Kingsbury Court

Kingsbury Court is a nursing and residential care home providing accommodation, personal care and nursing care to older people with physical support needs, some of who live with dementia. The home can support up to 60 people. At the time of our inspection there were 52 people using the service.

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

People’s experience of care was not always consistently good and safe due to staffing issues. There were not always enough suitably skilled staff effectively deployed in the home to ensure people were safely supported to mobilise freely, to manage their anxieties and day to day needs when they wished to have support and to take care of their wellbeing. This posed a range of risks to people, for example around falls, health deterioration or social isolation.

There was a new manager in post who made a range of positive changes around how people’s care was overseen. We saw positive changes were being made around how the quality was monitored, what support staff received on a day to day basis and how audit actions were followed up and completed. However, this was not consistent in the previous months and some outstanding actions had impacted on people’s experience of care they received and still needed addressing.

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.

People and their relatives told us they felt safe with staff and in the home and overall staff were kind and caring. Where people needed support around their medicines, they received this safely. People’s individual risks were addressed in their care plans and action was taken when needed to keep people safe. People’s care was affected by staffing issues which we addressed with the provider.

New staff were recruited safely. Staff overall followed good infection prevention and control practice. Staff felt more supported in their roles since the new manager was employed and commented the culture of the service was slowly improving.

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 07 August 2021)

Why we inspected

We received concerns in relation to staffing and risk management. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

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 changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to staffing and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Kingsbury Court is a nursing and residential care home providing personal and nursing care to people aged 65 and over with physical and health related support needs, some of whom live with dementia. At the time of the inspection, 58 people lived in the home. The home can support up to 60 people.

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

People received safe care and support and staff knew their individual needs. Where people’s risks changed, this was reviewed and addressed so they were protected from avoidable harm. Staff were trained in safeguarding and knew what to do should they worry someone could be abused or neglected.

People were protected from spread of infections, including COVID-19 and received safe support with their medicines. The registered manager ensured all incidents and accidents were reviewed and lessons learned actioned to improve people’s care.

There were enough staff on duty to provide safe care and support, although the home was busy at some points of the day. The registered manager regularly reviewed staffing levels, the mix of staff skills and experience and recruitment needs to ensure people received safe and timely care. People told us they received support when they needed.

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 good oversight of the quality and safety of the service and clear plans on how to continuously improve the care. For example, the mealtime experience and people’s individual care needs were reviewed, and a range of positive changes made to promote people’s dignity, independence and wellbeing.

People, their relatives and staff told us they felt the service had improved and was well-managed. They felt listened to, valued and involved in the service. The registered manager worked to improve partnership working with other healthcare professionals to ensure people received safe, joined up and timely care.

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 23 January 2021).

Why we inspected

This inspection was prompted by our data insight that assesses potential risks at services, concerns in relation to aspects of care provision and previous ratings. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. This enabled us to review the previous ratings.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. 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 good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Kingsbury Court 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.

Kingsbury Court is a care home which provides accommodation and personal care for up to 60 people, many of whom are living with dementia or have a nursing need. The service is divided into three separate living quarters, each with their own dining and communal areas. At the time of our inspection 57 people were living at the service.

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 coronavirus and other infection outbreaks effectively.

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

People told us they felt safe at the service and were treated well by staff. Risks to people were managed well and appropriate assessments and care planning was in place to keep people safe. We did however find some shortfalls in documentation about people’s medical conditions which we raised with the manager.

The provider had made efforts to recruit more staff since our last inspection although we still received a mixed response about how quickly staff attended to people. In turn, staff felt there had been an improvement in staffing levels though at times they still felt under pressure. The manager told us they would start call bell response monitoring to assess staffing levels.

We were assured by the provider’s infection control processes. Staff were adhering to Government guidance and helping to ensure people were kept free from risk of catching COVID-19. People’s medicines were managed well and in the event people had an accident or incident, action was taken and lessons were learnt.

The service was without a registered manager. Although there was a manager present within the service, they had not completed their registration with CQC. We found the manager was making positive changes and had a clear vision for the future. Staff told us they felt supported and had already seen improvements and people were positive about the new manager.

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 (report published 18 December 2019).

Why we inspected

This focused inspection was prompted due to the information we held about the service indicating that people may not be receiving safe care.

At this inspection we reviewed the Key Lines of Enquiry in the key questions of Safe and Well-Led only and this report covers our findings in relation to those.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Kingsbury Court 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 when we will carry out a fully comprehensive inspection looking at all key questions. If we receive any concerning information we may inspect sooner.

Kingsbury Court is a care home providing personal and nursing care to 46 people aged 65 and over at the time of the inspection. The service can support up to 60 people. The service is a large purpose-built building, over three floors based in Woking Surrey.

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

People did not always receive support from adequate numbers of staff deployed to keep them safe. However, there had recently been a successful recruitment drive. People continued to be protected against abuse, as staff received safeguarding training and knew how to respond to, escalate and report suspected abuse. Risk management plans gave staff guidance to mitigate identified risks. People were supported to receive their medicines in line with good practice. Infection control practices ensured people were protected against cross contamination.

Staff received on-going training to enhance their skills. Staff reflected on their working practices through supervisions. People were supported to access food and drink that met their dietary needs and preferences. People continued to be encouraged to live healthier lives and had access to healthcare services to monitor and maintain their health.

People continued to be treated with kindness and compassion. People’s dependency levels were recorded, and support provided adjusted to their changing needs. People were supported and encouraged to make decisions about their care and had their dignity respected.

Personalised care plans enabled staff to deliver care in line with people’s needs and wishes. There were a wide range of activities for people to participate in. People received information in accessible formats. Complaints were managed quickly to seek a positive outcome and minimise the risk of repeat incidents. People’s end of life care preferences were documented.

We received mixed comments about the management of the service. The registered manager carried out audits to drive improvements. The registered manager worked in partnership with other stakeholders to enhance people’s lives. People continued to be encouraged to share their views of the service.

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 12 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Kingsbury Court 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.

Kingsbury Court opened in April 2015 and provides accommodation, care and support for up to 60 people, some of whom may be living with dementia. The service is registered to provide nursing care although this area of the service had not commenced at the time of our inspection. The registered manager told us that nursing staff had been recruited and they anticipated that nursing care would be provided within the next two months. There were 34 people living at Kingsbury Court at the time of our inspection.

There was a registered manager in post who supported us during our inspection. 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.

At our last inspection on 11 August 2016 we identified five breaches of legislation relating to staffing, safe care and treatment, person centred care, complaints management and good governance. Following the inspection the provider wrote to tell us what they would do to meet the legal requirements in relation to the above concerns. At this inspection we found that improvements had been made in all areas which had made a positive difference to the people they support.

There were sufficient staff deployed to meet people’s needs safely. Staff had time to spend with people and the registered manager completed regular reviews of people’s needs and adjusted staffing levels where required. New staff completed an induction process which included shadowing more experienced staff members to help them understand their roles. Staff received regular training and supervision to ensure they had the skills required to meet people’s needs. Competency checks were regularly completed as part of staff induction and on-going supervision. Safe recruitment processes were in place to ensure people received support from suitable staff.

Risks to people’s safety and well-being were assessed and control measures were in place to help minimise risks. Staff were aware of how to support people to manage risks safely. Accidents and incidents were recorded and monitored to identify any trends and minimise the risk of them happening again. Staff were aware of their responsibilities in safeguarding people from potential abuse and any concerns were appropriately reported. The provider had a contingency plan in place to ensure that people’s needs would continue to be met in the event of an emergency or if the building could not be used.

Safe medicines practices were practised and people received their medicines in accordance with their prescriptions. Staff competency in managing medicines was regularly assessed. People’s healthcare needs were known to staff and appropriate referrals were made to healthcare professionals where required.

People’s legal rights were protected as staff were acting in accordance with the Mental Capacity Act 2005. Staff gained people’s consent prior to delivering care and understood the need to offer choices and respect people’s decisions. People told us they were involved in decisions regarding their day to day care.

People were supported by staff who knew their needs well and provided personalised care. People and their relatives told us that staff were caring and treated them with kindness. Care plans were person centred and contained details of people likes and dislikes. Staff supported people to maintain their independence and respected people’s privacy and dignity. People told us they enjoyed the food provided and choices were available. People’s nutritional needs were met and the catering staff were informed of people’s needs and preferences. People’s weight was monitored and appropriate action taken where significant changes were identified.

There was a range of activities available for people to take part in and people received the support they required to be involved. In addition to planned activities, staff spent time with people individually. Resident meetings were held quarterly and people and their relatives were able to make suggestions regarding the running of the service and the food and activities provided.

The provider had a complaints policy and people told us they felt any concerns would be addressed. The registered manager maintained a complaints log which showed that concerns had been addressed and responses given. Quality assurance processes were in place and regular audits of the quality of the service completed. The registered manager had taken action to rectify any shortfalls identified. Staff told us they felt supported by the management team and were able to discuss any concerns openly.

The inspection took place on 11 August 2016 and was unannounced.

There was no 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 and associated Regulations about how the service is run. A manager had recently started work at the service and supported us throughout the inspection. They told us they had begun the process of registration with the Care Quality Commission (CQC) and our records confirmed this

Sufficiently skilled staff were not provided throughout the service. There was a high level of agency staff used which impacted on the care people received. The manager told us that a number of staff had recently been recruited and were currently under-going recruitment checks prior to starting work. There was a lack of leadership throughout the service which led to staff not being deployed in an organised manner to ensure people were supported safely. Staff did not receive the induction and support they required to enable them to provide effective support to meet people’s needs. Risks to people’s safety and well-being had been identified although control measures to reduce risks were not always followed.

Care plans were completed and regularly reviewed although these were found to be repetitive and did not always provide guidance to staff in how to provide people’s care. Agency staff did not have access to people’s care plans and did not have access to personalised information about the people they were caring for. Where this information was provided we found that people received care in line with their preferences. People received health care support when required although relatives told us that communication in addressing healthcare needs had led to delays in their family members receiving the support they required. We have made a recommendation regarding this.

Suitable arrangements were not in place to ensure that medicines were managed safely. Gaps were present in some medicine recording and staff did not sign records immediately following administration. Guidance for staff in the administration of ‘as and when required’ medicines were not in place and staff told us they did not always feel confident when administering medicines to people.

People, relatives and staff told us that due to a number of changes in the management of the service there was a lack of communication and leadership. They told us the new manager appeared confident and was listening to concerns. Regular audits were completed to monitor the quality of the service provided. However, where actions were identified these were not always addressed in a timely manner.

There was a system in place to deal with people's comments and complaints however we found that a number of complaints had not investigated, recorded and dealt with in line with the provider’s policy.

Staff received trained in safeguarding adults and knew how to report any concerns. They were aware of the whistleblowing policy and how to access guidance. Accidents and incidents were monitored and action taken to minimise the risk of reoccurrence. Safety checks on the environment and equipment used were completed regularly.

The provider’s recruitment procedures were robust, which helped to ensure that only suitable staff were employed. Staff completed mandatory training to support them in their role.

People told us that the quality of food was good and a choice was always available. People were supported to maintain a healthy diet. Where people required support to eat this was provided in a dignified and unhurried way.

Staff were caring and treated people with kindness. People’s rights were protected and staff spent time with people to gain consent prior to delivering care. People’s privacy and dignity was respected and visitors to the service were made to feel welcome. There was a range of activities available although people, relatives and staff told us they felt a more varied programme was needed to meet people’s needs and preferences.