7 July 2014
During a routine inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
The Care Quality Commission (CQC) conducted this inspection on the 7 July 2014. At the time of this inspection the registered provider with CQC was Robert David White and Lesley Karen White. Since the date of the inspection a new provider and manager has been registered with the Commission to carry on the service at this home. This report is being published in the name of the provider who was registered with the Commission at the time of the inspection undertaken in July 2014 to comply with its publication duty. All references to the provider in this report relate to Robert David White and Lesley Karen White and the registered manager registered with the Commission at the time.
Our inspection was unannounced which meant the provider did not know we were coming.
We identified that the provider who was registered with the Commission at the time of the inspection was not meeting the legal requirements associated with the Health and Social Care Act 2008 during an inspection on 17 December 2012. Since that inspection that provider had not made the improvements required to raise standards in the service.
When we inspected Kingsley Rest Home on 30 December 2013 we found that; care was not always delivered in a manner that protected peoples safety and welfare, medicines were administered unsafely, care records did not contain the information required to enable staff to meet people’s needs in a safe and consistent manner and effective systems were not in place to assess and monitor the quality of care. The provider made improvements to the way medicines were managed, but the other required improvements have not been made.
Kingsley Rest Home provides residential care and support for up to 12 older people, some of whom may have a diagnosis of dementia. At the time of our inspection 10 people used the service. There was a registered manager in post at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.
We found that improvements were needed to ensure people received their care safely. Risks to people’s health and wellbeing were not always adequately assessed or recorded, and accurate and up to date information about people’s risks was not always available for the staff to follow.
The provider could not show that the required staff recruitment checks had been completed. Therefore they could not assure the people that the staff were suitable to provide them with care and support.
The legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were not being followed. Some people who used the service did not have the ability to make decisions about some parts of their care and support. The Mental Capacity Act 2005 sets out requirements that ensure where appropriate, decisions are made in people’s best interests when they are unable to do this for themselves. The staff had not received sufficient training to enable them to follow the legal requirements of the Act and the DoLS. The provider told us no one who used the service required a DoLS authorisation. However, we identified one person who was potentially being deprived of their liberty.
Care was not always planned for or delivered in a manner that met people’s individual care needs. People’s behaviours were not adequately monitored to identify changes and professional advice was not always sought when people’s needs changed. This meant people could not be assured that they were getting the right care for their needs.
The staff’s development needs were not being assessed or monitored by the provider. Staff had not received the training they required to meet people’s needs, and the provider did not have an effective system in place to supervise and support the staff’s development needs.
People told us their needs were met in a timely manner with dignity and respect. However some people told us that people who displayed behaviours that challenged others, such as aggression and agitation were not always treated in a caring manner by the staff. This was because the staff had not been trained in how to manage people’s complex behaviours.
Staff were aware of people’s likes, dislikes and care preferences. However some people’s bathing preferences had not been met for a significant period of time because the bath was out of action. The provider had not taken responsive action to ensure equipment and facilities were maintained to meet people’s bathing preferences.
The provider had started to involve people who used the service in the evaluation of the care. More improvements were required to ensure people were involved in the evaluation of all aspects of the care and contribute to the development of the service.
Effective systems were not in place to enable the registered manager or provider to assess and monitor the safety and effectiveness of the care. The concerns with the care we identified at this inspection had not been identified by the registered manager or provider registered at the time of the inspection.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. Our findings have been shared with the new provider who has submitted a plan to us detailing the actions they are taking to make improvements to care delivery.