough investigation of incidents.
Notifiable incidents were not always reported to the Care Quality Commission as they are required to by law
Staff compliance with training was poor, and not all staff had completed training in safeguarding. However, staff understood what constituted abuse and people felt safe living in the service.
Methods used to determine staffing levels were not thorough, and staff told us they did not always have time to spend with people outside of delivering personal care.
Some gaps were found in people’s medicine administration records. There were protocols in place for when required medicines were needed, and staffs’ competencies in relation to administering people’s medicines had been assessed.
Some equipment was found to be dirty, but action was taken to address this during the inspection visit. There was a delay in implementing increased cleaning of the home in light of the pandemic and policies and procedures in relation to COVID-19 were not sufficiently detailed.
Processes to assess and monitor the safety and quality of the service being delivered remained ineffective. The provider did not undertake any quality monitoring to gain an overview of the service.
Processes were in place to engage people who lived in the service, their relatives and staff. Meetings were held for people and staff, but sometimes information pertinent to people living in the service and the staff was not discussed.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection (and update)
The last rating for this service was requires improvement (published 28 February 2020) and there were four breaches of the regulations which were safe care and treatment, need for consent, good governance and notification of other incidents. At this inspection we found the provider remained in breach of three of these regulations.
Why we inspected
This was a planned inspection based on the previous rating.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. Therefore, we did not inspect them. Ratings from the previous comprehensive inspection for those key questions were used to calculate the overall rating at this inspection.
The overall rating for this service has changed from requires improvement to inadequate. This is based on the seriousness of concerns found at this inspection.
We have found evidence that the provider needs to make significant improvements. Please see the safe and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this report.
You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Kingsgate Care Home on our website at www.cqc.org.uk.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.
At this inspection we have identified breaches of regulation in relation to safe care and treatment, good governance, and notification of incidents.
Please see the action we have told the provider to take at the end of this report.
Follow up
The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
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.
Following the inspection, the provider made a decision to close the service. The local authority and provider supported people to find alternative residential care homes and the last person left the service on 11 February 2021.