Kings Manor Care Home

Kings Manor is a residential care home providing personal and nursing care to 54 people aged 65 and over at the time of the inspection. The service can support up to 66 people.

Kings Manor accommodates people in one purpose-built building set over three floors. Each floor has a dining room and at least one lounge area. Each bedroom has its own en-suite and some rooms are interconnecting for couples who choose to stay together.

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

People said they felt happy, safe and well cared for. Comments included, “I feel very safe here, the staff know how to look after you” and “I am happy, and I feel safe”.

Some people said getting help and support at key times was more difficult and they sometimes had to wait. One person said, for example, “It can be difficult getting them at times as we are all wanting then at the same time, but they come as quick as they can. They are very good at understanding me though, like yesterday, I didn’t want to get dressed as I didn’t feel well, and they looked after me”. Staffing levels were sufficient, but like all care providers there had been key times during the pandemic and lockdown when staffing levels had fallen slightly below the providers preferred numbers. This had not compromised anyone’s safety but did mean that care and support may be delayed slightly for some people at peak busy times.

During the inspection visit we observed staff being observant to people’s needs and wishes. Even during a medical emergency, staff remained calm and dealt with this in a professional and compassionate manner. Staff understood people’s needs and responded to them patiently and were warm and friendly at all times.

Relatives said the care and support was good but three mentioned that there were occasions when their relatives personal care was not as good as they had expected such as dirty or long fingernails. We fed this back to the registered manager and operations manager who said they had not been made aware of these issues from family members. They planned to hold some additional evening meetings for families and said this would be an opportunity to gain peoples’ views and ask for direct feedback for ongoing improvement.

There was sufficient staff with the right skills and competencies to provide safe and effective care to people at the time of the inspection. The registered manager said this was kept under review using a dependency tool to help them assess the right numbers and right deployment of staff for each floor. She explained that the top floor was mainly complex nursing, middle floor for people living with dementia and bottom floor for those who were more able. The whole service is registered as a care home with nursing so although nurses were based mainly on the top floor, their support was used across all floors for people assessed as needing nursing support.

Staff training and support was seen as key to providing high quality care and support. In discussion with the registered manager, we identified that staff had not yet received training in working with people with complex dementia care where diffusion and breakaway techniques may be needed. By the second day of inspection activity, the registered manager confirmed this training had now been sourced and booked for staff.

Staff were positive about the support and training they received. One staff member said they were being supported to complete a nursing qualification. Another said, “This is the best training I have ever had since working in care.” The training matrix showed staff had a wide range of training in all aspects of their work.

People were kept safe because risks for individuals and the environment were completed and reviewed when needed. Staff understood about abuse and who to report any concerns to. Staff recruitment was robust and ensured new staff only started employment once all their checks were in place to show they were suitable to work with vulnerable people.

People were supported to have a varied diet and snacks and drinks were offered throughout the day and evening. One person said they were not offered anything after teatime. We fed this back to the registered manager who said she would ensure people were made aware they could access food and drink 24/7 if they wished, and that there was a later supper trolley available with hot drinks, cakes and sandwiches. People said the meals and choices were good. Comments included “The food is very good, I enjoy everything they give me, especially the puddings.”

Where people were at risk of poor hydration or nutrition, staff supported them to encourage additional drinks and snacks and their daily intake was monitored.

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.

Systems and audits were effectively used to ensure the quality of care and support as well as the environment was being monitored and to help drive up improvement. An action plan was used to review areas identified for improvement.

Some relatives said that communication was not always consistent and three said they would like more regular contact from the service about their loved one. This had been fed back to the provider who agreed to look into how they could make improvements to this.

The service employed a liaison person whose role included forging links with the local community. Prior to the pandemic this was working really well with local groups coming to use the facilities, such as the ground floor, coffee bar area for things such as will writing sessions. People using the service were also able to join in these groups.

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

Rating at last inspection– This service was registered with us on June 2019 and this is the first rating inspection.

Why we inspected

This was a planned inspection based on the fact the service had been registered for over 12 months and had not yet had a rating.

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.

Kings Manor Care Home is a purpose built home providing personal and nursing care to 40 people aged 65 and over at the time of the inspection. The service can support up to 66 people.

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

People told us they were happy and felt safe living at Kings Manor. They told us that the staff were “very kind, very patient” but that there were not always enough staff on duty. One person told us that when they use their call bell they “wait longer than you should usually wait, it goes on and on and no one comes.” Staff consistently told us that whilst they had enough time to meet peoples needs and keep them safe, they did not have time to spend with people to support their emotional wellbeing. One staff member told us “there are a lot of unhappy staff here, the main worry is for the residents because they’re so isolated and no one can sit and have a cup of tea with them and just talk – just not enough staff.”

There had recently been a high turnover of staff, including senior staff and the previous registered manager. The provider had taken action to recruit more staff. However, there had been times when low staffing levels made it difficult for staff to meet people’s needs and give them the time that they felt they deserved.

Peoples relatives shared similar concerns, telling us that whilst the staff were “phenomenal” and “absolutely amazing” it was clear that they were “under pressure.” Two people’s family members told us that they had had concerns around communication which they had raised with the home previously. They both told us they had confidence in the interim manager to now address these concerns.

Risks to people were assessed and regularly reviewed, but inconsistent record keeping meant it was difficult to identify when people might need more support.

We were assured that there were effective measures in place to prevent and control infection.

People’s care plans contained enough information for staff to care for people safely. However, detail about people’s personal preferences was inconsistent. The provider had identified this as an area for improvement prior to the inspection.

Prior to the inspection, the provider had identified areas for improvement and put an action plan and a team of senior support staff in place to drive improvement. This meant arrangements were already in place when the previous registered manager left, and ensured people continued to receive safe care. Improvements had begun to be made and a staff member told us “it’s all going in the right direction”.

The staff members we spoke to shared a vision and a passion to deliver person centred care and were dedicated to the people living in the home and to making improvements.

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

Rating at last inspection

This service was registered with us on 20 June 2019 and this is the first inspection.

Why we inspected

We undertook this targeted inspection to check on specific concerns we had about staffing and record keeping.

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 coronavirus and other infection outbreaks effectively.

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.

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.