Archived: Kingsbury House

Updated 11 March 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check 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 inspection team consisted of an inspector and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of service.

The inspection was carried out over three days. We visited the service unannounced on 19 November 2014 with an expert by experience and announced on the 20 and 21 November 2014.

We spoke with the provider; general manager; operations manager; manager; four care workers; the cook; the housekeeper and the maintenance man.

Most of the people who lived at the home were unable to communicate verbally because of the nature of their condition. We therefore used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We also spoke with three relatives to find out their views.

In addition, we consulted with a district nurse who was visiting the home on the first day of our inspection. We also conferred with a GP and pharmacist by phone. We contacted by phone, a local authority contracts officer and a local authority safeguarding officer.

We checked four people’s care plans and looked at 20 medicines administration records. We looked at five staff recruitment and training files. We also examined various records relating to the management of the service such as minutes of meetings, surveys and audits.

Prior to carrying out the inspection, we reviewed all the information we held about the home. We did not request a provider information return (PIR) before we undertook the inspection, due to the late scheduling of the inspection. A PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

Updated 11 March 2015

The inspection was carried out over three days. We visited the service unannounced on 19 November 2014 with an expert by experience and announced on the 20 and 21 November 2014.

The service met all of the regulations we inspected at our last inspection on 12 July 2013.

Kingsbury House consists of terraced houses which have been converted and adapted to provide accommodation for up to 30 older people, some of whom are living with dementia. Nursing care is not provided. There were 22 people living at the home at the time of our inspection.

Following our inspection, the provider contacted us to advise us she had made the decision prior to our inspection to close the home imminently. She explained this was partly due to reduced occupancy levels since more people were being looked after in their own homes. It was also costing more to ensure the building met the relevant health and safety standards because of the age and size of the property. We are working with the provider and local authority to ensure the safe transition of people to other homes.

A manager was is post. She had not yet registered with the Care Quality Commission (CQC) in line with legal requirements. 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 and associated regulations about how the service is run.

There were three managers present at the time of our inspection. The home manager, general manager and operations manager. The general manager oversaw the management of both homes which the provider owned. The operations manager organised training and liaised with social workers amongst other duties. During the inspection, the general manager supported the manager with our requests for information.

The provider visited on the second day of our inspection. She told us that her background was not in care. Therefore, she left decisions regarding the running of the home to the general manager. She said, “[Name of general manager] has a free reign on decisions that need to be made. She has incredibly high standards. Her strengths are in elderly care.” She told us that she met with the general manager regularly to discuss any issues.

Although staff were knowledgeable about the action they would take if abuse was suspected; we found relevant agencies were not always notified in a timely manner of all safeguarding incidents. We considered improvements were required to ensure people were safeguarded from the risk of abuse.

We had concerns about certain aspects of the environment. A recent fire risk assessment had highlighted a number of issues with fire safety such as the standard of some fire doors. This was confirmed by our observations. In addition, we had concerns with infection control procedures at the home.

We found improvements were required to ensure staff received appropriate training to meet the needs of people who lived there. People received food and drink which met their nutritional needs. We observed people at lunch time and saw that staff provided discreet support to those who required assistance.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care

homes. DoLS are part of the Mental Capacity Act 2005 (MCA). They aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. The manager was submitting DoLS applications to the local authority to authorise. These procedures were in line with legislation. We found however, further improvements were required to ensure that individualised “decision specific” mental capacity assessments were carried out in line with legislation.

Staff were knowledgeable about people’s needs and we saw care was provided with patience and kindness and people’s privacy and dignity were respected. We found however, that care documentation did not always reflect the care which was delivered.

A complaints process was in place and people told us they felt able to raise any issues or concerns and action would be taken to resolve these.

Various audits were carried out to check the quality of the service provided. We noted however, these audits did not identify the concerns which we had found with regards to infection control, the premises and documentation.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These related to the safety and suitability of premises; cleanliness and infection control; assessing and monitoring the quality of service provision and record keeping.

You can see what action we told the provider to take at the back of the full version of this report.