Kingston Care Home

Updated 1 September 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection team consisted of two inspectors, a specialist advisor, and two Experts by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Kingston Care Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Kingston Care Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was not a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service.

We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make.

We used all this information to plan our inspection.

During the inspection

We spoke with 17 people who used the service and 15 relatives about their experience of the care provided. We spoke with 15 members of staff including the regional manager, deputy manager, a director, chef, maintenance worker, domestic staff and care workers.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We reviewed a range of records. This included 10 people’s care records and risk assessments.

We also reviewed a variety of records relating to quality assurance, audits and management of the service including some policies. We looked at eight staff files in relation to recruitment, training and supervision.

Updated 1 September 2022

About the service

Kingston Care Home is a residential care home providing regulated activities of personal and nursing care to up to 67 people. The service provides support to people living with dementia, mental and physical health needs. At the time of our inspection there were 57 people using the service.

The care home comprises of three separate floors, each of which has separate adapted facilities. One of the floors specialises in providing care to people living with dementia.

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

People did not always receive safe care. We received mixed feedback about the quality of care provided at the service. Comments included, “We have call bells. Sometimes they don’t leave it near to me as they know I will use it!”; “The really seem short staffed”; “[Care staff] do look in on you at night” and “During the day I feel very safe.”

We identified breaches of regulations in relation to privacy and dignity, staffing and good governance. People were not always treated in a manner that promoted their dignity and privacy. Staffing issues affected care delivery such as supporting people to undertake activities of their choosing and response times to requests when people required support. People were at risk of avoidable harm due to a lack of adequate oversight on the quality of care provided and the management of the home.

Staff understood their responsibilities to identify and report abuse and escalate concerns to keep people safe. People’s care records were not always kept up to date which could cause delays in providing appropriate support.

People had not always experienced consistently good care because of high staff turnover, use of agency care staff and changes in management. There was not a manager registered with the Care Quality Commission. A deputy manager was in charge and was being supported by a regional manager. Some agency care workers did not have the same level of knowledge and experience of their roles as permanent staff which sometimes caused people to experience poor care delivery. Staff morale varied due to these highlighted issues.

The provider’s quality assurance systems were not always effectively used to monitor and drive improvement of the quality of care. Staff received training required for their roles. However, the method of monitoring staff training and supervisions did not effectively identify any delays in staff uptake. The turnover of managers at the service caused distress to people, their relatives and staff. The provider had put plans in place to improve care delivery and we need to see consistent embedding of good practice and a stable management team.

The provider undertook safe recruitment practices and ensured new staff received induction before they started the job. People received their medicines in line with best practice and any concerns identified were resolved. People had access to health care services in a timely manner.

Staff followed good hygiene practices in line with best practice guidelines regarding the prevention and control of infection of COVID-19.

People were involved in planning for their care. Staff reviewed and updated care and support plans which ensured people received care appropriate to their needs. Staff had guidance which they followed to support people with their needs and choices. The provider had an effective partnership with other agencies and social and health professionals to meet people’s needs.

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 requires improvement (published 11 June 2021).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made. However, some aspects of the care were not always delivered consistently to provide people with safe care, provision of activities and promoting their privacy and dignity resulting in breach of our regulations. The service remains rated requires improvement.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last 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.

We carried out an unannounced focused inspection of this service on 4 May 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this comprehensive inspection to check they had followed their action plan and to confirm they now met legal requirements.

The overall rating for the service has remained requires improvement. 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 Kingston Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

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 privacy and dignity, staffing and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.