Kingfisher Court

Kingfisher Court is a residential care home which was providing personal and nursing care to 29 people at the time of the inspection. The service can support up to 39 people. The service is purpose built to provide specialist accommodation and rehabilitation facilities for those with acquired brain injury and associated neurological conditions.

People’s experience of using this service and what we found

People enjoyed living at the home and felt safe. However, improvements were required in some areas. We were not assured there was good infection prevention and control practice in the service, some areas would benefit from deep cleaning and other areas were in poor states of repair. Staffing levels for domestic staff were not sufficient. Gaps in training records put people and staff at risk of harm.

Relevant recruitment checks were conducted before staff started working at the service to make sure they were of good character and had the necessary skills. However, we did find that more robust procedures for checking full employment histories were required. We could not always be assured risks associated with people’s needs were always assessed appropriately or managed. More robust governance systems needed to be in place to monitor and improve the quality of the service provided. Records were not always in place to support actions taken.

Improvements were needed for medicines. This included risks not being appropriately assessed and not enough information to support people. We have made a recommendation about the management of some medicines.

Staff had received training in safeguarding adults and knew how to identify, prevent and report abuse. Staff worked collaboratively with health and social care professionals to support people with their healthcare needs. There was a system in place to allow people to express any concerns or complaints they may have.

Activities took place both inside the home and outside the home. Staff felt supported by management and enjoyed working at the service and felt staff morale was positive. Staff we spoke with were enthusiastic about their jobs and showed care and understanding for the people they supported.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Right Support: People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. For example, people lived in an environment where we found infection control concerns and not enough staffing to support the cleaning of the home.

Right Care: Care is person-centred and promotes people’s dignity, privacy and human rights

Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff ensure people using the service lead confident, inclusive and empowered lives.

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 good (published 10 November 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make 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 full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Kingfisher Court on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to regulation 12 safe care and treatment, regulation 18 staffing and regulation 17 good governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The provider and registered manager had a detailed communication plan for people living in the home. Communication with relatives was open and transparent on the reasons for lockdown. There was a plan in place for regular communication through whichever medium people preferred.The registered manager worked closely with people to ensure they were able to communicate regularly with the people they care about.

A rigorous cleaning regime was in place. It was the responsibility of each staff member, everyone was on the rota and cleaning of touch points took place every hour. Staff were fully involved and understood the importance of thorough cleaning.

The provider and registered manager split the staff team in two, so one team only worked on the ground floor and one team only worked on the first floor. The two staff teams did not mix. This has not only provided continuity of care for people but also provided stability and given staff confidence.

The provider and registered manager have worked creatively with staff to offer people a variety of activites to maintain their own wellbeing. The staff team have worked tirelessly to ensure activities were person centred and fun.

Kingfisher Court is a ‘care home’ and is registered to accommodate up to 13 people. People in care homes receive accommodation and nursing or 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. The service is purpose built to provide specialist accommodation and rehabilitation facilities for those with acquired brain injury and associated neurological conditions. At the time of the inspection, 13 people were accommodated at the home.

There was a registered manager in place. 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 and associated Regulations about how the service is run.

People felt safe at Kingfisher Court and they were very much at the heart of the service. We received consistent positive feedback from people’s relatives and health professionals. People’s relatives felt the service went above and beyond and were extremely experienced at looking after people needs. People received excellent care that was based around their individual needs and that ensured care was personalised and responsive.

Staff enjoyed working at the home and understood the needs of people using the service and supported people in a personalised way. Staff knew people well and we saw that care was provided respectfully and sensitively, taking into account people’s different needs.

Relevant recruitment checks were conducted before staff started working at the home to make sure they were of good character and had the necessary skills. Staff had received training in safeguarding adults and knew how to identify, prevent and report abuse. There were enough staff to keep people safe.

The risks to people were minimized through risk assessments. There were plans in place for foreseeable emergencies and fire safety checks were carried out.

Activities were provided on a one to one basis by staff according to each person’s needs and interests. People were supported to have good access to the local community and were able to take part in varied activities that they enjoyed.

People received varied meals including a choice of fresh food and drinks. Staff were aware of people’s likes and dislikes and went out of their way to provide people with what they wanted.

People were cared for by a motivated and well-trained staff team. Staff received regular support and one to one sessions or supervision to discuss areas of development. They completed a wide range of training and felt it supported them in their job role. New staff completed an induction programme before being permitted to work unsupervised.

Staff had an understanding of the Mental Capacity Act (MCA) and were clear that people had the right to make their own choices. Staff sought consent from people before providing care and support. The ability of people to make decisions was assessed in line with legal requirements to ensure their rights were protected and their liberty was not restricted unlawfully. People are supported to have maximum choice and control of their lives and staff supported them in the least restrictive way; policies and systems in the service supported this practice.

People were cared for with kindness, compassion and sensitivity. Care plans provided comprehensive information about how people wished to receive care and support. This helped ensure people received personalised care in a way that met their individual needs.

Regular audits of the service were carried out to assess and monitor the quality of the service. There were appropriate management arrangements in place.