Kingscourt

Kingscourt is a residential care home providing personal and nursing care to up to 37 people. The service provides support to older people, some of whom were living with dementia. At the time of our inspection there were 28 people using the service.

Kingscourt accommodates people in one building across three floors, each of which has separate adapted facilities.

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

There were some areas of the home which required redecoration or replacement of furniture. We received assurances from the provider which demonstrated plans were in place to address this.

Staff were also recruited safely. Staffing levels were safe and the provider responded to feedback we received during the inspection in respect of this.

People received a caring service and felt supported and valued as individuals. People told us they were treated with respect and staff upheld their dignity during care.

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.

Risk assessments and appropriate care plans had been developed to meet people’s needs. People were involved in developing their care plans which were person centred and changes were made as people’s needs changed.

The service was well-led and staff felt supported. The provider also worked with other professionals and organisations to ensure positive outcomes were achieved for people.

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

Rating at last inspection and update

The last rating for this service was good (published 24 October 2017).

At our last inspection we recommended that the provider reviewed its practices in relation to undertaking staff supervision and providing regular activities for people to engage with. At this inspection we found the provider had acted on these recommendations and had made improvements.

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding.

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.

Enforcement

Since the last inspection we recognised that the provider had failed to comply with a condition on their registration to have a registered manager in post. This was a breach of regulation and we issued a fixed penalty. The provider accepted a fixed penalty and paid this in full.

Follow up

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

We found the following examples of good practice.

The environment was clean and hygienic with an enhanced cleaning schedule in place to minimise the spread of infection. Staff wore appropriate personal protective equipment (PPE) and had their competency to use this assessed on a regular basis.

All visitors to the service have checks on their temperature and are required to complete a questionnaire in line with current COVID-19 guidelines.

COVID-19 care plans had been devised by the service for individuals to take the risk of them being infected into account. All people who use the service are regularly tested, have their temperatures daily twice daily and have been vaccinated at least once. Staff are also subject to COVID-19 testing.

Despite restrictions; people who used the service appeared relaxed, comfortable and a home-like atmosphere was sustained. Relatives were happy with the support provided and felt that their relatives were safe living at Kingscourt.

Further information is in the detailed findings below.

This inspection took place on the 7th and 8th of August 2017 and was unannounced.

Our last visit to the service was held in July 2015. Following that inspection we rated the service as Good. No breaches of regulation were identified during that visit.

The service did not have a registered manager. Our records found that whilst a manager had been in place since our last visit, they had not registered with the Care Quality Commission to become the 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 last manager had left earlier in 2017 and an interim manager was put in place to ensure continuity of the service. A new manager had been identified and their appointment was imminent. The registered provider must ensure that an application for registration is submitted to the Care Quality Commission.

Not all staff received regular supervision and group supervision through staff meetings had not occurred. This meant that individual accountability and progress in their role had not been discussed with all staff. We have made a recommendation about all staff receiving supervision.

Staff received training appropriate to their role.

The service was not providing a structured activities programme. While one had been in place in the past, people told us that there was not much to do in the day and in some cases relied on their own preferences or their families to assist in keeping active. We have made a recommendation in respect of reinstating a regular activities programme.

The interior of the building was in need of redecoration and refurbishment as wear and tear to internal doors and walls were noted. No firm plans were in place for when this would be achieved.

People felt safe living at Kingscourt. This view was echoed by relatives we spoke with. The premises were well maintained and this included items such as fire detection systems, lifting equipment and portable appliances. The premises were hygienic and clean.

A staff rota was in place. Staffing levels were maintained with annual leave and sickness being covered by members of the registered provider’s own bank staff pool. It was anticipated that this use of bank staff was temporary. Dependency levels were assessed by the manager and outlined that dependency levels were increasing within the service. This view was echoed by staff and relatives who were aware that people were becoming more dependent on staff to ensure that their needs were met.

Risk assessments were in place for people who used the service. These related to those risks faced by people in their daily lives such as malnutrition or pressure ulcers. All these had been completed and reviewed on a monthly basis. Where people were at risk from malnutrition for example, people had been referred to dieticians with weight monitoring increased.

Staff had a good understanding of the types of abuse that could occur and the action they would need to take if such incidents occurred. They had received training in this and were aware of how to raise concerns with external agencies.

Medication was safely managed. Medication was stored appropriately and audits in place to ensure that systems continued to be safely managed.

The recruitment of new staff was robust. Appropriate checks had been made on people’s suitability for the role.

The registered provider included considerations of the Mental Capacity Act 2005 into the support they provided. The capacity of people to make decisions had been assessed and measures introduced to ensure that the best interests of people could be served.

The nutritional needs of people were met. Choices of food were provided and staff endeavoured to ensure that food provided was in line with people’s preferences and nutritional needs. Drinks were provided to people at all times of the day. The health needs of people were taken into account. Any changes in the health of people were responded to immediately to ensure that their wellbeing was maintained.

People told us that they felt cared about. Observations of care practice found that people were supported in a friendly and respectful manner. The privacy of people was maintained during personal care tasks and staff were able to give practice examples of how this privacy was to be maintained.

Care plans were regularly reviewed and reflected the health and social care needs of people. Care plans were personalised.

A complaints procedure was in place informing people of how any concerns could be raised. Complaints records showed that the registered provider was responsive to any concerns raised.

The registered provider had ensured that the quality of support provided at Kingscourt had been assessed. The views of people and their families had been gained and the results put on display. A series of audits had been conducted to ensure that all systems within the home best served the people who lived there. The registered provider always told us of any adverse incidents that affected the wellbeing of people. The registered provider demonstrated a transparent approach to the standard of support within the service by displaying the ratings from our last visit.

"They are friendly and very helpful"

"I feel safe here"

"I always get my tablets on time"

"It is like a hotel"

"It is good on the whole"

"They act promptly if I am not well"

"The manager is very efficient"

"I am quite happy and satisfied. The staff respond to me well and are prompt. If I had a complaint, which I do not, I would speak to the manager and she would act"

"It is better here than my previous experience. There is always someone to talk to. The staff are lovely and they come to me quickly if I use my call alarm. I am safer here than before. I have no complaints"

"Staff are excellent, I am really pleased with the care my mother gets. They sorted out a health problem she had when she came to live here and it has improved her quality of life"

"Staff are watchful and there are always enough of them"

"They are always on top of things"

"They always tell me how my relation is doing, they are good and there is always enough staff"

"They look after her well"

We found on this visit that people living at Kingscourt had their needs met by sufficient staff in a safe environment. The management of medications promoted their health and welfare and people were confident that any concerns they had would be appropriately addressed.

We looked at five care records and all had assessments of their health and social needs completed. There were individual support plans and risk assessments in place. There was evidence to show they were evaluated on a regular basis. This meant the service could demonstrate they could meet people's needs and maintain their health and wellbeing.

We found that there was enough qualified, skilled and experienced staff to meet people's needs.

We saw that there was an effective complaints system available. Comments and complaints people made were responded to appropriately.

We have received two safeguarding concerns in relation to the service since our last inspection in January 2012. We saw that the provider responded in a way that protected people from harm or injury.