Kingsland House

Kingsland House is a care home registered to provide nursing and residential care and accommodation for 71 people with various health conditions, including dementia and sensory impairment. There were 59 people living at the service on the day of our inspection. Kingsland House is a large purpose built care home located in Shoreham-by-Sea, West Sussex.

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

People told us that they felt safe. Risks to people had been identified and assessed. There was a flexible approach to risk management which promoted people’s independence. Staff were recruited safely and there were enough staff to meet people’s needs. Medicines were managed safely. Infection prevention and control processes protected people from the risk of infections.

Systems and processes were in place to monitor the quality of the service being delivered. The culture of the service was positive, and people and staff were complementary of the management. People were treated with dignity and compassion by a kind, caring staff and management team who understood people's individual needs, choices and preferences well. People and staff told us that they felt supported and valued.

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.

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 good (published 5 May 2022).

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels and care delivery. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm from these concerns.

We undertook a focused inspection. This report only covers our findings in relation to the Key Questions Safe and Well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained Good based on the findings of this inspection.

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.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Kingsland House is a care home registered to provide nursing and residential care and accommodation for 71 people with various health conditions, including dementia and sensory impairment. There were 60 people living at the service on the day of our inspection. Kingsland House is a large purpose built care home located in Shoreham-by-Sea, West Sussex.

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

People were happy with the care they received, felt relaxed with staff and told us they were treated with kindness. They said they felt safe, were well supported and there were enough staff to care for them. One person told us, “You cannot fault the staff here, they are lovely.” Our own observations supported this, and we saw friendly relationships had developed between people and staff. A relative told us, “We’re very lucky to have [my relative] living here, she is taken good care of.”

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.

The registered manager had worked hard to embed a positive culture and ethos of care at the service. One member of staff told us, “I love working here, we treat the residents like they are our own parents. The manager has made changes, but they are for the better.” The provider had systems of quality assurance to measure and monitor the standard of the service and drive improvement. These systems also supported people to stay safe by assessing and mitigating risks, ensuring people were cared for in a person-centred way and that the provider learned from any mistakes. Our own observations and the feedback we received supported this.

People received good care that met their needs and improved their wellbeing. The staff team were dedicated and enthusiastic.

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 Good (published 26 August 2021).

Why we inspected

This inspection was prompted by a review of the information we held about this service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. Please see the safe and well-led sections of this full report.

We reviewed the information we held about the service. No areas of concern were identified in the key questions of effective, caring and responsive. We therefore did not inspect these. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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.

The overall rating for the service has remained as Good.

Follow up

We will continue to monitor information we receive about the service until we 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 service had appropriate procedures in place for visiting, including checking of COVID-19 passports for visiting professionals.

The registered manager has facilitated visits for people safely and regularly during the pandemic.

The service was clean and tidy throughout. There were robust cleaning schedules inclusive of high touch point areas, to promote safe infection control practices.

Staff had received all appropriate infection prevention and control training. This included the correct use of personal protective equipment (PPE), and donning and doffing safely. Staff were observed to be wearing PPE correctly.

The registered manager had managed risks to people from outbreaks through appropriate isolation and separation of areas within the service.

Kingsland House is a residential care home providing personal and nursing care to 63 people aged 65 and over at the time of the inspection. Kingsland House accommodates up to 71 people across three separate units, each with communal lounges and dining areas. One of the wings specialises in providing care to people living with dementia.

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

People were safe and happy at the home. We saw friendly interaction between staff and people. People and their relatives were happy with the care they received. We spoke to people at breakfast time who told us the food and staff were nice. People were happy and when asked if they liked living at the home one person told us, “Oh yes dear, lovely.”

Medicines were administered safely by trained staff. Care plans contained guidance for staff to ensure risks were minimised. The home was clean and staff understood infection control.

Relatives told us they were confident people were safe at the home, and that they had the freedom to live as they wanted. A relative told us, “We did look at some homes where they had different floors for different levels of dementia. But [my relative] liked to wander and have a nose. They loved it there, they often spent a lot of time in Memory Lane because they loved the residents in there. They’d often have breakfast one end then go to the other end and have another breakfast!”

On the day of the inspection there were enough staff to care for people safely. The registered manager told us they used a dependency checker to ensure safe staffing levels. However, some staff felt the checker was not always accurate and they could feel understaffed.

Staff told us people were safe but they felt very over worked and stressed. A staff member told us, “I think people are safe. Staff will stay longer, after their shift should have ended, to be sure people are safe. But staff are stressed and we worry about people.”

Staff workload, stress, and support were common themes among staff we spoke to. We identified managing staff workload and stress as an area that needed improvement.

The registered manager was supported by a senior team within the company. At the time of the inspection there was no deputy manager which meant the registered manager was very busy, however she told us she had support from a regional manager and a clinical development nurse.

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.

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 good (published 31 August 2019).

Why we inspected

The inspection was prompted in part due to concerns received about a lack of engagement with other healthcare professionals and low staffing levels. A decision was made for us to inspect and examine those risks.

We found some evidence during this inspection that people were at risk from these concerns. Please see the well-led section of this full report.

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

Follow up.

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

Kingsland is a care home registered to provide nursing and residential care and accommodation for 71 people with various health conditions, including dementia and sensory impairment. There were 63 people living at the service on the day of our inspection. Kingsland House is a large purpose built care home located in Shoreham By Sea, West Sussex.

People’s experience of using this service:

People were happy with the care they received, felt relaxed with staff and told us they were treated with kindness. They said they felt safe, were well supported and there were sufficient staff to care for them.

Our own observations supported this, and we saw friendly relationships had developed between people and staff. A relative told us, “[My relative] made the decision that she wanted to come here and says she is very happy and enjoys the company of others”.

People enjoyed an independent lifestyle and told us their choices and needs were met. They enjoyed the food, drink and activities that took place daily. One person told us, “The food is lovely, and I like everything we have”. A relative added, “[Registered manager] is interested in developing more community activities and residents recently had a lecture from a person talking about the history of Shoreham”.

People felt the service was homely and welcoming to them and their visitors. A relative told us, “Reception is always well supplied with drinks and snacks for us when we visit and for the residents who choose to sit there”.

People told us they thought the service was well managed and they enjoyed living there. A relative told us, “[My relative] has been here for three years and [registered manager] is approachable if I have any worries. She and [deputy manager] are always around the home checking on things”.

Staff had received training considered essential by the provider. It was clear from observing the care delivered and the feedback people and staff gave us, that they knew the best way to care for people in line with their needs and preferences. A member of staff told us, “The training I’ve had is of a good standard”.

The provider had systems of quality assurance to measure and monitor the standard of the service and drive improvement. These systems also supported people to stay safe by assessing and mitigating risks, ensuring that people were cared for in a person centred way and that the provider learned from any mistakes. Our own observations and the feedback we received supported this. People received high quality care that met their needs and improved their wellbeing from dedicated and enthusiastic staff. A member of staff said, “I think the home is very well managed. I give people the same respect that I would give my own family”.

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

Rating at last inspection: Requires Improvement (report published 30 July 2018).

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor the intelligence we receive about this home and plan to inspect in line with our re-inspection schedule for those services rated Good.

The service had an acting general manager who was in the process of applying to be the registered manager as a temporary measure, while the provider recruited to the registered manager’s post. The service had not had a registered manager for four months. 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 13 August and 7 September 2017, the service was rated ‘Inadequate’. This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

At this inspection the provider was found to have met the previous breaches of regulations, having carried the actions from the action plan they provided to tell us how they would address the breaches. These breaches were in relation to shortfalls in staffing levels, medicines administration practice, the promotion of dignity, notifying the Care Quality Commission of serious events and the management and governance of the service. We undertook this inspection to check that the provider had followed their action plan and to confirm if they had met legal requirements. Many improvements had been made, however we found continued improvements were needed to sustain and embed those made. The overall rating for Kingsland House has been reviewed to Requires Improvement. This report discusses our findings in relation to this.

People and their relatives told us that staff were available to support them when required and our observations during the inspection demonstrated that staff were available to assist them with their needs, preferred choices and comfort. One person told us, “I don’t know how many staff are here but there seems to be quite a few of them. Considering it’s a home, it’s a very good home. I’ve not had problems waiting for someone to help me. I’m happy.” The service was not full to its capacity of 71 people during the inspection. However, the acting general manager and the regional director explained that it was staffed on the days of the inspection as it would be at capacity. Although, the feedback from people, relatives and staff was that there was sufficient staff. We were unable to determine whether the current service provision could be sustained over time, should the number of people living at the service increase.

People and their relatives told us, and our observations demonstrated, that the management of the service had improved. The quality assurance systems in place ensured they were meeting people’s needs. Shortfalls were recognised and the provider and management team had worked hard and taken a considered approach, concentrating their efforts and additional resources on specific areas of practice to ensure that improvements were made.

Although, feedback from people, relatives and staff and our own observations demonstrated improvements had been made and people’s care needs. Including; dignity, preferences and choices were being met. We could not fully determine whether the improvements made could be sustained. The service had experienced several periods, without a registered manager in the previous four years, and this had impacted on their quality assurance systems. We were unable to determine whether the governance systems could be sustained over a defined period of time. As the quality assurance systems and processes were still in the process of being embedded, and as they had benefitted from the experience of the general manager, an extensive period of review and the involvement and additional management support from the provider.

People and their relatives told us they were safe. One person told us, “The people make me feel safe. It’s very warm and comfortable. I like it here very much.” People were protected from the risk of harm and abuse as they were cared for by staff that understood how to recognise and report abuse and all types of discrimination. Staff and relatives were confident that if they reported a concern it would be taken seriously and acted on by the service’s management. Risks to people’s safety, in relation to their physical, emotional and healthcare needs, were regularly assessed and appropriate care was provided to ensure that people received safe care that ensured their dignity was maintained.

People could make choices about how their care was delivered and suitable levels of staff were available to support their preferences in relation to mealtimes, personal care, daily routines and activities. Comment’s from people included; “There’s two kinds of food every lunchtime and if I don’t want that they’ll get me something else.” “I’ve never had any problem when I press my bell. Someone always comes along. I don’t time them but I don’t think I wait very long. I think the staff are excellent. They make me feel very much at home. I’ve no complaints.” “I have the freedom to make my own choices. Generally, there is no problem with getting up or going to bed when I want and do what I want during the day. I may go out, I may have a visitor, I may go to the activities, it’s my choice.”

People were able to live in an environment that was adapted to meet their physical, sensory, emotional and cognitive abilities. People could freely access all areas of the building and could choose where they spent their time including; the garden, quiet spaces, the foyer or one of three lounge dining areas. One person told us, “I like that we’re on one level like a bungalow. There are lovely gardens and it’s safe to go out there as it’s enclosed.” People were supported to be an independent as they could be.

The provider had arrangements in place for the safe ordering, administration, storage and disposal of medicines. People were supported to have their medicine safely when they needed it. One person told us, “They are very good and conscientious about giving medicine; very cautious and make sure you take it and not just leave it on the side.” The management team had worked hard to improve the auditing and management of medicines, and to ensure staff were suitably trained and guided in administering all medicines, including time critical and as required medicines.

Care plans and risk assessments were comprehensive and provided detailed guidance for staff in how to support people with their needs including; moving and handling, personal care, skin integrity and nutrition. Staff received the training they needed to support people and worked closely with healthcare professionals completing assessments relating to the risks that were managed.

Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar incidents occurring. Risks associated with the environment and emergencies including fire and infection control were identified and managed. We observed audit activity for areas including, medicines, and fire safety and infection control. The building was freshly decorated in all areas and odour free.

People, relatives and staff told us there were suitable levels of skilled staff available to meet people’s needs safely. One person told us, “They’re very good, all of them. Yes, I think they know what they’re doing and they always ask if I’m happy.” Staff received an induction and training to ensure they understood how to support people living with dementia with complex health needs. Staff told us they felt well supported through supervision, appraisal and training and could demonstrate how to work with people’s complexity of need. Staff received suitable specialist training including; dementia awareness, medicines, Mental Capacity Act 2005 (MCA). The provider ensured that when new staff were employed, safe recruitment practices were followed to ensure they were suitable to work with people.

People’s diversity and right to maintain important relationships was respected and promoted within their day to day experience and care planning.

Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and the provider was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). People’s capacity to make decisions had been assessed. People were supported to make choices and take decisions where they could. Staff supported people in the least restrictive way and when required they had access to advocacy services.

People’s relatives told us and we saw that the staff were caring and respectful. One relative told us, “My relative has been happy, comfortable and peaceful here.” Care and support provided was personalised and met peoples’ diverse needs. People and their important relationships were resp

Kingsland House is registered to provide nursing and residential care for up to 71 people with a range of healthcare needs, including people living with dementia and chronic conditions. On the first day of our inspection, there were 66 people living at the service. On the second day of our inspection, there were 62 people living at the service, as some people were in hospital, or had sadly passed away. Kingsland House is a purpose-built care home which is divided into two units: Memory Lane, which accommodates people living with dementia and Bluebell, which accommodates people with a range of health and nursing needs.

A registered manager was in post. 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.

We were told that staffing levels had been assessed based on people’s care and support needs. However, people, relatives and staff felt that there were insufficient numbers of staff on duty at certain times of the day and night to ensure people’s safety. Our own observations supported this.

Certain aspects of the management of medicines required improvement and we saw that safe procedures for the giving people their medicines were not routinely being followed.

Several people commented they were well looked after by care staff. However, care was not always personalised to the individual. For example, people did not always get up or spend their day how they wished. It was recognised that staff had a good understanding of person centred care and knew people’s routines well. However, staffing levels at the service did not allow staff to routinely meet people’s preferences in relation to how their care was delivered.

There was a range of quality assurance systems to help ensure a good level of quality of care was maintained. However, these systems had not fully ensured that people received a consistent and good quality service that met individual need, specifically in relation to the assessment of staffing levels.

Unpleasant odours and the smell of urine were evident in Memory Lane at the time of our inspection and cleanliness was not of a high standard.

People were complimentary about the food and drink on offer. There was a varied daily choice of meals, special dietary requirements were met, and people’s weight was monitored. However, improvements were needed to the mealtime experience, and people’s food preferences being met in some parts of the service.

Care plans were accurate, however three out of the 10 we looked at lacked information to guide staff when people’s needs had changed.

Although some staff spoke positively of the culture and how they all worked together as a team, feedback from other staff was mixed and indicated that there was a lack of cohesion, support and a negative culture in the service. We received mixed feedback from people, relatives and staff in relation to the service being well led.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service. Staff had received both one-to-one and group supervision meetings, and formal personal development plans, such as annual appraisals were in place. However, some improvement was required in relation to the induction provided for agency staff.

When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future. Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

People took part in activities in the service and outside the service. They told us they enjoyed the activities, which included singing, films, arts and crafts and themed events, such as reminiscence sessions and visits from external entertainers. People were also encouraged to stay in touch with their families and receive visitors.

People told us that friendly and genuine relationships had developed between them and staff. They also said they felt listened to and confident that they could raise any concerns or issues. Health care was accessible for people and appointments were made for regular check-ups as needed.

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

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe, so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary,

another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Kingsland House is a purpose built home that provides nursing care and accommodation for up to 71 older people with a physical disability, dementia and/or related mental health conditions. The service includes ‘Memory Lane Community’, a dedicated part of the home that accommodates people living with a dementia and ‘Bluebell Community’, part of the home where people with complex and general nursing needs reside. Services offered at the home include nursing care, end of life care, respite care and short breaks. At the time of this inspection, there were 45 people living at the home. Kingsland House belongs to a large corporate organisation called Barchester Healthcare Homes Limited. Barchester Healthcare Homes Limited provides residential and nursing care in a large number of services across the United Kingdom.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the improvements identified at the previous inspection had been met. We found that they had. The overall rating for Kingsland House has been revised to good.

There was a registered manager in post. 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.

The improvements that we identified in relation to staffing levels and the planning and delivery of personalised care had been fully embedded and sustained. Robust pre-assessment protocols and criteria had been implemented, to ensure that care could be delivered safely and appropriately when the numbers of people living at the service increased.

Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and the provider was meeting the requirements of the Deprivation of Liberty Safeguards. People were being supported to make decisions in their best interests. The manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement. The service had an ongoing action plan for improvement and the registered manager was required to feedback progress weekly to senior management. This information was then fed into a central action plan to monitor progress. Significant improvements had been made, and it was identified that improvements had been fully implemented and sustained.

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. One person told us, “They answer my bell quickly. I don’t know where I’d be without it”. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place.

Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future. Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service, including treating people with dignity and the care of people with dementia. Staff had received supervision meetings with their manager, and formal personal development plans, such as annual appraisals were in place. One member of staff told us, “I think the training here is very good and it’s very helpful to have an in-house trainer and a training room with access to a computer. I thought the dementia training was really brilliant, it made you think from the resident’s point of view and made you more aware of how you communicate”.

People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. One person told us, “The staff help me and the food is very good”. Special dietary requirements were met, and people’s weight was monitored, with their permission. Health care was accessible for people and appointments were made for regular check-ups as needed.

People chose how to spend their day and they took part in activities in the service and the community. People told us they enjoyed the activities, which included quizzes, singing, exercises, films, arts and crafts and themed events, such as reminiscence sessions. One person told us, “A lot of effort is put in and the activities co-ordinator comes and sees me. There’s good information every week about the activities”. People were also encouraged to stay in touch with their families and receive visitors.

People felt well looked after and supported. We observed friendly and genuine relationships had developed between people and staff. One person told us, “The staff here are all very nice and they always come and talk to us”. A member of staff told us, “When I was chatting to one person living here, they got upset because they could not remember the date of their marriage or their wedding song. I did a bit of research with their family and found out what they were. I then bought a CD with the song on and put the date of the wedding and the track the song was on the front. This means that they can now remember and go back to a happy day for them”. Care plans described people’s needs and preferences and they were encouraged to be as independent as possible.

People were encouraged to express their views and had completed surveys. Feedback received showed people were satisfied overall, and felt staff were friendly and helpful. People also said they felt listened to and any concerns or issues they raised were addressed. Staff were asked for their opinions on the service and whether they were happy in their work. They felt supported within their roles, describing an ‘open door’ management approach, where managers were always available to discuss suggestions and address problems or concerns.

Kingsland House is a purpose built home that provides nursing care and accommodation for up to 71 older people with a physical disability, dementia and/or related mental health conditions. The home includes ‘Memory Lane Community’, a dedicated part of the home that accommodates people living with a dementia and ‘Bluebell Community’, part of the home where people with complex and general nursing needs reside. Services offered at the home include nursing care, end of life care, respite care and short breaks. At the time of this inspection, there were 41 people living at the home. Kingsland House belongs to a large corporate organisation called Barchester Healthcare Homes Limited. Barchester Healthcare Homes Limited provides residential and nursing care in a large number of services across the United Kingdom.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had followed their action plan, and confirm that the service now met legal requirements. We found improvements had been made in many areas. However, further areas were identified in order to improve some practices in relation to the need embed and sustain improvements in relation to staffing levels and increased occupancy, the need to obtain consent and there being no registered manager in post.

The overall rating for Kingsland House has been revised to requires improvement. We will review the overall rating of requires improvement at the next comprehensive inspection, where we will look at all aspects of the service and to ensure the improvements have been sustained.

There was a manager in post, however they had not currently registered with the CQC. The service had been without a registered manager for approximately ten months. 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.

Despite the improvements that we identified in relation to staffing levels and the planning and delivery of personalised care, we were unable at this inspection to determine whether the current service provision had been fully embedded and could be sustained over time, should the number of people living at the service increase.

Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and the provider was meeting the requirements of the Deprivation of Liberty Safeguards. However, several MCA assessments did not record the steps taken to reach a decision about a person’s capacity. Capacity enables people to make their own decisions about their care and support. Assessing capacity in the right way at the right time is vital in care planning. A senior manager told us, “It is a work in progress with the MCA assessments, it is not consistent across the home”.

The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement. The service had an ongoing action plan for improvement and the manager was required to feedback progress weekly to senior management. This information was then fed into a central action plan to monitor progress. Significant improvements had been made, however the delivery of the action plan would need to be monitored over time to ensure that the improvements identified could be fully implemented and sustained.

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. One person told us, “Yes we are very safe here”. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place.

Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately. One person told us, “The nurses are nice. They give me my medicines every day, I would forget otherwise”.

Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future. Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service, including treating people with dignity and the care of people with dementia. Staff had received supervision meetings with their manager, and formal personal development plans, such as annual appraisals were in place. One member of staff told us, “Brilliant training, lots of opportunities”.

People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. One person told us, “The food is marvellous and we get to choose what we have. It’s lovely”. Special dietary requirements were met, and people’s weight was monitored, with their permission. Health care was accessible for people and appointments were made for regular check-ups as needed.

People chose how to spend their day and they took part in activities in the service and the community. People told us they enjoyed the activities, which included quizzes, singing, exercises, films, arts and crafts and themed events, such as reminiscence sessions. One person told us, “There are lots of activities, singing, memory games and quizzes. They are all good”. People were also encouraged to stay in touch with their families and receive visitors.

People felt well looked after and supported. We observed friendly and genuine relationships had developed between people and staff. One person told us, “I have been here a long time. I am very lucky. People are very kind to me”. Care plans described people’s needs and preferences and they were encouraged to be as independent as possible.

People were encouraged to express their views and had completed surveys. Feedback received showed people were satisfied overall, and felt staff were friendly and helpful. People also said they felt listened to and any concerns or issues they raised were addressed. Staff were asked for their opinions on the service and whether they were happy in their work. They felt supported within their roles, describing an ‘open door’ management approach, where managers were always available to discuss suggestions and address problems or concerns.

People who used the service told us that they liked living at the home, they were happy with the care they received and the service met their needs. They told us that staff were 'Very kind and caring' and there was usually someone around to provide help and support. However they also told us 'We do have to wait sometimes, when they are busy but I don't mind too much.' One relative we spoke with told us 'It's a bit quieter here at weekends and there are not so many staff around.'

We saw that individual care plans provided guidance for care workers, to ensure that the assessed current and on-going support needs of people using the service could be met consistently and safely.

People were protected against the risks associated with medication because the provider had appropriate arrangements in place to manage medicines.

There were enough qualified, skilled and experienced staff to meet people's needs.

Staff told us that they had received regular training and supervision. They said they felt valued and were supported to carry out their roles and meet the needs of people who used the service.

We reviewed how the service managed medication and found that improvements were made since our last visit. However, additional improvements were identified to achieve compliance.

We found staffing levels were satisfactory and that recruitment was in progress. One member of staff told us, "We are coping although at times it gets so busy we could do with extra staff".

We found that the food provided was of a good standard and in sufficient quantities. A relative told us, "My mother loves the food here, it is always good".

We found that staff were appropriately supported, trained and encouraged to gain qualifications. One nurse told us, "Our training programme is ongoing and we are encouraged to progress within the organisation".

People told us that 'It feels like home' and 'I'm as happy as I can be when not in my own home'. People said they felt 'Well cared for' and we saw many people being visited by relatives. People described staff as 'Friendly and helpful and always smiling' and 'Have a caring nature'.

In the last year, the home has had two managers, and the most recently appointed manager left suddenly without giving notice. The Manager's post is being fulfilled by an Operations Manager and the Deputy Manager.

Throughout the inspection we saw that people were spoken to with dignity and respect and that the atmosphere in the home was friendly and relaxed. The home was well presented, clean and all the people we spoke with seemed well looked after.

We saw that the medications policy was not being followed and that there were gaps and inconsistencies in recording and dispensing medicines.

Staff told us that sometimes they were short staffed and people told us that they sometimes had to wait longer than they wanted for call bells to be answered.

The provider had a comprehensive audit system in place, but where improvement actions have been noted they had not always been put in place.