This comprehensive inspection took place on 14 October 2015 and was unannounced. The Care Quality Commission (CQC) has carried out three other inspections of Kingston Care Home in 2015 on 6 January, 23 June and 14 September.
Kingston Care Home provides accommodation, nursing and personal care for up to 67 older people. The service specialises in the care and support of older people who may be living with dementia. The home is purpose built and accommodation is arranged over three floors. There were 50 people using the service when we visited, of whom approximately two-thirds were living with dementia.
At the time of our inspection, the service was undergoing some organisational and management changes. The parent organisation was being re-structured into sub-organisations with separate identities, purposes, objectives and management structures. Kingston Care Centre was moving into one of those groups- Brighterkind.
The service is required to have a registered manager, but had not had one in post since November 2014. In the preceding 12 months four different temporary acting managers have been in day-to-day charge of the home for varying lengths of time. Constant changes to the management team and a lack of continuity have inevitably had an adverse effect on the quality of the care and support people living at the home receive. The provider told us a new permanent manager had just been appointed and was in the process of applying to the Care Quality Commission (CQC) to register with us.
A registered manager is a person who has registered with the (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.
At this inspection we found the provider had taken appropriate action to address the two outstanding breaches identified in a previous inspection of the home. These breaches related to poor medicines management and lack of staff training and support. During this inspection we saw staff correctly followed the provider’s safe medicines policies and procedures. This meant people received their medicines as prescribed. Staff were also appropriately trained and supported to carry out the duties they were employed to perform. This helped ensure staff were knowledgeable about the individual needs and preferences of people they cared for.
However, although we found some improvements had been made at Kingston Care Home, we identified a number of new issues where the provider had failed to meet their legal obligations. This included ensuring the care people received was provided with the consent of the relevant person, ensuring people were involved in the planning and reviewing of their care plans, and the care they received was personalised and reflected their personal preferences. The provider had also not ensured that people were supported to be involved in social activities as much or as little as they wished and not left unnecessarily isolated.
In addition, although most areas of the home were clean and free from odours; we found there was one area where an odour lingered. This was traced to a mattress that had not been cleaned after clean sheets had been used to make the bed. Staff promptly attended to the issue when we pointed this out, but we were not clear why staff themselves had not identified the issue and rectified it themselves.
The above comments made above notwithstanding, people told us they felt the standard of care provided at the home had significantly improved in recent months. We saw staff looked after people in a way which was kind and caring. Our discussions with people using the service and their relatives supported this. People’s rights to privacy and dignity were also respected. When people were nearing the end of their life they received compassionate and supportive care.
People were safe living at the home. Staff knew what action to take to ensure people were protected if they suspected they were at risk of abuse or harm. Risks to people’s health, safety and wellbeing had been assessed and staff knew how to minimise and manage these risks in order to keep people safe.
The provider ensured regular maintenance and service checks were carried out at the home to ensure the building was safe.
People were supported to maintain relationships with people who were important to them. There were no restrictions on visiting times and we saw staff made people’s guests feel welcome.
We saw staff actively encouraged and supported people to be as independent as they could and wanted to be.
People were supported to keep healthy and well. Staff ensured people were able to access community based health and social care services quickly when they needed them. Staff also worked closely with other health and social care professionals to ensure people received the care and support they needed. There was a choice of meals, snacks and drinks and staff supported people to stay hydrated and to eat well.
There were enough suitably competent staff to care for and support people. The management team continuously reviewed and planned staffing levels to ensure there were enough staff to meet the needs of people using the service.
The views and ideas of people using the service, their relatives, professional representatives and staff were routinely sought by the provider and used to improve the service they provided. The service had arrangements in place to deal with people’s concerns and complaints appropriately.
People and their relatives felt comfortable raising any issues they might have about the home with staff.
There were effective systems in place to monitor the safety and quality of the service provided at the home. The management team took action if any shortfalls or issues with this were identified through routine checks and audits to make the necessary improvements.
We identified two new breaches of the Health and Social Care (Regulated Activities) Regulations 2014 during our inspection. You can see what action we told the provider to take at the back of the full version of the report.