Kingswood Court Care Home

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

Since the last inspection, improvements had been made to some key areas. However, we found that the governance system continued to be ineffective. Although we found no evidence that people had come to harm, we did identify shortfalls in relation to people’s records and monitoring of their wellbeing. Food and fluid charts were not consistently filled out by staff. Repositioning charts in place for people contained gaps. Further work to embed governance systems was required.

Improvements had been made in relation to staffing levels at the home. Staffing levels during the day had increased on some floors. The provider had successfully recruited into all care and nursing roles. Agency staff were used only when deemed necessary. The registered manager was mindful of any admissions to the home. Only those people’s needs that could be met were admitted to the home.

The medicines system was now safe. Medicines records confirmed people had their medicines safely. The actual time of administration was recorded by the nurses and safe gaps were left in between doses. The nursing staff confirmed they felt supported with their role. They now had more time to undertake other nursing duties that were previously impacted by staffing. People and their relatives told us staff were kind and looked after them well.

Improvements had been made with monitoring risks within the home. The staff were aware of guidance in relation to infection control. Observations of the staff were carried out to check that staff were compliant with wearing PPE safely. People were observed sitting in lounge chairs and no longer spent long periods of time in wheelchairs. Staff repositioned people in bed or assisted them to a table and chair to eat. This helped to minimise the risks of choking. People at risk of weight loss were referred to the GP with weekly weights taken.

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 (published 15 September 2022). We found there were breaches of 3 regulations.

We found at this inspection that improvements had been made with 2 breaches met, however, some other areas in relation to record keeping needed further improvement. This meant the provider remained in breach of one regulation.

Why we inspected

We carried out an unannounced inspection of this home on 12 April 2023. We identified several shortfalls. The provider completed an action plan after the last inspection to show what they would do and by when to improve the home.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe and well-led which contain those requirements.

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 to good. This is based on the findings at this inspection.

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

Enforcement

At this inspection, we have identified a breach of regulation in relation record keeping and good governance.

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

Follow up

We will continue to monitor the home and the intelligence we receive. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the home, which will help inform when we next inspect.

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

People were not always receiving care that was person centred and they were being put at increased risks due to insufficient staff. People were seen spending prolonged periods in their wheelchairs rather than being supported to sit in comfortable chairs. We observed people spending time in their bedrooms with little interactions unless personal care or staff assistance was required. People were not being supported in a way that took into consideration their preferences such as being washed and dressed at a time to suit or spending time in different parts of the home.

Feedback from relatives and people was mixed but also echoed our observations and the delays in receiving care due to staff shortages. Staff were evidently caring in their approach, but the care was task led as there was not enough staff to spend quality time with people engaging in conversations and one to one activity.

Some people told us they did not participate in the activities on the ground floor because they were concerned they would not be returned to their room in a timely manner. Call bells and drinks were not always in close proximity to people and one person was not positioned safely to eat their breakfast as they were in a lying down position. This put people at potential risk of choking and dehydration and meant they could not always alert staff if they needed assistance.

Improvements were needed to ensure people received safe care including the management of medicines and infection control procedures. Some people were experiencing delays in receiving their medicines because of the time it took for the nurse to complete the medicine round especially when they were covering other areas in the home. Not all staff were wearing face masks in accordance to government guidance and personal protective equipment such as gloves and masks was being stored on dirty linen trolleys. This increased the risks to people and staff due to cross contamination risks.

There was a new manager working in the service. They planned to hold regular meetings with staff and people living in the home. They were being supported by the provider’s regional team and a registered manager from another home to drive improvements in the service. There was an action plan in place to drive improvements. Governance arrangements were in place but had not been robust to identify the areas of concern we found at this inspection.

Assurances were provided that staffing numbers would be reviewed and increased post inspection and kept under review. This would include an additional member of staff working on each shift and a second activity co-ordinator who would be employed daily to help with activities on the middle and top floor. This would enable those people that did not want to participate in group activities on the ground floor to have one to one time in their bedrooms.

Improvements were planned to the décor of the home and a refurbishment plan was in place to commence in November 2022. Some work had already been completed to bedrooms as they became vacant.

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 20 January 2022). The rating from this inspection had now changed to requires improvement.

Why we inspected

The inspection was prompted due to concerns shared about the staffing levels within the home which was impacting on the care of people and putting them at risk. A decision was made for us to inspect and examine those risks. 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 relevant key question safe and well led in this 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 Kingswood Court Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to staffing, management of medicines, infection control and the quality assurances systems in place to monitor the service.

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.

Kingswood Court is a residential care home providing personal and nursing care to 35 people aged 65 and over at the time of the inspection. The service can support up to 66 people. Care is provided over three floors of the home, with the ground floor for people with residential care needs.

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

People received good care and support. This was evident in the feedback we received from people and their relatives. Comments included, “the main thing is that Dad is happy and settled and sees it as his home, we are the most relaxed that we have been for years and that is down to the staff” and, ”they do their absolute best to ensure each resident is treated as individual”.

People told us they felt safe and there were systems in place to manage risk. People had individual risk assessments in place to guide staff in how their care should be delivered. Safe staffing levels were assessed using a dependency tool and there were systems in place to recruit staff as safely as possible.

Staff received training and support in order to be able to carry out their roles effectively. Records of training were kept so that this could be monitored. Supervisions were undertaken as a means of monitoring staff performance and development needs. People’s health needs were met and they were supported to attend appointments when needed. People’s nutritional needs were met and they were able to make choices about their meals and where they wanted to eat. Health professionals were contacted if there were concerns about a person’s weight.

Staff understood people’s individual needs well and provided personalised care. People and their relatives had opportunity to be involved in planning and reviewing their own care and support. There was a procedure in place to manage and respond to complaints.

There was a system of audits and checks in place to monitor the service and these were used to identify areas for improvement. At the time of our inspection, there were improvements being made to the physical environment of the home.

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 the service under the previous provider was good published on 7 July 2018. This was the first comprehensive inspection for this service under the current provider.

Why we inspected

This was a planned inspection in order to give the service a rating under the current provider.

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.

Kingswood Court is a residential care home providing personal and nursing care for up to 66 people aged 65 and over. At the time of the inspection 41 people were living at the home. Accommodation is provided in one building over three floors.

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

People were positive about their experiences of living in the home and told us they felt safe. Comments included; “The staff always ask me and check on me. They’re very nice.”, “The staff are all ok”, “Staff always ask me what I prefer or what I want to wear or do. They always do that.” and “I like it here. It’s very pleasant.”

Staff were trained in safeguarding and told us they felt able to report any concerns if they had them and were confident they would be listened to.

There were sufficient staff on duty to ensure people’s needs were met. A dependency tool had been used to calculate the required numbers. There was a feeling amongst staff that staffing levels were at the minimum required level to be safe and that with more staff they would be able to do more for the people they supported.

There was a training and induction programme in place for staff and this had been adapted during the pandemic to ensure delivery of the programme was safe. There were competency checks in place to assess staff skills and abilities.

People’s health needs were met. We saw that healthcare professionals were contacted when there were any concerns about a person. Nutritional needs were assessed and 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.

The home had been through a challenging period of time, with the demands of working during the pandemic and a change in provider. However, there was a sense amongst staff that the home had stabilised, and they were positive for the future. There were systems in place to monitor the service and share developments with staff. Regular team meetings took place to support communication and engage staff.

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 the service under the previous provider was Good, published on 7 July 2018.

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels, skills and training and how staff interact with people. A decision was made for us to inspect and examine those risks.

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 under the previous provider, by selecting the ‘all reports’ link for Kingswood Court on our website at www.cqc.org.uk.

We found the following examples of good practice.

Safe provision had been thought about when receiving professional visitors to the home. Prior to our visit the policy and procedure for visiting professionals was shared with us so that we knew what to expect on arrival. Professionals are asked not to visit the service if they displayed any symptoms related to Covid 19.

We were greeted by the home manager and had our temperature taken, we were asked to change into clean clothes, wash our hands and to wear the PPE given to us. This included, an apron, gloves and mask. All visitors are asked for contact details to support the track and trace system. They were shown to the area of the home they were visiting, by the shortest and most direct route.

The emotional wellbeing of people and their families had been supported throughout the pandemic. The manager and staff ensured contact was maintained through various initiatives. They were sensitive to people’s feelings including anxiety, sadness and loss. Throughout the spring and summer garden visits were arranged by appointment. Procedures ran smoothly and designated staff were available fi required whilst promoting privacy for people and their relative.

As the autumn winter season was approaching the provider had considered alternative visitor arrangements. An internal pod was being installed which had external access to help reduce entry to other parts of the service and reduce risk. A hearing loop system will help assist communication between each other. Each person had been individually risk assessed to ensure visits were person centred. This would help ensure their visits were meaningful whilst maintaining their safety, meeting needs and respecting privacy. A designated member of staff will be available should anyone require assistance, for example if they needed to use the bathroom facility.

For those people who were bedbound or receiving end of life care, potable Perspex screening was available so that family members could visit in people’s rooms. The robust visitor’s policy and procedure we previously mentioned would then be applied when wearing PPE.

All staff recognised their responsibility to protect the people they cared for and how crucial it was that when they were not at work, they respected and followed government guidelines to reduce their own exposure to risks. The manager was very proud of all staff and recognised and celebrated their efforts during the pandemic.

When people were admitted to the home, risk assessments were completed, and people were isolated for 14 days. Social distancing was encouraged throughout the home. Where this was not achievable, staff were aware of the need for enhanced cleaning of frequently touched surfaces and people were supported to wash their hands regularly.

There were clear policies, procedures and contingency plans in place. Audits were undertaken, and actions were taken to ensure improvements were made. Staff had received training and regular updates were provided. The manager and senior staff completed ‘spot checks’ of the environment. These were completed to check staff understanding and compliance with use of PPE and infection prevention and control practices. There was effective, supportive communication between the directors, area manager, manager, staff, people using the service and relatives.

The home was clean. Housekeeping and laundry practices were overseen by the housekeeper, who checked work had been completed to a satisfactory standard and that supporting records were maintained.