Kings Lodge Nursing Home

Kings Lodge Nursing Home is a residential care home providing personal and nursing care to 67 older people with a variety of health needs at the time of inspection. One part of the home provides specialised care for people who were living with dementia. The service can support up to 77 people.

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

Medicines were not always administered or stored in a safe way. New admissions to the home were not managed in line with government guidance. Some infection prevention and control systems were not sufficiently robust to protect people from unsafe care or treatment.

Care plans for some people with a learning disability did not provide detailed information or guidance for staff to ensure they received person-centred care.

People told us they felt safe living at the home. The home was open to visitors. A friend of one person was visiting the home and told us, “We were able to visit in the pod. It wasn’t ideal, but at least I was able to see her again. It was so important that we could visit”. Staffing levels were sufficient to meet people’s needs and new staff were recruited safely.

People’s needs were assessed before they came to live at 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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support:

• Model of care and setting maximises people’s choice, control and independence

Care records lacked information for staff as to how people’s independence could be promoted, or how to support people to have choice and control of their lives.

Right care:

• Care is person-centred and promotes people’s dignity, privacy and human rights

Staff knew people well and provided personalised care. However, records did not show how staff should promote people’s dignity and privacy or protect their human rights.

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives

There was no evidence to show how the home promoted inclusion in order for people to feel empowered.

The registered manager was not aware of the principles of Right support, right care, right culture. On the second day of inspection, they told us they had accessed this strategy and would be reviewing the care, including records, that people living with a learning disability or autism received.

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 3 November 2018).

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding to test the reliability of our new monitoring approach.

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.

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.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection. The provider has taken some action to mitigate the concerns

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

Enforcement

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.

We have identified breaches in relation to the safe administration and management of medicines, infection prevention and control, and governance. 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

The home was open to visitors and had effective infection control practices in place to promote their own and others safety. For example, on arrival visitors were asked to sanitise their hands, have their temperature taken, wear personal protective equipment (PPE) and undertake a lateral flow test (LFD) for Covid-19. There was guidance for visitors on what was required of them on arrival and leaving the service, and facilities available for the safe application and removal of PPE.

Visits took place in the ‘pod’ or in the dining room on each floor and the times were adequately spaced to allow for cleaning. The pod was a purpose built room housing a transparent screen with a microphone and speaker so conversations between people and their relatives could be heard easily. The pod had external access so visitors did not have to enter the home, therefore reducing the risk of potential infection transmission. People receiving end of life care could have visits from relatives in their rooms.

Staff were observed wearing correct PPE and had received training in how to safely put on and remove PPE. Staff told us they felt confident in their knowledge of how to use and dispose of PPE safely.

The registered manager had created a group email system to keep relatives up to date with general information about the home. For people who had given their consent, there was a social media page where pictures could be shared of residents enjoying the homes activities, entertainment and fundraising events. We were told this offered assurance to relatives who could see that their loved ones social and emotional needs were being met.

Staff knew people well and had sensitively considered their wellbeing following an outbreak of Covid-19 earlier this year. The residents and staff worked together to create their own entertainment throughout the pandemic. For example, staff had performed a pantomime and built a beach area outside for people to enjoy during warmer weather. There was also a cinema room, a sensory table and gaming chair for people to use.

Support had been sought from specialist community services who offered visits for people who were affected by Covid-19. Staff had arranged a memory walk to raise money for charity and encouraged residents to come together for remembrance, to share stories and celebrate peoples lives.

The registered manager had an admissions policy which enabled people to be admitted to the care home safely. All new admissions had to isolate for 14 days on arrival. If arriving from hospital, the ward would need to provide the home with the date and results of any Covid-19 test, the date of the onset of symptoms and a care plan for ending the period of isolation.

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 managers, 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.

At the last inspection on 7 March 2016, the service was rated ‘Good.’ At this inspection we found the service remained ‘Good.’ This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People and relatives told us they felt the service was safe. One person told us they felt safe they were never rushed and the home was clean, “It’s all spotless.” People remained protected from the risk of abuse because staff had a good understanding of safeguarding and there were systems and processes in place to keep people safe. Risks to people’s safety had been assessed, monitored and managed to ensure people remained safe. Regular health and safety checks and audits of systems and processes including care planning took place to ensure staff had current guidance when supporting people’s needs. We observed audit activity for areas including, moving and handling equipment, fire safety and infection control.

Medicines continued to be managed safely. There were arrangements in place for the safe ordering, administration, storage and disposal of medicines. People were supported to have their medicine safely with their consent and when they needed it. People were supported to maintain good health; their nutritional needs were met and they had good access to health care services. One person told us, “When I was living alone, my relative was worried because I was losing weight. I eat really well here.”

People and their relatives felt there were sufficient numbers of skilled staff to effectively meet people’s needs. Staff were recruited using robust recruitment processes and confirmed they received training and specialist guidance to support their understanding of the needs of people living with dementia and other complex health needs.

Staff considered peoples capacity using the Mental Capacity Act 2005 (MCA) as guidance. People’s capacity to make decisions had been assessed. People were supported to have choice and control of their lives and the service continued to review and reduce restrictive practices to ensure people were supported in the least restrictive way possible; the policies and systems in the service supported this practice. The provider was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS).

People’s needs and choices were assessed prior to people moving into the service, and they were supported by staff that knew their background life experiences and likes and dislikes. One person told us, “The girls look after me well, I can’t fault the care.” Care continued to be personalised to meet people’s care, social and wellbeing needs.

We observed positive and responsive interactions between people and staff. People’s independence continued to be encouraged. Staff promoted and respected people’s equality, diversity and human rights and their right to maintain important relationships. This culture continued through to the provision of end of life care. People were able to remain in their home, if they chose to for end of life and relatives were positive about the care they and their loved one’s received during this time.

Quality assurance audits continued to be completed to ensure a good level of quality was maintained. The provider was committed to improving the service through complaints, surveys, engaging with best practice initiatives with health professionals and was an active partner in local forums. The provider consistently demonstrated that the service monitored and made improvements to the systems when required.

Further information is in the detailed findings below

We spoke with 11 of the people who lived at the home. Some people were unable to tell us their experiences of living at Kings Lodge Nursing Home because of their complex needs. To ensure that everyone in the home was involved in the inspection we observed the care and support provided, and spoke with relatives and friends. People who spoke with us said, "I am very comfortable here, the staff are very good", and "I prefer to spend most of my time in my room, I like the peace and quiet, although I can go to the lounge if I want to'.

We spoke with five relatives and two visitors, one nurse, eight care staff, the activity person, the chef, the manager and the operations manager during the inspection. We reviewed six care plans and associated documentation; we looked at the management of medication and the systems in place to support staff.

We considered our inspection findings to answer questions we always ask:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

Is the service safe?

The care plans showed that staff were aware of people's capacity to make decisions, and there was evidence that relatives had been involved in assessing people's care needs if appropriate. We also found that 'best interest' meetings were held in relation to any restrictions that were in place.

We saw that staff had received training in safeguarding vulnerable adults. Relatives we spoke with told us they felt people who lived at the home were safe. Staff felt that they provided care and support in a way that ensured people's safety, whilst also allowing them to take make choices.

Systems were in place to ensure the management and staff learned from events. The issues identified at the last inspection had been addressed, and the manager had recognised that there were some areas of the service that needed to be improved.

However, we found that some of the records did not reflect the needs of some people; or the support and care provided by staff, and the homes policies and procedures were not specific to the needs of people who lived at the home.

Is the service effective?

We saw that people were supported by kind and attentive staff. Staff were seen to interact with people when providing support and care.

A person who used the service said, ""People are all very nice." One relative told us, "I am 100% satisfied." "The food is outstanding. There is a choice of food. The staff are great you can have a bit of banter".

Is the service caring?

We saw that people were supported by kind and patient staff. People were encouraged to make decisions about how they spent their time and were support to do things, such as have their lunch or take part in an activity.

However, we had some concerns that staff did not interact with some people who used the service in a meaningful way.

Is the service responsive?

We saw evidence that when people's needs had changed, the staff had made appropriate referrals to outside agencies, including GPs and the local authority.

Is the service well led?

Staff spoken with were clear about their roles and responsibilities. They said they had an understanding of the needs of people who lived at the home, and they felt well supported by the management.

We were told that a satisfaction survey was sent out to relatives and people at the home, but the results were not available.

Relatives told us they could talk to the manager at any time; they had been involved in planning care people received and staff responded when they put forward suggestions.

Relatives spoke positively about their experiences at the service and how the service cared for their relatives. They told us how attentive the staff were and how well they knew their relatives.

We saw that not all staff had undertaken the necessary training in order to help ensure that they are able to work safely with people. Shortfalls were found in the homes medication practices. Medication had been administered covertly without appropriate safeguards in place to ensure that people's best interests were protected. We found that action had not been taken when people's nutritional risk assessments placed them at risk. Some of the people living at the home had lost weight without any action being taken. People were not always protected from the risks of unsafe or inappropriate care and treatment.

Everyone told us that they were happy with the care and support they received. One person told us, "They are very good here, the staff are so kind, they always look after me well".

Another person said, "I only have to ring my bell and they do their very best to help me, I can't say anything bad about any of them they all do there best for me".

As one family member explained, "My mum has thrived since she came here, she arrived in a terrible state and we really didn't think she would last the night, but thanks to the staff here she is back on her feet and doing well".

People also told us that staff treated them with respect and promoted their privacy. They told us that they felt safe from harm living at the service and that they would be listened to if they raised any concerns. Our evidence gathered during this inspection supports the comments made by people who were receiving a service.