Kingston Care Home

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.

We found the following examples of good practice.

The provider was facilitating visits for people using the service in accordance with current Government COVID-19 guidance on visiting care homes. For example, the care home was now open to visitors providing they followed strict COVID-19 guidelines. This included ensuring all care home workers and other professionals visiting the service were fully vaccinated against COVID-19, unless they had an exemption.

Alternative arrangements were in place to help people who were self-isolating remain in contact with their family and friends. For example, people were supported to keep in touch with people that could not visit them in-person at the care home through the use of video and telephone calls. The service continued to facilitate garden visits which enabled people to see and speak to their relatives through the safety of a window or portable Perspex screen.

Staff wore their personal protective equipment (PPE) in accordance with current infection prevention and control (IPC) guidance. To support communication and reassure people living in the care who may be anxious seeing staff wear PPE the provider ensured staff wore clearly visible photos of themselves to help people identify different members of staff. The service had adequate supplies of PPE that met current demand and foreseen outbreaks.

Staff received up to date IPC and PPE training, which was routinely refreshed. Staff we spoke with demonstrated a good understanding of their IPC and PPE roles and responsibilities.

New admissions to the care home had been put on hold as a temporary measure to reduce the spread of infection there following a recent COVID-19 outbreak at the service. People returning after a stay in hospital or time away were continued to be required to have a negative COVID-19 test and to self-isolate in their bedroom for at least 10 days.

The provider participated in a ‘whole home’ COVID-19 testing program. This ensured everyone living, working or visiting the care home were regularly tested for COVID-19. The provider knew how to apply for COVID-19 home testing kits and had adequate supplies.

Staff who worked at the care home were vaccinated against COVID-19 in line with government requirements. This was because the provider operated effective monitoring systems to check staff complied with best IPC practices and were fully vaccinated against COVID-19.

The care home was kept hygienically clean. There were detailed records kept of staffs new cleaning schedules, which included a rolling program of continuously cleaning high touch surfaces, such as light switches, grab rails and door handles. Managers told us they had increased the number of domestic staff working on day time shifts during the pandemic to help with their increased cleaning responsibilities and demands.

Managers and nursing staff routinely monitored and audited compliance with IPC practices. This included daily walkabout tours of the care home to check staff continued to wear their PPE correctly, were socially distancing as and when required, and were routinely cleaning high touch surfaces.

The provider had assessed infection risks everyone living and working at the care home might face, and where people were deemed to be disproportionately at risk from COVID-19, appropriate action had been taken to minimise the impact.

The provider had put robust measures in place to mitigate the risks associated with COVID-19 related staff pressures. They had also reduced the number of temporary agency staff they used and ensured bank staff worked exclusively in the one care home to reduce the risk of spreading infection.

We were assured that this service met good infection prevention and control guidelines.

Kingston Care Home is a care home providing personal and nursing care for up to 67 people. At the time of our inspection, there were 61 people using the service. The home is arranged over three floors, each with their own separate adapted facilities.

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

We found evidence during our inspection of breaches of regulation and the need for this provider to make improvements.

People’s care records were not consistently completed to ensure safe care delivery. Staff had not always attended the necessary training courses to update their skills and knowledge regularly. This meant that people had been put at risk of potential harm and their safety was compromised.

People’s ‘when required’ medicine management procedures were not always robust which put people at risk to not receiving their medicines as prescribed.

Governance systems in place to monitor the quality and safety of the care delivery were not always operated effectively. This is because the provider had failed to pick up a number of issues we identified during our inspection. Processes in place to support staff on the job were not always used as necessary.

People felt safe supported by the staff team who knew their care needs well. Appropriate recruitment checks were carried out to ensure that suitable and fit staff were employed for the job. Staff had the necessary support related to the COVID-19 so that they could ensure good infection control practices during the pandemic. Records showed that actions were taken to make improvements related to incidents and complaints that took place.

Care plans included information related to people’s end of life wishes and how they wanted to me supported when the time comes. Staff had advice from the healthcare professionals to improve the end of life care at the service as needed.

The service had a new manager in post who staff described as supportive and approachable. Communication systems were in place to ensure good information sharing between the staff team. People felt that staff were caring and had been kind to them. Healthcare professionals were requested when people’s health needs deteriorated. People and their relatives were encouraged to feedback about the service delivery as necessary.

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 11/04/2018). We also inspected the service for use by a Local Authority as a designated community care service in response for people discharged home from hospital who had previously had COVID-19, but we did not rate the service during this inspection (published 13/01/2021).

Why we inspected

We received information of concern in relation to a number of safeguarding investigations taking place. As a result, we undertook a focused inspection to review the key questions of safe and well-led and targeted inspection to end of life care only in responsive.

We reviewed all 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 the key questions of Effective, Caring and Responsive were used in calculating the overall rating at this inspection.

We undertook the targeted inspection to check on a specific concern we had about the end of life care provided by the care home. Rating for the key question of Responsive has not changed following this targeted inspection and remains good.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

The overall rating for the service has changed from good to requires improvement because we found evidence that the provider needs to make improvement.

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

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We identified two breaches of regulations in relation to safe care and treatment and good governance. Please see the action we have told the provider to take at the end of this report.

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.

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 the relevant local authorities to monitor progress. We will 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 been proactive in employing additional staff in order to provide enhanced support to people using the service at Kingston Care Home. This included trained nurses, support staff and domestic staff. The extra staff provided on shift also helped ensure there were no shift shortages due to staff sickness or isolation.

The service implemented isolation and zoning in line with good practice. Each floor was treated as a bubble with their own communal spaces and dining rooms. Where people were in isolation, signage was used to indicate this and barrier nursing procedures were effectively implemented. A responsible senior staff member oversaw and audited practice around areas such as the correct use of personal protective equipment (PPE), handwashing and cleanliness.

Staff and people at the home were engaged in the ‘whole-home’ testing programme. People living in the home were routinely tested for COVID-19 every four weeks and staff were tested weekly. Staff also had access to antibody testing.

The six bedded unit identified for use by the Local Authority as a designated care setting was located on the top floor, self-contained and physically separated from the other units. Access to this unit would be restricted to staff who needed to enter to perform their duties and they could do so via a stairway direct from a back entrance. People using the unit would enter via the front entrance and lift. These areas were already subject to a deep cleaning schedule and additional touch point cleaning would be implemented during any admission. Accommodation would be provided in single occupancy bedrooms, each with their own en-suite bathroom and toilet facilities.

Policies and procedures had been reviewed and updated since the pandemic started. The service regularly monitored and audited compliance with the infection prevention and control measures in place.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

Kingston Care Home 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.

Kingston Care Home provides nursing and residential care for sixty-seven older people. The home is located opposite Kingston Hospital with good access to public transport. Accommodation is provided over three floors that are served by a passenger lift. At the time of inspection 53 people were using the service.

The registered manager had recently resigned and the service was actively recruiting for a replacement.

People told us they felt safe at Kingston Care Home. There were appropriate safeguarding policies and procedures in place, staff had received training in safeguarding adults and had a good knowledge and understanding of how to identify if people were at risk of abuse and knew what action to take in these circumstances.

Risks were identified and plans were in place to monitor and reduce risks to help keep people safe.

There were systems in place for the safe storage, administration and recording of medicines. Each person’s medicine was stored securely and only trained and competent staff were authorised to administer medicines. During the inspection all medicine records we observed had been filled out correctly and medicine audits were completed to ensure medicine procedures were robust.

Staff had been recruited safely with appropriate checks on their backgrounds completed. Staff had completed an induction programme and on-going training was provided to ensure skills and knowledge were kept up to date.

We observed positive and appropriate interactions between the staff and people who used the service. Staff were caring and treated people with kindness, dignity and respect. People and their relatives were complimentary about the quality of care they received.

There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. People were encouraged and supported to eat and drink well and their nutrition and hydration were monitored regularly.

Staff had received training which gave them the knowledge and skills to support people effectively. Staff had received training in the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS). People were asked for their consent to the care and support they received. Where people were unable to give informed consent staff acted in people’s best interests.

People and their relatives were encouraged to express their views and opinions. They knew how to complain and make suggestions, and were confident their views would be acted upon. The provider had a complaints procedure to support this.