Archived: Kingswood Home

Kingswood Home is a residential care home providing personal care to 20 people at the time of the inspection. People had a range of health and support needs and included people living with dementia. The service can support up to 23 people.

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

People were not safe living at Kingswood Home. At the time of the inspection, a team of local authority social care professionals had been brought in to assess people’s care and support needs, with a view to moving them into other care homes. People were at risk of receiving unsafe care. Staff had not ensured people had sufficient to eat or drink and their needs were not effectively monitored. Staffing levels were unsafe and meant that people did not have the support or care at the time they needed it. People were not protected from the risk of neglect or abuse. One person who was at risk of choking was given the wrong texture of food which increased their risk of choking. Another person, who was at risk of skin breakdown, was not repositioned regularly according to monitoring records. Medicines were not always managed safely. Stocks of medicines did not tally with records to confirm that people received their medicines as prescribed. There was a strong smell of urine in some parts of the home indicating that cleanliness and hygiene standards were not maintained.

Staff had not completed all the training they needed to ensure people received appropriate care and support. Where training had been completed, staff demonstrated a lack of understanding in key areas, such as safeguarding and types of abuse. People were not always given the correct consistency of food, in line with their assessed risks. Some people presented as being very hungry or thirsty. Drinks were not freely available and people often had to wait for their drinks to be served at set times dictated by staff.

Because of the lack of staff available, people received a poor standard of care. They were not treated with dignity and respect. Care was not personalised to meet people’s needs. Care plans were detailed and provided information about people’s likes, dislikes and preferences, including their interests. However, there was a lack of activities to provide mental stimulation or to engage people.

The culture of the home was negative and staff were dissatisfied working there; some staff felt the registered manager did not listen to them and was not supportive. The registered manager demonstrated poor oversight and capability in their management of the home and of their legal responsibilities. A system of audits had been implemented but was not effective in identifying all the issues found at the inspection or by external professionals who had intervened at the service.

By the end of the third day of inspection, all service users had been moved from Kingswood Home to alternative care placements.

Due to the nature of this urgent responsive inspection and the enforcement action which proceeded it, we were not able to fully answer all of Key Lines of Enquiry (KLOEs) in this report. The report has, instead, focussed on the KLOEs of highest significance to people’s safety, care and welfare.

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, (report published 24 April 2019).

At this inspection not enough improvement had been made and the overall rating has deteriorated to Inadequate.

Why we inspected

The inspection was prompted due to serious concerns received about people’s safety and poor quality of care people had received. In response to these concerns, CQC inspected Kingswood Home as a matter of urgency. Prior to the inspection, we were notified of an incident whereby a person using the service had died. Since the inspection, another person died in hospital. These incidents, as well as concerns about neglect of other Kingswood Home residents, is subject to safeguarding and criminal investigations. As a result, this inspection did not examine the specific circumstances of these incidents. .

Enforcement

We have taken urgent action to safeguard people from the risk of harm. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded. Please see the ‘Enforcement Actions’ section at the back of this report.

Follow up

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Kingswood Home is registered to provide care and support for up to 23 people who may live with a dementia type illness or an acquired brain injury. The service provided support for both younger and older people. People required a range of help and support in relation to their care needs, which included diabetes and post stroke. There were 19 people living at the home at the time of the inspection.

People’s experience of using this service:

• People, relatives and other stakeholders told us the quality of care and support was good. People told us, “I was a dairy farmer so I know about safety-I had 150 cows-I am safe here-they have locks on all the doors and they look after me well.” and “Couldn’t be cared for better, I’m safe here.” A health professional told us, “I have no concerns about people’s well-being.”

• Whilst the provider had quality assurance systems to review the support and care provided, there was a need to further embed and develop some areas of practice that the existing quality assurance systems had missed. This included ensuring that care plans and risk assessments were updated to reflect important changes to a person’s health and that the cleaning and medicine management were regularly audited. The provider did not have an overview of staff training and staff had not received a robust induction or skill competency checks.

• There were safeguarding systems and processes that protected people from harm. Staff knew the signs of abuse and what to do if they suspected it. One staff member said, “I have received training in safeguarding, I wouldn’t hesitate to raise a safeguarding if our residents were at risk.” Another staff member said, “I would raise it straight away.”

• There were sufficient staff to meet people’s individual needs: all of whom had passed recruitment procedures that ensured they were suitable for the role.

• There were systems to monitor people's safety and promote their health and wellbeing, these included health and social risk assessments and care plans. The provider ensured that when things went wrong, these incidents and accidents were recorded and lessons were learned.

• Medicines were managed safely. Medicine documentation and relevant policies followed best practice guidelines to ensure people received their medicines safely.

• Staff told us they received appropriate training and support to enable them to perform their roles effectively. People told us, “Staff know their stuff, look after me really well,” and, “They are really well trained, I have to have help to get up and they do it so nicely.”

• People’s nutritional needs were monitored and reviewed. People had a choice of meals and staff knew people’s likes and dislikes. People gave positive feedback about the food. Comments included, “Plenty of choice and always tasty,” and, “Homemade meals and cakes, I’ve put on weight since I have lived here.”

• The environment was comfortable and was adapted to meet people's needs. One person said, “It’s so beautiful here, warm, cosy and friendly.”

• People and relatives told us staff were ‘kind’ and ‘caring’. They could express their views about the service and provide feedback. One person said, “A fantastic group of staff, everyone is wonderful, its calm and we can have a laugh.”

• People's care was personalised to their individual needs. There was sufficient detail in people's care documentation that enabled staff to provide responsive care.

• The service provided a variety of activities in line with people's interests, such as quizzes and sing- songs and encouraged people's involvement. People, relatives and social care professionals told us staff engagement and interaction had a positive effect on people's quality of life. People told us they had been involved in choosing activities they enjoyed on a day to day basis.

• Management and staff demonstrated a good understanding of and response to people's diverse needs.

• People and staff told us the registered manager was, “Approachable and very kind,” and, “Runs the place well.”

• Referrals were made appropriately to outside agencies when required. For example, GP visits, community nurses and speech and language therapists (SALT). Notifications had been completed to inform CQC and other outside organisations when events occurred.

• More information is in the full report.

Rating at last inspection:

Good (report published 29 November 2016).

The overall rating for the service has changed to Requires Improvement. The service remained Good in safe, caring and responsive and Requires Improvement in effective and well-led.

Why we inspected:

This inspection was brought forward due to CQC receiving a number of anonymous concerns regarding staffing levels and the cleanliness of the service.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner. We will follow up on our recommendations at the next scheduled inspection.

A registered manager was in post. 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 were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. One person told us, “I feel safe here”. Another said, “I think there are enough staff here, there are two shifts”. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place.

Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future. Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service, including caring for people with dementia, and stoma care (a stoma is an opening on the front of the abdomen which is made using surgery. It diverts faeces or urine into a pouch on the outside of the body). Staff had received both one to one and group supervision meetings with their manager, and formal personal development plans, such as annual appraisals were in place. One member of staff told us, “Whatever training is available is sent to me. Training is definitely promoted, it’s good”.

People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. One person told us, “The food is good”. Special dietary requirements were met, and people’s weight was monitored, with their permission. Health care was accessible for people and appointments were made for regular check-ups as needed.

People chose how to spend their day and they took part in activities in the service and the community. People told us they enjoyed the activities, which included singing, films, beauty treatments and themed events, such as reminiscence sessions. One person told us, “All activities are organised for us”. People were also encouraged to stay in touch with their families and receive visitors.

People felt well looked after and supported. We observed friendly and genuine relationships had developed between people and staff. One person told us, “The staff are very nice and kind”. Care plans described people’s needs and preferences and they were encouraged to be as independent as possible.

People were encouraged to express their views and had completed surveys. Feedback received showed people were satisfied overall, and felt staff were friendly and helpful. People also said they felt listened to and any concerns or issues they raised were addressed. One person told us, “There are lots of people to talk to if I have concerns”.

Staff were asked for their opinions on the service and whether they were happy in their work. They felt supported within their roles, describing an ‘open door’ management approach, where managers were always available to discuss suggestions and address problems or concerns. The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement.

One inspector carried out this inspection.

We considered our inspection findings to answer the questions we always ask; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with three people who used the service and two relatives who were visiting people, three of the four staff who were on duty and from looking at records.

If you want to see the evidence supporting our summary, please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. One person told us, 'I've nothing to complain about, all of them (staff) are very nice."

We saw people's needs were assessed and care and treatment was planned in a way that was intended to ensure people's safety and welfare. Care records contained information on people's needs and clear instructions for staff on how to meet them. We saw that potential risks to people were appropriately assessed and planned for.

We found staff were knowledgeable about people's needs and were respectful of people's dignity. Staff provided care and treatment in a way that was intended to ensure people's safety and welfare.

We found that people were supported to eat and drink sufficient amounts to meet their needs. People were protected from the risks of inadequate nutrition and dehydration.

We saw that the property was clean and well maintained and that improvements to the property had been carried out. There was appropriate equipment and items available such as hand wash and disposable aprons to ensure people were cared for in a clean hygienic environment. People were protected from the risk of infection.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We were told that no applications had needed to be submitted. The manager and staff demonstrated their knowledge of their responsibilities in respect of this.

Is the service effective?

People told us that they were happy with the care and support provided. One person told us, "Very good, it's better than I've ever had before."

It was clear from our observations and from speaking to staff, that they had a good understanding of people's care and support needs and they knew them well. Care plans contained clear instructions for staff on a person's needs and how to meet them. Staff signed to confirm that they had read the care plan, would follow it and adhere to best practice.

Is the service caring?

People were supported by kind and caring staff. We saw that people were treated with respect and dignity and that staff were warm and friendly. We observed that staff were patient and did not rush people when they were supporting them with walking and assisting them at lunch. Staff repeated instructions or questions and checked they were understood. Relatives told us how they observed staff were patient when responding to people's needs. They told us the staff, 'Are lovely, they always know people's names. They are always smiling and say hello."

Is the service responsive?

We saw that the provider had introduced residents meetings and were shown the minutes of these. We noted that the provider had employed an activities coordinator in response to feedback from staff. One person told us how they had been able to change rooms to the ground floor after finding it difficult to use the stairs and as they did not like to use the lift.

People and relatives told us they found the provider approachable and gave us examples of changes they had requested and that had been carried out.

We found that the service had a quality assurance system and that issues were highlighted and addressed to ensure people were supported within a safe service.

We found that people were asked for their consent and the provider acted in accordance with their wishes. People's care and support was planned and implemented in line with their needs and preferences. People and relatives told us that the staff spoke to them about their care and asked for their permission to be supported.

People told us they felt safe living at Kingswood Home and felt comfortable to raise any concerns with staff. People were protected from the risk of abuse or neglect because the provider had taken reasonable steps to identify risks and prevent abuse from happening.

We found that people were cared for by staff who were suitably qualified. Staff had received appropriate training and support in their roles. We spoke with four members of staff who told us they were happy with the training and support they had received.

We saw that the provider used various methods to assess and monitor the quality of service that people received. The provider also had plans for future quality monitoring of the home.

People's relatives were also happy with the quality of care and with the staff. One relative said, "since day one it's been lovely." They continued by saying their family member was "a lot happier here . . . has a better quality of life." Another relative commented, "we know [our family member] is safe here." A further family said "staff are absolutely lovely, brilliant."

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We observed that people had several positive interactions with staff members which showed people warmth, respect, and inclusion.

We found that people were treated with dignity and respect. People's care was planned and delivered in line with their needs and choices. People's safety and well-being were protected. We found there were sufficient staff to support people safely. Staff were experienced and trained to a good standard.