Archived: Kingfishers Nursing Home

Kingfishers Nursing Home is a care home providing personal and nursing care to older people with a range of physical and mental health needs, including support for people living with dementia. The service supports up to 35 people and at the time of our inspection 32 people were using the service. The care home operates from a large, detached house which has had a purpose-built extension added in the 2000s.

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

We found environmental risks to people using the service were not fully managed. We also identified concerns in relation to the safe management of medicines, and the management of safeguarding concerns and accidents and incidents. Whilst we were satisfied immediate actions were taken when incidents occurred, the service had failed to consistently analyse potential themes or trends to identify wider learning.

People told us they felt safe, and most relatives were satisfied their family members received safe care. A relative commented, “My view is that [family member] is quite safe…it is just the general atmosphere there and the interaction with staff that makes me feel that she is safe.”

Some people and relatives told us the service was sometimes short staffed. A relative commented, “I don't feel there are enough staff. The carers are absolutely brilliant. They are doing the care that they need to do to look after [person], but there is rarely any time for them to spend talking to her.” People and relatives also indicated the response time to call bells was variable, with a relative commenting, “Experience has shown that if the call bell is pressed, the response is not that quick.” We have made a recommendation in relation to staff deployment.

The service was working to mitigate the impact of staffing vacancies through use of regular agency staff, continuous recruitment and initiatives to maximise staff retention. Staff were safely recruited and a structured induction process was in place to equip staff with the skills required to provide safe care.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible, however the systems in the service were not operated effectively to support this practice.

People were supported by a service which lacked effective oversight by the registered manager. Some records were found to be not accessible or incomplete following the registered manager’s departure. Audits had been inconsistently completed. We found some incidents had not been reported to CQC in line with requirements, and the service had failed to provide an appropriate written response under their duty of candour for some incidents.

Some staff and relatives raised concerns regarding the responsiveness of the registered manager. Comments from relatives included, “I always thought [registered manager] was marvellous and listened, but he did not always carry through what he promised, such as emails that he said he would send but which never came” and “I thought [registered manager] was a very nice…man, but he did not communicate effectively with me. It appears to be well run, but I am not sure that tasks are delegated appropriately by management.”

The registered manager left the service on the first day of our inspection. The provider was committed to ensuring that, following the registered manager’s departure, any lessons learnt would be acted upon and that governance arrangements would be further improved. Prior to our inspection the provider had already provided additional support via an interim support manager and care consultant. Further investment was planned to improve governance, including a new call bell system.

Some systems were in place to gather feedback and a relatives meeting had been recently held. People and relatives told us there had been ongoing concerns regarding the quality of the food. The service had an action plan in place to address this area of concern. The provider had also taken steps to seek and respond to staff feedback. The service generally worked well with professionals and built links with the local community.

People, staff and visitors were protected from the risks of infection. The service presented as generally clean throughout. Staff received training in relation to infection control and wore appropriate personal protective equipment (PPE). Systems were in place to respond to outbreaks of infection, such as COVID-19. A relative commented, “Visiting is back to normal, but we have to wear PPE. I went in yesterday and I only had to wear a mask and have my temperature taken. We do have to wear all the PPE if there is an outbreak.”

People and relatives provided consistently positive feedback about the caring nature of staff. Comments from relatives included, “I would say that they are very caring and there are a couple in particular who are outstanding with their patience and kindness” and “They are amazing, are caring, patient, considerate and compassionate.”

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

Rating at last inspection

The last rating for this service was good (published 4 July 2019).

Why we inspected

We received concerns in relation to safe care and the management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 Kingfishers Nursing Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches at this inspection in relation to safe care and treatment, safeguarding people from harm, governance, consent, meeting the duty of candour and in informing the Commission of information they are required to.

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.

Kingfishers Nursing Home is a care home with nursing in south Buckinghamshire. At the time of the inspection 29 older people with a range of physical and mental health needs lived at the home. People had personalised bedrooms and had access to communal dinning, lounge and a library area.

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

People and their relatives told us they were supported by staff who were kind and considerate. Comments included, “Quite happy with all carers, nice and kind, no complaints whatsoever, quite happy with everything, happy and content, getting spoiled”, “Staff great, helpful, realise what we are going through” and “Very nice bunch of people, nursing staff kind”.

The provider and registered manager had systems in place to ensure people and visitors to the home were supported to be safe from the risk of catching COVID-19. We provided some additional guidance to the registered manager and operational manager about changes to personal protective equipment. We found them very responsive to this and they acted swiftly to ensure it was adopted by all staff.

People told us they were supported to maintain positive relationships with family. Comments included, “Kept in touch with son on mobile, grandson lives local he rings and says he’s outside and I go to the window and we have a chat on mobile as I’m on first floor” and “I have regular contact, they do window visits when possible”.

People were protected from avoidable harm. Staff were aware of potential risks to people and ensured risk assessment were updated when any changes occurred. Accidents and incidents were recorded and acted upon to prevent a re-occurrence.

We found the provider and registered manger open to learning when care fell below expected standards. Additional training and learning were provided to staff following complaints or feedback.

The provider had good systems in place to cascade knowledge to staff. Staff had access to an online portal which had links to the company policies and training. Staff felt valued and respected. During the pandemic the provider had developed weekly catch up calls with all their senior staff. We observed these meetings provided clarity of any changes to government guidance and provided an opportunity to reflect on what had worked well.

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.

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

Rating at last inspection

The last rating for this service was Good (published 4 July 2019).

Why we inspected

We undertook this targeted inspection to check on specific concerns we had about risk management, and good governance. The overall rating for the service has not changed following this targeted inspection and remains Good.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Kingfisher Nursing Home is a care home with nursing in south Buckinghamshire. At the time of the inspection 23 older people with a range of physical and mental health needs lived at the home. The care home operates from a large detached house which has had a purpose-built extension added in the 2000s. Since the provider purchased the business as an ongoing nursing home it has made significant financial investment and the environment has been significantly improved.

People’s experience of using this service:

People told us they had a good experience of living in the care home. They were supported by staff who provided kind and compassionate care and support. Comments from people included, “She really is lovely, she always goes that extra mile,” “They’re a good bunch here, very polite and kind. If you need anything they go out of their way to help you,” “Since being here we haven’t looked back” and “I love it yes, it’s lovely thank you.”

People were supported staff who promoted independence and dignity. People told us I’ve got used to it now. There’s enough staff yes and they’re very good. They all treat me with respect. They’re kind and they don’t rush me. The food is very, very good” and “It’s wonderful here, everybody goes past and waves! I couldn’t believe my luck coming here.”

People were supported by staff who had been recruited safely. People told us they felt staff were trained and had the right skills to support them.

The provider had made significant improvements to the environment and people told us they were happy with the changes.

People were safeguarded from abuse. Staff were knowledgeable about how to recognise signs of abuse and had confidence to report any concerns.

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

The provider had systems in place to monitor the quality of the service provided and drive improvements.

Rating at last inspection:

This is the first inspection since the provider has registered with us in June 2018.

Why we inspected:

The inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Inspections will be carried out to enable us to have an overview of the service, we will use information we receive to inform future inspections.

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