Archived: Kingsley Nursing Home

There was a registered manager in post, however, at the time of the inspection they had been suspended pending investigations by the provider and the Nursing and Midwifery Council (NMC). A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 2008 and associated regulations about how the service is run.

People’s medicines were not managed appropriately. We found that the provider was unaware that one person had received too much of one medicine on two separate occasions within the previous two weeks. Staff did not always record when they had administered people’s medicines.

Poor standards of care had not been identified, or recognised as safeguarding concerns and as a result safeguarding notifications had not been completed to the appropriate authorities. This included the inappropriate use of bed rails, insufficient hydration and nutritional support, inappropriate care and support for people with diabetes, insufficient support to manage people’s general health and wellbeing, medicine errors, inadequate care plans and neglect by a member of staff to follow medical advice following a serious fall. As a result the Commission raised six safeguarding alerts following our visit to the home.

People were not protected from unsafe care as their risk assessments were incomplete and were not regularly reviewed or updated. The safety of the home environment was not maintained and we identified a number of areas that caused concerns regarding safe fire procedures which we referred to the local fire service and they identified a number of breaches of the fire regulations.

People did not have enough to eat and drink to maintain their body weight, health or well-being. We had serious concerns about the oversight of people’s nutritional care which led to most people losing weight and becoming dehydrated. There was a lack of nursing oversight to identify when people required medical care or referral to other health professionals. We told the provider to take urgent action for five people who were particularly frail. People were not provided with adequate support to eat their meals, or drink adequate fluids.

People had not been adequately assessed regarding their mental capacity to make their decisions about the care they received. Generic mental capacity assessments had been made for everybody which were not tailored about the decisions people may be able to make for themselves, or what could be in their best interests. Generic Deprivation of Liberty Safeguard (DoLS) had been made however they did not specify that people were being cared for in a recliner chair, or that bedrails were in place which could act as a form of restraint. We raised concerns about this and requested the home urgently review the suitability of these measures, and if appropriate to make urgent DoLS applications.

People’s healthcare needs were not adequately met. It appeared that nursing staff took people’s clinical observations such as blood pressure and pulse, however when results significantly changed and there were indications that people’s health had deteriorated, no action was taken to highlight this to the GP. When people had seen the GP, their advice was not adequately documented and there was insufficient evidence to show staff had followed this advice. In addition, staff had inadequate systems to manage the wound’s people had and the care they received.

Staff that were in senior positions did not have the knowledge, competence or ability to provide staff with adequate direction to ensure everyone’s needs were met. Members of care staff did not have the appropriate skills to support people to have all of their care needs met. There was a failure by staff to recognise that people did not have their care needs met.

People choices and preferences were not always respected. People with mobility difficulties asked to go into different areas of the home and this was not accommodated by staff, and they were left where they were, against their wishes.

People’s care plans showed that most people had not been involved with their care planning. Staff had a limited knowledge of people’s preferences or how they liked to spend their time.

Inappropriate assessments had been made about people’s needs before they moved into the home which failed to recognise that the service could not adequately meet their needs. This meant people were not always able to live at the home on a long term basis as expected.

People were not supported with their care and support needs in a consistent and person centred way. Not everyone had a care plan in place, and the care plans that were in place contained insufficient information and guidance to staff about how people liked to receive their care. Care plans were not adequately reviewed or updated when people’s needs changed.

People did not receive care that met their needs for pressure relieving support. Pressure mattresses were not set to the appropriate setting for each individual and people were not regularly supported to change their positions.

People were not supported to live a fulfilled life. Staff did not engage people in meaningful conversations or activities and people spent long periods of time without any significant interaction.

Inadequate systems were in place to identify and manage complaints. People were not supported to make complaints, and there was a failure to record and investigate people’s complaints.

There were inadequate arrangements for the day to day management and clinical leadership within the home. Standards of care had deteriorated and this had not been identified or actioned. Quality assurance systems were unsatisfactory and relied on members of the management team alerting the provider to changes of people’s needs or of significant events.

Records that were maintained within the home were not adequately reviewed. For example, people’s food and fluids charts were not reviewed, people’s repositioning charts were not reviewed, accidents and incidents were not reviewed and people’s care plans were not audited. This led to significant failures of care.

There have been seven breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We have taken urgent action to place conditions on their registration that prevents any further admissions to the home and provide evidence that people are receiving safe care and treatment.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Kingsley Nursing Home is registered with The Care Quality Commission (CQC) to provide the regulated activities, accommodation for persons who require nursing or personal care, treatment of disease, disorder or injury and diagnostic and screening procedures.

The service provides care for up to 25 older people, including people living with dementia and physical disabilities. On the day of our inspection 25 people were using the service.

Delays in submitting Deprivation of Liberty Safeguardings (DoLS) authorisation applications to the Local Authority supervisory body had placed some people using the service at risk of being unlawfully deprived of their liberty.

The provider had not always notified the Care Quality Commission (CQC), as required by law of people that were placed under Deprivation of Liberty Safeguards (DoLS) authorisations.

The Mental Capacity Assessments had not always considered having ‘specific decision’ MCA assessments in place, as set out in the MCA 2005 code of practice.

People received their medication as prescribed. However robust medicines records were not always maintained as staff did not always sign the medicines administration records.

The service had a registered manager. 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 2008 and associated Regulations about how the service is run.

We were informed by the provider that the registered manager had resigned and was due to leave within a week of our inspection taking place. A new manager had been appointed and they had submitted their application to register with the Care Quality Commission (CQC).

Staff were aware of what constituted abuse and of their responsibilities to report abuse. Risks to people using the service and others were assessed, and control measures were in place to reduce any identified risks.

There was enough staff available to meet people’s assessed needs. The staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service. Staff induction training and on-going training was provided to ensure they had the skills, knowledge and support they needed to perform their roles.

Consent was gained from people before any care was provided. People had a choice of meals, nutritional assessments were carried out and special diets catered for, and people were supported to see healthcare professionals as and when they needed to.

Staff treated people with kindness, dignity and respect and spent time getting to know them and their specific needs and wishes. The views of people living at the service and their representatives were sought and areas identified for improvement were acted upon to make positive changes.

People and their families were fully involved and in control of their care. Care was based upon people’s individual needs and wishes. They were reviewed and updated, to ensure they reflected the most recent and up-to-date information regarding people’s care.

Leisure and recreational activities were provided for people to participate in if they wished.

The service had a complaints procedure in place, to ensure that people and their families were able to provide feedback about their care and to help the service make improvements where required.

The provider had informed the Care Quality Commission (CQC) of notifiable events such as, deaths and serious injuries as required by law.

Routine management audits were carried out to assess and monitor the quality of the service. The vision and values of the service were person-centred and made sure people were at the heart of the service.

We identified that the provider was not meeting regulatory requirements and were in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

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, discussions with people using the service, the staff supporting them and looking at records.

If you wish 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. There were sufficient numbers of suitably experienced and trained staff working at the home at all times. The service undertook a series of checks to ensure the safety and wellbeing of people using the service. These checks included making sure people had access to their drinks and were comfortable in their environment and the safety of people's bed safety rails were maintained.

Is the service effective?

People's health and care needs were assessed and we observed that people were relaxed and looked well cared for. People and relatives of people who used the service told us they were happy living at the home. One person told us that they liked the food served at the home and liked their bedroom which was comfortable and clean.

Is the service caring?

People were supported by kind and attentive staff. We observed that staff cared for people in a respectful and sensitive manner. One relative told us that, 'Mum is happy here and the staff are really nice'. Another relative said that the home was 'A very open and relaxed place and the staff are very caring'. We observed one person who was unable to communicate verbally, showed us by using facial expressions that they were comfortable and happy with the care provided.

Is the service responsive?

We observed that staff were responsive to people at the home and provided care to a range of their individual needs. People and relatives of people who used the service told us that staff responded quickly to their changing needs. One relative said their family member 'Always looks clean and tidy, dressed in their own clothes and is eating well'.

Is the service well-led?

Staff had a good understanding of the ethos of the service and said there were clear expectations to provide good care and maintain a clean and tidy home. The registered manager demonstrated an understanding of people's care needs and the plans in place to improve the quality of service provided. Senior care staff told us that they had a duty to ensure people were well cared for and that appropriate care records were completed by all staff. The provider had a 'carer of the month' award in place to celebrate good practice identified among the care staff.

One person told us that the staff were 'nice and friendly' and that they provided them with the assistance to live their daily life. They told us that the food was 'not bad' and that they usually enjoyed eating their meals.

Another person told us that the staff were 'fine' and that they cared for them well. They also told us that the staff assisted them to move their position on a regular basis to make sure that they were comfortable and to prevent them developing pressure ulceration. They also told us that they enjoyed eating their sandwiches at teatime.

We found that people received adequate levels of care and nutrition and were given their medication in a safe way. We also found that the staff were recruited to ensure the safety of people who used the service. However, we had some concerns that some of the records at the home had not been properly maintained.

Most of the people who lived at the home were not able to tell us their experiences of what it was like to live at the home. This was due to their dementia. We therefore used a number of different methods to help us understand the experience of people living at the home.

We observed staff were considerate when helping people with their needs and assisted them in a dignified manner. One person we spoke with told us that they had a choice about what they wanted to eat and drink at meal times.

One relative we spoke with told us that the care their family member had received from the staff was 'marvellous'. They said that their family member had regained weight since coming to live at the home and they were having a special thickened diet to help them eat their food. They also told us that the staff helped their family member to move their position when they were lying in bed, to make them feel comfortable.

The relatives we spoke with told us that their family member's were well looked after by staff and always clean and well presented. They also told us that the staff communicated with them on a regular basis to inform them how their family member was feeling, and if there were any changes to their condition. They also told us that they had been involved in making decisions regarding their care and we saw that this was reflected in a sample of care plans that we reviewed.