Archived: Kingston Court Care Home

Kingston Court Care Home is situated in the grounds of the Cumberland Infirmary in Carlisle.

Kingston Court is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The home accommodates up to 74 people in a purpose built building with three floors. At the time of our visit there were 63 people living there.

The home had a suitably qualified and experienced 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 2008 and associated Regulations about how the service is run.

The staff team were aware of their responsibilities under the Mental Capacity Act 2005. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service to support this practice required further development; we made a recommendation about this.

The service provided structured activities for people who lived at Kingston Court. People told us they welcomed these activities and enjoyed them. The service intended to develop in this area and create a broader range of activities.

Risk assessments and care plans provided guidance for staff in the home. People in the service were involved in the creating of support plans and were able to influence the content. The management team had ensured the plans reflected the person centred care that was being delivered.

The staff team understood how to protect vulnerable adults from harm and abuse. Staff had received suitable training and talked to us about how they would identify any issues and how they would report them appropriately. Risk assessments and risk management plans supported people well. Arrangements were in place to ensure that new members of staff had been suitably checked before commencing employment. Any accidents or incidents had been reported to the Care Quality Commission as necessary and suitable action taken to lessen the risk of further issues.

The registered manager ensured that there were sufficient staff to meet people's needs in a timely manner. Our findings corroborated this. Staff were suitably inducted, trained and developed to give the best care possible. We met experienced and kind team members who understood people's needs as well as new staff who were keen to learn.

Medicines were appropriately managed in the service with people having reviews of their medicines on a regular basis. People in the home saw their GP and health specialists whenever necessary. They accessed hospital appointments as a matter of routine.

We saw that an assessment of needs was in place and that the staff team analysed the outcomes of care for effectiveness. People were very happy with the food provided and we saw well prepared healthy meals that staff supported and encouraged people to eat.

The home itself was clean and comfortable on the day we visited. Suitable equipment was in place to support people with their mobility.

We observed kind, patient and suitable support being provided. Staff knew people well. They made sure that confidentiality, privacy and dignity were maintained. Staff were suitably skilled in providing end of life care.

The registered manager had successfully improved the home since our last inspection and intended to develop it further. Staff were able to discuss good practice, issues around equality and diversity and people's rights.

Complaints and concerns were suitably investigated and dealt with and good records management was in place in the service and there was a quality monitoring system in place which was used to support future planning.

Kingston Court Care Home is a care home that provides accommodation, nursing and residential care. The home is registered to provide care for up to 80 people who may be living with dementia, physical disability or require nursing care. The home is a three storey purpose built home situated in Carlisle. It is near to all the city amenities and is served by good public transport. All accommodation is in single en-suite rooms. The home cares for people with dementia in a specialist unit situated on the top floor of the building called the Memory Care Centre. The ground and first floors have people who need personal and nursing care, and some may also have dementia.

At the time of our inspection 70 people were living at Kingston Court Care Home. The provider and owner of the home is Executive Care Group. The registered manager informed us that the running of the home had been recently transferred by Executive Care Group from one operating company to another called Careport.

The service had a registered manager in place. A registered manager is a person who has registered with the CQC 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 found the home had met the breach found at the last inspection and now had good systems to ensure that care plans were up to date and reviewed when people’s health care needs changed.

People told us contradictory things about the service. While some people were happy, others were not. We also received mixed views from relatives about the care. People told us that at times there were not enough staff available to answer their call bells and provide support when they needed it. We observed that staff were very busy and were at times under pressure. Care and support was mainly based around completing tasks and did not always take account of people’s preferences or meet their social and recreational needs. People living in the home and several relatives reported issues with fluctuating staffing levels. One person said, “There aren’t many staff sometimes, mostly less at night.” Another told us, “If you push your buzzer you have to wait.” They also told us that staff were often rushed. We found that this was the case with staffing levels on the middle floor of the home particularly being insufficient. Staff reported being “very over stretched” on this floor.

Overall we found that there were insufficient staff available, and deployed in such a way to in order to meet people’s needs. The management team agreed to undertake a full review of the dependency levels of people to check how many staff was required to meet people’s needs and to adjust staffing levels accordingly. Considerations of roles and task was also to be undertaken to see that staff were clear on their role and where deployed in the most effective way possible.

The majority of people living in the home told us that staff were caring and treated them well. One person told us, “There's a lot of good staff, they are good at their job, it’s clean and there’s no odours. The cleaners and laundry staff work hard too.”

People told us that their family could visit whenever they liked and were made to feel welcome. One relative said, "I can come in when I like and the care is on the whole good."

Whilst the majority of staff had good relationships with the people they were caring for and on the whole respected their privacy and dignity, we noted some issues that compromised people’s dignity and did not always demonstrate a very caring attitude. For example, we found that some of the language used by staff was not always respectful. We found that the home was exceptionally noisy through the use of a tannoy system that sounded to all floors along with the call bell and telephone system. This meant that one person pushing their buzzer sounded to all the other floors. This did not respect that this was people’s home and numerous people living in the home commented on how intrusive and disruptive this was. One person said, “The bells drive you mad!” Another said of the alarms, “It’s hard to get a snooze in the afternoon.”

We found overall that the service was not always responsive to the needs of people living with dementia especially in relation to the physical environment, the staffing levels and the level of dementia specific activities on a one to one basis on the ground and second floor units. Care plans did not contain enough detail on people's wishes and preferences.

We have recommended the service looks at ways to ensure that maximum use is made of the skills and expertise of the staff team so that all people living with dementia have the same positive outcomes as those living in the 'Memory Care Centre’ on the top floor. For example in sharing best practice on how to diffuse situations where people become agitated and to identify triggers to prevent these situations from occurring.

The home employed two activity coordinators and we saw a range of activities were available. However due to pressures of providing care the coordinators often did care tasks and care staff could not always spend quality time with people such as chatting with them, taking them out or doing activities that interested them. We were concerned that some people living in the home felt isolated. People’s life stories, hobbies and interests were not always recorded and care plans did not identify how these needs would be met. Therefore, the activities in the home had not been designed to meet the needs of the individual.

Staff followed guidance from health professionals to ensure that people were able to have adequate food and drink safely. However, support to assist people at mealtimes and to take drinks was inconsistent. We again received mixed views from people living in the home on the food and menus. We saw some polite and caring interactions from staff but we also noted a number of negative experiences, such as staff standing to assist people with meals or the food being cold. We saw that some people did not get enough help and support to eat their meal in a timely fashion.

We judged that providing a person centred approach to people’s care and support needs had not been consistently implemented across the home. The care records for people on the two lower floors were basic and lacked detail about people’s backgrounds, preferences for care and interests. Staff also reported on these floors of having little time to get to know people properly and did not always have time to read people’s care plans. People's care records on the unit for people living with dementia, ‘The Memory Care Centre’, were more detailed containing personalised information about their life histories, backgrounds, interests and family connections.

Overall we found that medicines were not always managed safely as some medicines needed to be recorded more thoroughly and there were lapses in good practice. For example, we found instructions for care staff to administer topical creams did not accurately reflect the directions of the GP. This meant there was a risk that prescribed creams may not have been applied when required, which could have resulted in unnecessary discomfort for the person.

During this inspection we identified that the provider had complied with their duties and notified us of all authorised DoLS. However, we recommended that the service looks for good practice methodology in this area so that people’s capacity, ability to give consent and support needs are assessed and recorded more thoroughly and consistently.

The service had good recruitment processes to ensure only suitable staff were employed. Staff were receiving regular supervision and annual appraisals to enable them to carry out the duties they are employed to perform.

People told us they felt safe living in Kingston Court Care Home and the home provided them with a safe environment. Staff understood how to recognise and report abuse which helped make sure people were protected. We saw any allegations of abuse had been dealt with appropriately and reported to the local authority safeguarding team.

People had access to healthcare services and we saw specialist advice was sought in a timely manner. We saw some good instructions set out in care plans and clear instructions for staff on how to respond to people in particular situations.

The home’s statement of purpose included information about how to make complaints, which people were provided a copy of when they moved into the home. There was a system in place for receiving, handling and responding to concerns and complaints.

The system the provider had for monitoring the quality of the service had not identified the issues we found on this inspection. While we saw some good practice and care this was not consistently applied across the home. The registered manager and regional manager, from Careport, had recently drawn up an improvement plan for the home, and part of this was to update all the policies and procedures.

We identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 including staffing, dignity, meeting nutritional needs, g

"It is marvellous here, the staff are very good."

"Everything is fine. The place is clean and my bed is comfortable, all my meals are made and I do get out and about."

People were generally happy with the food provided, the delivery of care and the activities on offer.

We saw sensitive and compassionate care being delivered to people with dementia. We also had evidence to show that for people with complex health needs the delivery of nursing care helped them to be as well as possible.

We walked around the home and we saw that all areas were clean, fresh and tidy. We also checked on the availability of equipment and found that equipment to help with moving and handling people and with nursing care was readily available.

On the day of our visit the staffing levels were good, staff were attending training and there were enough nurses on duty to give people good levels of care.

We checked on recruitment, induction and deployment of staff and this too was suitable for the assessed needs of the people in the home.

We checked on a wide variety of records kept in the home and we had evidence to show that these reflected what was happening in the home and that they were up to date, easily accessible and suitably detailed.

People received good levels of personal and nursing care.

"I am happy with the care I get...the staff are very good and I trust the nurses to help me with my needs".

We looked at medicines in the service and these were stored, administered and disposed of correctly.

Staff in the service get good levels of support and ongoing training.

Complaints are dealt with appropriately by the manager and by the company. No one we met on the day had any complaints.

"I have nothing to complain about. I have a nice room and good food. I am cared for properly and feel safe here."