Kingsclear

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Although on the day of our assessment we observed suitable numbers of staff available to support people, feedback from people and relatives demonstrated that this was not always the case. They were also concerned about the high use of agency staff. Staff were knowledgeable in their responsibility to safeguard people from harm. Processes were in place to support staff to do this. Risks to people were managed appropriately and safe infection prevention and control procedures were in place. The management of medicines was safe.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us the staff and the leadership team were open to improvement and willing to learn from concerns. One relative told us, “They try. The leaders have been open and transparent with some issues I have had.” Another relative said, “I have had to raise things before and they sorted it.”

The provider encouraged a culture of openness and took seriously any concerns raised. One staff member told us, “I have no concerns about the safety of our residents and our staff, there are processes and policies that are adhered to ensure best practices.” Another staff member said, “[The registered manager] also encourages everyone i.e. residents, families, and the team to inform him of any concerns they may have to ensure these are dealt with promptly and correctly following the correct processes.”

Where concerns had been raised by relatives or anonymous sources, the provider ensured they investigated these. From their investigation, we saw evidence they put in place action plans which were regularly reviewed. There was a commitment from senior staff and managers to learn from mistakes and make improvements.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

On the whole, people we spoke with told us they felt safe and well looked after. They did not feel intimidated or bullied by anyone. A person told us, “I feel safe here, oh yes. They look after me well.” Another person said, “We are lucky to live here, it is better than other homes.” One relative told us, “Yes, I do feel she’s safe. The whole reason she moved in was because she wasn’t safe at home.” Another relative said, “Mum feels safe and cared for.” However, one person and one relative shared with us examples where people did not feel safe. These included the lack of prompt support from the staff and incidents of altercations involving other people living at the service. We raised these concerns with the regional manager.

Staff received training in safeguarding and understood the meaning of abuse and how to prevent this and report anything of concern. One staff member told us, “Any concerns regarding safeguarding would be addressed to my manager.” Another staff member said, “Regarding safeguarding, I had training on e -academy, face to face and on the care certificate standards. If I have any safeguarding concern I can speak to the nurse on duty and the manager.” Whistleblowing concerns were taken seriously, investigated and addressed. The management team were transparent and worked with the local authority to investigate concerns.

We observed staff having positive and caring interactions with people. They spoke with them in a friendly and soft manner. People seemed to know who the care workers were and had chats with them. None of the people we spoke with said they were badly treated or neglected. We saw their needs were met throughout the day, and call bells were responded to promptly. People’s personal care needs were responded to in a discreet manner.

We saw evidence the provider took seriously any safeguarding concern, and reported these to the local authority’s safeguarding team and the Care Quality Commission as needed. They were proactive at investigating concerns and putting measures in place to protect people.

Overall, people and relatives we spoke with indicated they felt safe living at Kingsclear. A person told us, “I feel safe. The day staff are very good and know our needs.” One relative said, “[Person] is now bed bound as they found she’s got grade 3 pressure sores. She’s on a pressure relieving mattress and staff are turning her often. They’re managing it well at the moment.” Another relative told us, “Risks are managed without being unduly restrictive to the residents.”

Staff felt they were able to ensure risks to people were managed appropriately. One staff member told us, “The staff are professional and the residents receive a good service. We have monthly relatives meetings floor by floor so it is specific to people’s needs.” Another staff member said, “Staff know people very well so we understand their needs. So especially for the dementia unit, there are regular staff who already know them and how to protect them from risk. We remind them to use their walking aids if they forget. We look out for them to protect them.”

On the day of our visit, we saw people being active and walking around enjoying their environment. They were supported to remain as independent as possible.

People were consulted about their care and support and consent was obtained for a range of areas such as the use of photographs and sharing documents and care records. Care plans included information and management plans of risks known to each person. The home was well maintained. There was access to an external garden, but this was secured so people who were unsafe to exit the home by themselves were able to walk about safely but unable to leave unaccompanied. There were also secured balconies and patios on upper floors which were well equipped with garden furniture and plants and see-through panels so people could benefit from the views whilst being safe. There had been some good measures to reduce falls. There were rails on both sides of the corridors and these were clear of trip hazards. There were also several sitting rooms on each floor so people could stop and rest.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

People’s views of staffing levels were mixed. One person told us, “There are enough staff during the day but not at night. They have to use agency staff at night and they are not as good as our own staff.” Another person said, “I think there are enough staff. They always help me when I need them.” Relatives echoed this. One relative told us, “Often I get phone calls from mum in tears saying she’s pressed the bells and no ones come but I’m not sure if that’s true. When I’m there and she presses the bell they come. Another relative said, “It seems to be a regular excuse that they’re short staffed. It was a 15 minute wait this morning for the call bell while I was there, other times its around 5 minutes.” A further relative told us, “The turnover of staff of late has been quite a worry to me. There are not enough senior well trained carers. A new carer is given in house training which I believe is standard in this industry. However, this system just doesn’t work. The workload on the dementia floor is huge and very demanding. The staff become so stressed that they either leave or ask to work on the lower or second floor.”

Staff felt there was enough of them to meet people’s needs. One staff member told us, “Sometimes we use agency staff but as far as I am aware, there are no shortage of staff. I think it’s the opposite. We have increased the staffing levels due to people’s needs. We have had extra carers sometimes.”

On the day of our inspection, there were enough staff on duty to meet people’s needs appropriately. People did not have to wait long when they called for staff.

The provider carried out checks on the suitability of staff before they started working at the service. These included checks on their identity, eligibility to work in the United Kingdom, references from previous employers and Disclosure and Barring Service (DBS) checks. New staff completed inductions, where they shadowed experienced staff and their skills and abilities were assessed by senior staff. These systems helped assure the provider staff were suitable and could carry out their roles. The provider used a ‘Dependency assessment’ to determine the level of care a person required in a range of areas such as eating, transferring, personal care, oral care and mobility. Based on this, they ensured the person received the correct support from staff. This was regularly reviewed in line with people’s changing needs. We saw evidence that additional care hours were put in place when this was needed, for example when a person’s needs increased.

People and their relatives told us they felt the service was clean and they were protected from the risk of infection. One person said, “They clean every day. The place is always clean and the staff are nice and know our names.” A relative told us, “On the whole yes [it is clean and tidy]. The linen store is much tidier than it was and you can actually find linen in there now. The housekeeping in the residents’ rooms is good. Other relatives told us they felt safe infection prevention and control practices were followed.

The staff told us they received appropriate training in infection prevention and control and we saw evidence of this. The staff told us they had access to personal protective equipment (PPE) and followed appropriate infection control guidance. One staff member told us, “Infection Control training is given on e-learning , staff not practicing this adequately will be asked to do the training again.” Another staff member said, “I had training online and face to face about infection control, and it is also present on the care certificate standards. To avoid spread of infections we must use PPE materials, always use gloves during residents personal care, and put waste materials and soiled clothes in the correct bags.”

The whole home was very clean and hygienic with no malodours. There were housekeeping staff around throughout the day. Bathrooms and toilets were clean and fresh. We observed staff completing cleaning schedules during our on site assessment. The furniture were of an excellent quality and the décor was fresh and welcoming. This lead to a calm and comfortable atmosphere.

The provider was preventing visitors from catching and spreading infections through promoting safety through the layout and hygiene practices of the premises. Infection outbreaks were effectively prevented and managed.

People and their loved ones felt medicines were managed safely. One person told us, “I normally get my medicines on time.” A relative said “Theres never been any issues. [My loved one] is on lots of medications and they give them to her every 4 hours on time.” Another told us, “We haven’t had any issues with prescribed medicines.”

Senior staff were trained in administering medicines and had their competencies checked regularly. One staff member told us, “I am fully trained to administer medication but only do so when required.” All other staff were trained to a basic level of medicine awareness to support their job role. A staff member told us, “Personally I don’t administer medicines, but I did some trainings about it on [pharmacy] academy.”

Processes and systems were in place to ensure medicines were safely stored and administered. Temperatures in the clinical room and all fridges were recorded to ensure correct storage guidance was followed. All medicine stock was in date and correctly and securely stored. Protocols were in place for as and when medication (PRN). This informed staff when medication, such as paracetamol, should be given and how long there should be between doses. Staff competency in administering medicines was reviewed on an annual basis to ensure skills were up to date and safe.