Kingfisher Lodge

Kingfisher Lodge is a residential care home providing regulated activities personal and nursing care to up to 60 people. The service provides support to people with dementia, older and younger adults, and people with a learning and/or physical disability. At the time of our inspection there were 52 people using the service.

Kingfisher Lodge is laid out over two floors, with en-suite bedrooms, communal dining and lounging areas, to each floor. Both floors are accessible by lift and stairs. People have level access to a large, well-stocked garden from the ground-floor. The manager’s office is located adjacent to the reception area on the ground-floor.

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

The manager raised potential safeguarding concerns with the local authority safeguarding team. Staff spoke confidently about how they would identify abuse and what they would do if abuse was witnessed or suspected. Risk assessments were in place where required, for example for people at risk of falls. The manager had identified medicines related recording was not always robust and was working to improve this at the time of our inspection. The provider used a staffing dependency tool based on peoples’ needs, we received mixed comments about staffing levels.

The provider submitted notifications as required and used checks and audits to identify shortfalls, errors and omissions. Staff knew people well and had recently worked with a dementia specialist to provide people with more person-centred care. At the time of our inspection, the service did not have a registered manager in place, a recent application for registration had been withdrawn and a general manager was in post for the interim. The manager and regional director had identified areas for development, plans were in place to support this.

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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of safe and well-led, the service was able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support: People were supported to have maximum control of their lives and make their own choices. The service shared relevant information with external professionals to support these choices.

Right care: Staff had not received learning disabilities training, however this had not impacted people and the manager planned to rectify this. Staff knew people well.

Right Culture; The service worked with peoples’ families to ensure people experienced good outcomes.

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 good (published 20 November 2020)

Why we inspected

We received concerns in relation to the management of medicines and safeguarding concerns. 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.

Follow-up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Assessments were carried out by phone or remotely. People were not admitted to the service unless they tested negative for Covid-19; there were procedures in place to isolate new admissions for a further two weeks to ensure they were free of the virus.

The service was on two floors, each floor could be isolated using a zoning system. Wherever possible staff worked on one specific floor. The provider reported no suspected outbreaks to date. If there was an outbreak the registered manager knew the organisational policy to inform PHE, CQC and the commsioning team.

Training was robust, staff knew how to put on and take off PPE. Staff had IPC supervision and staff told us they had additiona training. One staff member told us they had been trained as a Covid Carer so they could support clinical staff in the event the home had an outbreak.

The registered manager ensured regular testing was carried out on both staff and people living at the service. Staff we spoke with were confident and knowledgeable about how to protect people from the risk of infection.

There were effective systems in place to support visits. All visitors to the service were required to sign in, have their temperatures taken and wash their hands. The provider had plans to improve the current visiting arrangements, for example they planned to create patio doors in rooms to enable people to come in through the garden rather than through the home. This will improve social distancing further.

Staff ensured people remained as active as possible, duplicating activities on each floor and offering one to one support for people who did not want to leave their rooms. Staff limited activity groups to six people and wiped all items after use. Staff had created a sensory room to support people with anxiety issues.

Further information is in the detailed findings below.

People’s experience of using this service: People were supported by caring and passionate staff in a spacious environment with a large accessible garden area. The service was clean, tidy and furnished thoughtfully to a high standard.

Care and support was person centred and enabled people’s wishes and preferences to be met. People were encouraged and supported to remain independent. There was a wide variety of activities to engage people in. Links had been developed to ensure the service was an active part of the local community.

People enjoyed the food provided by the service. There was a positive staff culture and this reflected in a happy and friendly atmosphere.

Improvements had been made to ensure the service was working in line with legislation and guidance around people’s consent to care.

Medicines were administered safely. People were supported with their health conditions and we received consistent positive feedback from health and social care professionals about the quality of care provided.

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 CQC website at www.cqc.org.uk

Rating at last inspection: The last rating for this service was Requires Improvement (published 10 July 2018).

Why we inspected: This was a planned inspection based on the previous rating.

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.

During this inspection we checked that the provider was meeting the legal requirements of the regulation they had previously breached. You can read the report from our last inspections, by selecting the 'All reports' link for, Kingfisher Lodge on our website at www.cqc.org.uk

Kingfisher Lodge 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. Kingfisher Lodge can provide care and support for up to 60 older people, some whom are living with dementia. At the time of our inspection there were 48 people living at the service.

The service provides accommodation in purpose built premises. The service is over two levels and has three areas Chaffinch, Lark and Robin. There are communal lounges and dining rooms. There was access on the ground floor to a large, secure, well-appointed garden area. This had shrubs and bright flowers, raised flower beds and ample seating. A balcony area was available on the first floor.

There was a 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 2008 and associated Regulations about how the service is run.

Training had been reviewed and changed in regards to The Mental Capacity Act (2005). Competency assessments monitored knowledge gained from training. New documentation had been introduced in regards to consent to care and treatment. However, despite this revised training we found that consent to care had not always been completed in line with legislation and guidance.

Changes to the governance systems had made improvements. However, prompt progress had not always been taken to address shortfalls identified. The provider had not identified the mismanagement of some records and that people’s experience of staffing required further analysis.

Staff said they were well supported in their role through an induction, regular supervision and ongoing training. The service was bright, clean and well maintained. People had access to a safe and attractive garden. The environment was suitable for people living with dementia. People had space to move about safely and independently. There were private, communal and outdoor areas for people to spend their time in.

People were supported by staff who were kind and caring. People were treated with dignity and respect. Staff demonstrated passion and pride in the care and support they undertook. People had developed good relationships with staff and this enabled effective care strategies to be implemented. There was a constructive staff culture which had a positive impact on people’s well-being.

A varied programme of activities was available and people were involved in choosing future activities. There were systems in place to obtain feedback from people and relatives through meetings, reviews and surveys. Actions were taken to suggestions made.

The service had developed local community links by events and fundraising activities. Visitors were welcomed at the service and support was offered to relatives. Care plans were person centred. People received effective support with their health needs.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We made a recommendation about advanced care plans. You can see what action we told the provider to take at the back of the full version of the report.

During August and September 2016, we received a significant number of concerns about staffing levels and care provision at Kingfisher Lodge. This information of concern was received from people’s relatives, staff and from healthcare professionals who had visited the service. As a result of that information, we undertook an unannounced inspection of Kingfisher Lodge on 19 September 2016. During the inspection in September 2016, we found five breaches of the Health and Social Care Act 2008.

Following that inspection in September 2016, and due to the level of concerns we had identified, we requested an urgent action plan from the provider to ensure that people living at Kingfisher Lodge were protected from being exposed to the continued risk of unsafe or inappropriate care and treatment. The provider engaged with us, and acknowledged the concerns we had identified within the service during the inspection. They sent us an action plan in October 2016 detailing how they intended to immediately safeguard people and achieve compliance with the regulations.

As a result of the inspection in September 2016, the service was rated as ‘Inadequate’ and the service was therefore placed in ‘Special measures’. Services in special measures are kept under review. During this comprehensive inspection in April 2017, we reviewed what improvements had been made at the service since they were placed into ‘Special measures’ following our inspection in September 2016.

Kingfisher Lodge provides accommodation for people who require nursing or personal care to a maximum of 60 people. At the time of our inspection, 34 people were living at the service. The service is split over two floors, ‘Chaffinch’ unit is on the lower floor with ‘Lark’ and a newly created unit named ‘Robin’ on the upper floor. Lark and Robin units primarily supported people living with dementia.

There was no registered manager in post during this 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.

During this inspection, we saw that the service had made improvements and this was reflected in the feedback we received from people, their relatives and staff. However, we found that consent to care and treatment was still not consistently sought in line with legislation and guidance. We have made a recommendation in relation to achieving compliance with the Mental Capacity Act 2005. In addition to this, although governance systems had improved we found they had not consistently identified the record keeping issues we identified during the inspection.

People spoke positively about feeling safe. We received mixed feedback in relation to staffing levels, however in general the feedback commented on how it had improved since the last inspection. In general, staff felt there were sufficient staff on duty to meet people’s needs. People’s medicines were managed safely, however we identified some recording omissions we identified to senior management. Infection control practice had improved and incidents and accidents were reviewed. People’s risks were assessed and recruitment was safe. Staff understood their responsibilities to safeguard people.

People said that care was effective, and we saw that staff received training, supervision and appraisal. Appraisal completion was currently poor but being addressed. New staff received an induction when they started employment. The service understood their responsibilities in regard to the Deprivation of Liberty Safeguards (DoLS). DoLS is a framework to assess the requirement to lawfully deprive a person of their liberty when they lack the mental capacity to consent to treatment or care and need protecting from avoidable harm.

People were supported to eat and drink enough, however we found a small number of recording inconsistencies that had not been identified by the current governance arrangements. It was evident that staff we spoke with understood people’s food and drink needs well. People had access to on-going healthcare and we saw examples of how the service had met people’s needs.

People felt well cared for and relatives were positive. The service had received compliments since the last inspection. People felt they were treated with dignity and respect and we observed positive interactions between people and staff. People were supported to have a comfortable, pain free and dignified death in accordance with their wishes. People’s care plans detailed their preferences and wishes.

People were involved in decision making and relatives we spoke with agreed with this. We did receive some feedback where relatives did not feel consulted about a change in the service, but the senior management we spoke with acknowledged this could have been handled better. We saw good examples of care plans that were detailed and clear in relation to wound care, however a care plan we reviewed in relation to catheter care was inaccurate in places. Another care plan relating to pressure ulcer care was also contradictory. This again had not been identified by current governance arrangements. We received mixed feedback on activities. There was a complaints system in place people and their relatives felt able to use.

People, their relatives and staff commented positively about the current leadership arrangements at the service. People spoke positively about changes at the service and we received similar feedback from nearly all the staff we spoke with who were now positive about their employment. There were systems to communicate with staff to ensure messages about the projected improvements within the service were going to be achieved together with the expectations of the staffing team. There were systems to communicate with people and their relatives. There were some effective governance systems and the service had received support from the provider.

We found one continuing breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

When the service was last inspected in November 2014, we found the provider had failed to ensure there were adequate staffing levels to meet the needs of people at the service. The provider wrote to us in February 2015 and told us how they would achieve compliance with this regulation. During this inspection, we found the provider has not ensured staffing levels were adequate to meet the needs of the people at the service.

Kingfisher Lodge provides accommodation for people who require nursing or personal care to a maximum of 60 people. At the time of our inspection in September 2016, 47 people were living at the service. The service is split over two floors, with Chaffinch unit on the lower floor and Lark unit on the upper floor. Lark Unit primarily supports people living with a dementia type illness.

A registered manager was not in post at the time of 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. A general manager had assumed post in May 2016 and was currently undertaking the registration process with us to become the registered manager.

Following this inspection in September 2016, we wrote to the provider to outline the immediate concerns we identified and requested that an urgent action plan to address our concerns was produced. The provider responded to us within the requested timeframe. They acknowledged the seriousness of the concerns we had raised and the impact they were having on the quality of care provided to some people. We have since responded to the provider and requested they send reports to us at specified frequencies. These reports relate to the current staffing levels at the service in order to demonstrate to us that the service is able to meet people’s assessed needs.

The provider had not ensured there was enough staff on duty to consistently meet people’s needs. This placed people at the service at risk of not having their assessed needs met. Medicines were not always managed safely and medicine recording omissions made it unclear if people had received their medicines as prescribed. There were no effective systems in operation that ensured accidents and incidents were reviewed to reduce the risk of recurrence and risks to people. People were placed at risk through poor cross infection prevention practice.

There were insufficient systems to show that the service had met the Deprivation of Liberty Safeguard (DoLS). DoLS is a framework to approve the deprivation of liberty for a person when they lack the mental capacity to consent to treatment or care and need protecting from harm. There was no evidence that the service understood the conditions attached to people’s DoLS or how they were being implemented. In addition to this, the provider was not consistently providing care in line with people’s consent and with mental capacity legislation.

Staff at the service were caring and people and their relatives spoke very highly about the caring nature of staff. We made positive observations of care provision, however we also received information from people and made observations of how staff were unable to be consistently caring through inadequate staffing numbers. People’s clinical needs were not consistently met in relation to pressure ulcers and diabetes care. In addition we found that where people required pressure relieving mattresses to meet their needs, there was no effective system to ensure these were correctly set which placed people at risk.

There were governance systems provided, however these had not always been effectively used. There were inconsistencies between Chaffinch and Lark units and no management systems in operation that identified this. People, staff and their relatives gave mixed feedback on the management of the service. Although we noted the service had received regional support from the provider, this was not consistent. Prior to the inspection the provider had failed to ensure people’s health, safety and welfare needs were met by failing to ensure sufficient management arrangements were in place during a pre-planned absence of both regular managers.

People and their relatives spoke positively about the staff at the service. Most wished to stress that although they were giving us information about negative experiences at the service, they felt the staff were very caring.

The service had safe recruitment procedures. The environment was risk assessed and there were regular systems to ensure the equipment within it were serviced and functional. Staff were supported through a training programme and supervision was completed. It was noted that supervision completion was low but the manager told us this was being addressed.

People were supported with their nutritional needs and people had access to healthcare professionals when required. There was a complaints procedure in operation however we saw the responses were inconsistent.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.

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.

The provider sent us an action plan that detailed how they would achieve compliance with this regulation. During this inspection the actions the provider told us they were planning to take, had been implemented within the service.

People we spoke with told us they were happy with the service they received. We spoke with three people who used the service and five members of staff during our inspection. One person that lived in the home told us 'it's lovely here the girls are so kind and they try very hard to please us'.

Staff we spoke with told us many improvements had been made and measures had been put in place to ensure all records were completed at each shift. Staff comments included; 'things have improved greatly, we have structure to our day and residents are much happier". Another staff member told us, 'we have received lots training around wound management and medication and have clear records that we complete every shift'.

At the time of our inspection there was no registered manager in place at Kingfisher Lodge.

The provider submitted an action plan that told us how they were going to improve these areas. We returned to the home on the 30 June, 1 July and 10 July to review the areas of non compliance.

During our inspection days we spoke with 15 people that used the service, 18 staff and four relatives. We also looked at care records, documentation, made observations of practice and examined systems that had been put in place by the provider since our last inspection.

Overall comments we received from people were positive. Comments included; 'things have improved since your last inspection, it still has a way to go but you can see the improvements'. 'It is lovely here, the staff are good and do try, but are very busy'.

Some people were living with dementia and were not able to verbally tell us of their experiences. Therefore we observed staff interactions with people to gain a view of what it was like for them living in the home.

Staff we spoke with told us things had improved over the past few months and were pleased a permanent management team was now in place. Comments included;" we have a way to go but it is much improved".

The provider submitted an action plan that told us how they were going to improve these areas. We returned to the home on 15, 16 and 19 April to review the warning notices.

We spoke with nine members of staff, five relatives and eight people who used the service. Overall people we spoke with told us they were happy living in the home. Comments included; 'staff are lovely but so busy', ' I wish they had more time, they are run ragged', 'it has improved though since you last came, we seem to have familiar faces more often than not'. One person said 'sometimes at weekends there is not enough staff'.

Relatives we spoke with confirmed things had improved since our last inspection, however staff did appear in 'short supply' at times. For example one relative told us 'the management now listen to our concerns, staff are lovely and caring but they are extremely busy'. Another relative told us "weekends seem to be the short or busy times".

Staff we spoke with confirmed things had improved somewhat since our last inspection and looked forward to new permanent staff coming on board.

The conclusion of our inspection was the provider is now compliant with the warning notices served in respect of Regulation 11 and Regulation 22.

Not all the people we met were able to verbally tell us about the care they received and their experience of living in the home. Therefore we observed how staff interacted and supported people, to enable us to make a judgement on how their needs were being met.

We observed some people being supported and examined their care plan documentation. This was to ascertain if an appropriate level of care was being provided, in line with their assessed needs.

People made positive comments regarding the staff that supported them, but overall they felt there were not enough staff on duty. Other comments included; 'the staff are lovely but they are to busy', 'they are so busy, you don't want to ask them for anything, it's ok for us we can do things for ourselves, but some of the others rely totally on the staff. It's them I feel sorry for'. Relatives we spoke with also had concerns regarding the staffing levels.