The inspection visit took place on the 19 November 2015 and was unannounced which meant the staff and provider did not know we were visiting.
We last inspected the service on 23 April 2013 and found the service was compliant with regulations at that time.
Kings Court Care Home is registered with the Care Quality Commission (CQC) to provide accommodation for persons who require nursing or personal care for up to 37 people. The home does not provide nursing care. The home is owned and run by Care UK Community Partnerships Limited and is located in the centre of Barnard Castle, County Durham.
There was a registered manager in post who was on a training course at the time of the 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.
There were policies and procedures in place in relation to the Mental Capacity Act and Deprivations of Liberty Safeguards (DoLS). There were two people subject to DoLS authorisations. We raised an issue regarding the appropriateness of the assessments being used by the service to assess someone’s capacity. The deputy manager agreed that some people at the service may lack capacity at times and this was not clearly recorded. During the inspection, the service immediately sought support and training and also sourced a more appropriate capacity assessment that they were going to implement straight away.
We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.
All people told us they felt safe at the service. Staff were aware of procedures to follow if they observed any concerns. The staff team were supportive of the registered manager and each other. Feedback from visiting professionals on the day were very positive about the service at Kings Court.
On the day of our visit the deputy manager was on duty along with three other care staff members for 30 people. The layout of Kings Court is very complex with it being an old building and we observed call bell buzzers were constantly active throughout the morning. We witnessed the administrator supporting people with breakfast and at lunchtime and other staff such as the activity staff member helped out at this time. Feedback from all staff we spoke with was there were not enough staff to ensure the service ran smoothly. The service had recently had to use agency staff to cover sickness although they were actively recruiting. Whilst we did see that care needs were being met and people said they were well cared for, it was apparent that staff were extremely busy. We discussed this with the registered manager after the inspection who agreed to increase the number of care staff to four during the day whilst service user numbers remained at this level.
Appropriate systems were in place for the management of medicines so that people received their medicines safely. Medicines were stored in a safe manner. We witnessed staff administering medicine in a safe and correct way. Staff ensured people were given time to take their medicines at their own pace.
There was a regular programme of staff supervision in place and records of these were detailed and showed the service worked with staff to identify their personal and professional development. Training records showed that all staff had received an induction and statutory training was running at approximately 95% of staff being up-to-date.
We spoke with kitchen staff who had a good awareness of people’s dietary needs and staff also knew people’s food preferences well. They also told us that they received any equipment and supplies that they requested promptly. People told us they were very happy with the food at Kings Court and we saw where people needed nutritional support or monitoring this was carried out.
We saw people’s care plans were personalised and had been well assessed. Staff told us they referred to care plans regularly and they showed regular review that involved, when they were able, the person. We saw people being given choices and encouraged to take part in all aspects of day to day life at the service.
The service encouraged people to maintain their independence and the activities co-ordinator ran a full programme of events which included accessing the community with people. We saw people popping in and out of the duty office to chat and spend time with staff and the deputy manager if they were in there and it was evident that staff listened and supported people to be comfortable in any area of the service.
We observed that all staff and the deputy manager were very caring in their interactions with people at the service. People clearly felt very comfortable with all staff members. There was a warm and caring atmosphere in the service and people were very relaxed. We saw people were treated with dignity and respect. Relatives and people told us that staff were kind and professional.
The service undertook regular questionnaires about the safety and quality of the service, not only with people who lived at the home and their family, but also with visiting professionals and staff members. We also saw a regular programme of staff and resident meetings where issues where shared and raised. The service had an accessible complaints procedure and people told us they knew how to raise a complaint if they needed to. We saw that complaints were responded to and lessons learnt from them. This showed the service listened to the views of people.
Any accidents and incidents were monitored by the registered manager to ensure any trends were identified. This system helped to ensure that any patterns of accidents and incidents could be identified and action taken to reduce any identified risks.
The service had a comprehensive range of audits in place to check the quality and safety of the service and equipment at Kings Court. Action plans and lessons learnt were part of their ongoing quality review of the service.