Kingsmount Residential Home

Kingsmount Residential Home is a residential care home providing personal care to 32 older people, some of whom may be living with dementia or memory loss. At the time of the inspection, there were 28 people living at the home.

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

The provider had made improvements since our last inspection and were no longer in breach of regulations. Further improvement was needed to ensure the improvements made were sustained and systems and processes in place to ensure the delivery of quality care, were robust. We have also made two recommendations to continue to drive improvements.

People told us they felt safe living at Kingsmount. One person said, "Oh yes I feel safe. I’m safe in their hands." Staff knew what to do to keep people safe and were confident any concerns would be taken seriously.

Risks to people were assessed and managed safely and risk assessments were in place which guided staff in caring for people in a safe way. Systems were in place that ensured accidents and incidents were recorded and investigated. Accident or incident records were not analysed to consider any lessons which could be learned. We made a recommendation to the provider about this.

People's care plans provided staff with guidance in how to support each person. However, some care plans were not as detailed or person-centred as others to ensure people's preferences were reflected. We recommended the provider seek guidance to ensure all care plans are person-centred.

Systems to monitor the quality of the service provided had been strengthened and improved. Further improvement was being implemented and embedded into practice to ensure people continued to receive safe care and treatment.

Medicines were managed safely. Staff were trained to administer medicines and regular audits were completed to ensure medicines continued to be given safely and as prescribed.

People told us staff were kind and caring and they treated them well. One person said, “There’s some delightful staff, they really are good. Nothing’s too much trouble for them.” There was a relaxed and friendly atmosphere in the home and people were supported by staff who knew them and their needs well. During the inspection, we observed staff interacting with people and found there were sufficient staff available to meet people's needs. Staff were recruited safely.

Staff received supervision and training which enabled them to deliver effective care. Staff told us they felt supported, listened to and able to make suggestions.

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.

Staff encouraged people to maintain a healthy diet. Referrals were made to healthcare professionals where required to ensure people's health needs were met.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 20 February 2019) and there were breaches of regulation.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

Kingsmount Residential Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Kingsmount Residential Home is registered to provide care, nursing and accommodation to a maximum of 32 older people, some of whom may be living with dementia or memory loss. At the time of the inspection, there were 31 people living at the home.

At the time of the inspection there was no registered manager in post. The provider had employed a new manager who had started at the home two days prior to the inspection. The new manager was an experienced care home manager and they told us they would be submitting an application with the Care Quality Commission to become the registered manager of the home. The new manger was supported during this inspection by the deputy manager and the nominated individual. The report refers to them as ‘the management team’.

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.

Risks to people were assessed and risk assessments tools were used to identify common risks such as those relating to falls, skin integrity and medication. However, daily monitoring records did not always show that care was being delivered as it should. Equipment used to minimise risk was not always set correctly in order to reduce the risk of skin damage.

Where people were at risk of dehydration, fluid monitoring charts did not indicate if action had been taken or guidance sought when a person had consistently not reached their target intake amount.

Improvements were required to ensure that medicines were managed safely. Whilst medicines were stored and administered safely, random sampling of five medicines found discrepancies with the stock levels of three medicines. Other aspects of medicines were managed safely

Systems and processes in place to monitor the quality and safety of the home failed to identify and address the issues we found during this inspection.

People told us staff supported them with kindness and respect. Comments included, “They are very caring here”, “Staff are on hand and we can call them anytime, they have been as good as gold” and “They’ve always been kind to me, it feels safe here.” Staff respected people's privacy and dignity and interacted with people in a caring, compassionate and professional manner. People were encouraged to be as independent as possible but where additional support was needed this was provided.

People told us they felt safe when they received care and support from staff at the home. One person told us, “It’s very clean here, and safe.” A relative said, “I sleep at night because they look after mum so well.” People were protected from the risk of abuse because staff understood how to identify possible abuse and were clear in how they would report this. Staff told us they had received safeguarding training.

People were supported by staff that had been recruited safely and had sufficient knowledge and skills to enable them to care for people. There was a comprehensive staff training programme in place and staff told us they felt supported and received regular supervision. However, during the inspection we saw three recently completed appraisal forms were identical and not individualised for the staff members. We made a recommendation to the provider about ensuring appraisals were tailored to the individual staff member.

People and their relatives gave us a mixed response about there being enough staff. One person told us, “The girls don’t really have time to speak to me sometimes, it’s time that does it as they’re so short staffed.” Another person told us, “I use the call bell they don't take very long to come.” Staffing rota's and observations during the inspection showed us there were sufficient numbers of staff to meet people's needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way; the policies and systems at the home supported this practice. Where people lacked capacity to make specific decisions about their care and treatment, decisions had been made in their best interests. However, one person, who had been assessed as not having the capacity to decide about taking their medicines or the use of a sensor alarm mat placed in their room to keep them safe, did not have a best interests decision recorded in their records. This was addressed immediately. We made a recommendation to the provider to ensure that all assessments and best interests decisions are made in compliance with the Mental Capacity Act 2005.

People received support that was tailored to them as individuals and were supported by staff who understood their specific needs and how to support them in the way they wanted to receive care. People's records were comprehensive enough to give staff a good understanding of people's preferences and life experiences. This helped staff to support people to engage in meaningful activities that they enjoyed. Since the last inspection the home had worked very hard to improve the provision of one to one engagement and activities to reduce the risk of social isolation.

People living at the home, relatives and staff were happy with how the home was being managed. They found the management team and staff approachable. The provider regularly sought feedback from people living at the home and their relatives about the support provided. We saw evidence that the feedback received was used to develop and improve the service.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of this report.

Kingsmount Residential Home is a care home for older people some of whom may be physically frail or living with dementia. At the time of our inspection there were 22 people living at Kingsmount. The home has two lounges, one of which is a smaller “quiet” lounge with direct access to a small garden area containing garden furniture at the rear of the property. The dining room leads off from the main lounge. All bedrooms are pleasantly decorated, some with fantastic sea views and all are fitted with a call system and have access to bathroom and toileting facilities.

The home 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 and associated Regulations about how the service is run.

The registered manager had been in post for seven years and was highly regarded by the staff, residents and their visitors. The management team had a positive and proactive approach to managing the home and maintaining high standards of care.

People who live at the home told us they felt safe, and we found that the provider had a number of systems and processes in place to promote safety. Staff received training in and understood their responsibilities in safeguarding of vulnerable adults. We found risks to individuals were well assessed and staff applied measures to minimise risk to people. However, risk assessments did not clearly document what measures the home had put in place to minimise risk to individuals. This was discussed with the registered manager and immediate action was taken to address this.

Care plans contained assessments of people's capacity to make decisions in line with the Mental Capacity Act 2005. Where people lacked capacity to make a decision we saw documentation of best interests decisions and who had been involved in making those decisions.

People received personalised care and staff treated them as individuals and with respect. Staff knew peoples' likes and dislikes. We saw staff offering people choices and people who lived in the home, where able, told us how they made choices in relation to their care and support such as when they wanted to get up, what they wanted to eat and where they wanted to spend their day.

There were systems in place for monitoring the quality of the service and the care and support that people received. If there were areas for improvement that were highlighted through the audit process there were action plans to rectify the issues.

Recruitment processes were robust and thorough checks were always completed to make sure staff were safe and suitable to work in the care sector before they started work at the home. Staff had received sufficient training to support them to carry out their roles. They received regular supervision and appraisal. They told us they felt supported by the management team and were comfortable making suggestions.

People were supported to take their medicines. Medicines were secured safely and accurate records were maintained. Safe systems were in place to manage medicines so people received their medicines at the right times.

People were given a choice of nutritious and seasonal home cooked meals. There were plenty of hot and cold drinks and snacks available between meals. However, we had mixed reviews from people about the quality of the food provided. Some people told us they liked the meals and they had plenty to eat. Some people remarked that the food was inconsistent and not very hot. We saw good support given to people who needed assistance to eat. We saw that staff were patient with the people they were supporting and did not rush them.

People had their healthcare needs identified and were able to see healthcare professionals such as their GP or dentist when they needed to. Staff knew how to access specialist professional help when needed.

The home employed an activity coordinator and offered a variety of different activities for people to be involved in. Whilst we were there we observed a number of activities in the communal rooms, including group sessions and people having individual activities more suited to their needs and preferences such as playing chess and having their nails painted. However, we found that people who chose to stay in their rooms did not receive meaningful activity and were often only stimulated by the television or radio playing. We were also told by people and their relatives that there were no outside activities offered.

We have made a recommendation that the home seek advice and guidance from a reputable source, about supporting people at risk of social isolation.

The home was clean, tidy and free from odour and effective cleaning schedules were in place. It was decorated to a high standard and people's rooms were personalised. There was an on going decorating improvement plan in place to ensure constructive adaptations are made to meet individual needs and accessibility, for example grab rails in bathrooms. Although the home supported people living with dementia, communal areas and corridors were not well signed and the floor coverings in the lounge and communal areas were highly patterned which was not suited to the needs of people living with dementia.

We have made a recommendation that the provider should take advice from a reputable source to ensure that the home's environment is suitable for people living with dementia.

People's comments and complaints were responded to appropriately and there were systems in place to seek feedback from people and their relatives about the service provided. We saw that any comments, suggestions or complaints were appropriately actioned.

We found the provider had audits in place to check that the systems at the home were being followed and people were receiving appropriate care and support.

We found that people's consent had been obtained for care and treatment provided to them by the service. People were being given choice about their daily activities and treated with kindness and respect.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. There was a variety of healthy and nutritious food and drink available. Where people had special dietary requirements or needed support we saw staff met those needs and skilfully assisted people to enjoy their meals.

We observed that care workers had time to complete tasks. They were busy, well organised and were meeting people's needs. We saw care workers were courteous and were vigilant to people's wishes. One person told us "delighted with things here'.

We looked at the quality assurance systems in place to monitor the quality of care

delivered. We saw that the provider monitored the service and sought feedback.

People we spoke with told us the home met their needs well. A relative told us "The atmosphere is always homely. It doesn't matter what time I come up". Another person told us "They look after you so well. Nothing is too much trouble".

We observed an activity session which showed us that people had very much enjoyed the activity. This was down to the approach and skills of the staff involved. A visitor confirmed that activities were provided every day.

We saw staff knocking on people's doors before going into their rooms and consulting with them about day-to-day issues.

We saw that people with impaired communication were given time to make decisions when staff were communicating with them. We saw this with medication being given out and at mealtimes. We saw staff communicated with individuals at their eye level.

Some of the care plans we saw contained information about people's social and personal history. This helped staff understand people's behaviour in the context of the life they had lived.

We found people's care files contained good information about their physical needs. However, there was little information of how any memory loss impacted on their lives, and we did not see clear information on how people's capacity to make decisions had been assessed.

Some of the records, staff training and support systems needed attention or updating.