Archived: Kingsthorpe View Care Home

We found the following examples of good practice.

The staff supported people to socially distance whenever possible, for example the chairs in the communal areas were placed at least 1m apart. The dining area was also adapted to ensure social distancing could take place.

The provider completed an infection and prevention control audit and had taken actions to address the shortfalls identified. For example, the provider purchased wipeable, easy to clean chairs for the communal areas to ensure effective cleaning could take place.

The provider had made improvements to the laundry management and adapted a separate room for storing clean laundry to reduce the risk of contamination.

The home was clean, and the provider evidenced frequent cleaning was taking place, including enhanced cleaning and disinfection of surfaces, particularly those that are classed as ‘high-touch’.

During an active outbreak of COVID-19 people were supported to stay in touch with their relatives via video and phone calls. The provider had built a visiting pod to facilitate visits safely.

Staff wore the correct personal protective equipment (PPE) as per the current government’s guidance. The provider evidenced taking correct actions when staff had not complied with the current guidance.

Kingsthorpe View is a purpose-built residential care home, providing personal and nursing care to people living with a mental health diagnoses, dementia, physical disability or sensory impairment. The service can support up to 50 people. At the time of our inspection there were 28 people living at the service.

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

The provider and registered manager had failed to ensure effective infection prevention and control measures were in place. Some staff were observed not wearing masks.

Some areas of the environment remained in need of repair and redecoration. In particular some areas of the flooring and

some bedrooms in the service. Whilst we saw the provider had an improvement plan in place for the service, these were actions that had been requested following our previous inspection of 11 November 2020.

The registered manager had failed to implement robust systems and processes for the governance and oversight of the service. This meant audits were ineffective as improvements identified, had not been implemented. There were no effective audits found for some aspects of care delivery. For example, we found a lack of audits for the call bell system. This meant the registered manager could not be confident that staff were responding in a timely manner when people requested assistance via their call bells.

The registered manager had not been responsive to complaints and concerns raised by relatives of people using the service. Which would allow them to bring about improvement across the service.

The provider and registered manager had failed to ensure all staff had received training which the provider had deemed as essential for their roles. For example, not all staff had received training in safeguarding vulnerable adults or diabetes awareness.

Care plans and risk assessments seen, were inconsistent in their directions to staff to support safe and consistent care. Whilst some contained clear information, others lacked detail.

People living at the service were receiving their medicines safely and as prescribed for them. Systems and processes were in place to ensure medicines were managed safely.

People told us they were happy living at Kingsthorpe View, they felt supported by a sufficient number of kind and caring staff. The majority of relatives we spoke with did not express any significant concerns regarding 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 did support 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 and update

The last rating for this service was Inadequate (published 25 September 2021) and there were multiple breaches of the regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made or sustained and the provider was still in breach of some regulations.

Why we inspected

The inspection was prompted in part due to concerns received about a poor response to complaints from the registered manager and indications of poor infection control practices in the service. A decision was made for us to inspect and examine those risks.

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.

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

The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement.

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 have identified breaches in relation to the environment, infection control, staff training, governance and oversight 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.

The overall rating for this service is ‘Requires improvement’. However, this service remains in special measures. We place services in special measures when they have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Kingsthorpe View is a purpose-built residential care home, providing personal and nursing care to people living with a mental health diagnoses, dementia, physical disability or sensory impairment. The service can support up to 46 people. At the time of our inspection there were 29 people living at the service.

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

We found significant concerns around how the service was managed, medicines management, care plans and records, health and safety and risk management.

People living at the service were not always receiving their medicines safely and as prescribed for them. Systems and processes in place to manage medicines safely were inadequate.

Health and safety and infection prevention and control were not always well managed. We found the environment and furniture to be in a poor state of repair in some areas. Whilst we saw the provider had an improvement plan in place for the service, there were inadequate systems in place to identify this prior to the inspection.

There was a lack of robust managerial oversight of the home. There were no effective audits of some aspects of care delivery. Care and support plans for people were not person centred or reflective of people’s current level of needs.

We observed people to be happy living at Kingsthorpe View, supported by kind and caring staff. People and their relatives did not express any significant concerns regarding the service.

Staff understood safeguarding and how to keep people safe from abuse. Staff told us, and we saw that they received training to support them in their role.

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 27 September 2019).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of the regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

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.

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.

We carried out an unannounced inspection of this service on 10 November 2020. 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 the breach in Regulation 17 Good Governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. 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 Kingsthorpe View Care Home 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 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 have identified four breaches of regulation around person centred care, medicines management, infection control, premises and equipment, safe care and treatment, staffing and good governance. The failings found are detailed in the main body of the report.

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

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

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Kingsthorpe View is a purpose-built residential care home, providing personal and nursing care to people with mental health issues, dementia, physical disability or sensory impairment. The service can support up to 50 people. At the time of our inspection there were 33 people living at the service.

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

The risks to people’s safety were not always well managed. Staff’s management of the environment put people at risk of harm. People were not always protected from the risks of infection as there were some communal areas of the service that were not clean. Staff did not always manage medicines safely.

There was feedback from people and staff that staffing levels were not always consistent. However, on the day of our inspection we saw there were enough staff to meet people’s needs, and the registered manager had been consistently working to recruit appropriately trained staff to support people.

Staff were supported with regular supervision and mandatory training, however one new member of staff had not received training for their role. This was addressed following our inspection.

There were examples of people’s nutritional needs being well managed, people received appropriate diets. However, the management of some of the mealtimes we observed lacked engagement and organisation and the support some people received needed to be improved.

The majority of 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. However, the information in some mental capacity assessments needed further improvement to give more detail on how the assessments had been conducted.

Although some staff treated people with care and respect, there was at times a lack of engagement with people, and several interactions we saw were task orientated. People and their relatives had not always been involved in developing their care plans.

The registered manager had quality monitoring systems in place to monitor the standards of care. However, we found these tools were not always robust enough to highlight some issues we found on our inspection.

There was a lack of engagement with people on the way the service was run.

People were protected from potential abuse and staff understood their roles in protecting people in their care. Their care was assessed using nationally recognised assessment tools and there were risk assessments in place to guide staff provide safe care.

People’s health needs were well managed. They lived in an environment that allowed them the freedom to move around the service safely. The service needed some refurbishment; however, we saw the provider had an action plan in place and was working to improve the environment.

People’s privacy and dignity was respected by staff and staff were aware of their role in maintaining people’s dignity.

People received care from staff who had a good knowledge of their needs. Their communication needs were met, and the provider worked to the accessible information standards to provide people with information in a way they could understand.

Staff worked to meet people’s social needs in an individualised way and reflected the differing needs of the people who used the service. Complaints were managed in line with the providers complaints policy.

People’s end of life wishes had been discussed where appropriate and there was information in their care plans.

The registered manager and provider worked in an open and transparent manner and understood their responsibilities in relation to the duty of candour.

Rating at last inspection

The last rating for this service was requires improvement (published 31.05 2018) and the service was in breach of one regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. 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 and the provider was no longer in breach of this regulation. However, we found a further breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this full report.

Why we inspected

This was a planned inspection based on the previous rating.

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

Kingsthorpe View Care Home is registered to provide accommodation, nursing care and personal care for up to 50 older people. The home is on two floors with various communal areas for people to sit and meet with relatives. There were 33 people living at the home at the time of our inspection.

The service did not have a 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 provider had recruited a new manager and they were due to register with CQC.

Since the new manager has been in post there have been a number of extenuating circumstances beyond the provider and new manager's control. These have caused a number of problems in managing the service effectively. These have included staffing issues, a fire and total heating system failure. The fire had happened as a result of a person, who now no longer uses the service setting fire to their bedroom. Swift and appropriate action was taken by staff to ensure people were safe.

A new heating system had been installed due to failure of the previous system.

Not all areas of the service were clean and hygienic. This included communal areas, bathrooms and toilets. The environment was not always suitable in maintaining people's privacy as some toilets and bathrooms did not have locks fitted.

People using the service told us they felt safe living at Kingsthorpe View. Relatives we spoke with agreed their family members were safe living there.

The staff team were aware of their responsibilities for keeping people safe from avoidable harm and knew to report any concerns to the management team.

Risks associated with people's care and support had been assessed but had not always reviewed and updated following an incident. Where risks had been identified these had, wherever possible, been minimised to better protect people's health and welfare.

Appropriate pre-employment checks had been carried out on new members of staff to make sure they were safe and suitable to work there. Suitable numbers of staff were deployed in order to meet people’s needs.

New staff members had received an induction into the service and on-going training was being delivered. This enabled the staff team to gain the skills and knowledge they needed to meet people's needs. The staff team felt supported by the acting manager and were provided with the opportunity to share their views of the service. The acting manager had yet to implement regular supervision for all staff.

People were supported with their medicines in a safe way. Where people received covert medicines appropriate consultation with the pharmacist had not taken place. Where people needed their medicines prior to eating or taking other medicines, it was not always clear which staff had the responsibility to administer these particular medicines. Where people were living with dementia there was no guidance to ensure they received appropriate pain relief if they were unable to tell the nurse they were experiencing pain.

The acting manager had assessed people’s care and support needs prior to them moving into the service to make sure they could be met by the staff team.

The staff team supported people to make decisions about their day to day care and support. They were aware of the Mental Capacity Act (MCA) 2005 and Liberty Protection Safeguards (LPS) ensuring people's human rights were protected.

People's food and drink requirements had been assessed and a balanced diet was being provided. Records kept for people assessed as being at risk of not getting the drinks they needed to keep them well, were not always kept up to date.

People were supported to maintain good health. They had access to relevant healthcare services such as doctors and community nurses and they received on-going healthcare support.

The staff team were kind and caring and people's privacy and dignity was respected and promoted.

The area where people could go to smoke was not ideal due to the fire door being left open and cold air and smoke coming into the lounge. We have made a recommendation about the siting of this area.

People had plans of care, however these were not personalised and did not reflect the individual care staff actually provided.

Activities did not always reflect people's interests and hobbies. So opportunities had been missed to provide good stimulation to people and keep them from being bored.

A formal complaints process was displayed and people knew who to talk to if they had a concern of any kind. Complaints received by the provider had been appropriately managed.

Relatives and friends were encouraged to visit and they told us they were made welcome at all times by the staff team.

The provider has not carried out a survey to involve people in the running of the service provided.

Systems in place to monitor the quality and safety of the service being provided were not always effective.

Further information is in the detailed findings below.