Archived: Kingsmead Lodge

Updated 11 August 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 11 and 12 May and was unannounced. The inspection was undertaken by two inspectors and an expert 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.

We reviewed the information that we had about the service including statutory notifications. Notifications are information about specific important events the service is legally required to send to us.

Some people who used the service were able to tell us of their experience of living in the home. For those who were unable we made detailed observations of the interactions between staff in communal areas. 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 to us.

On the day of our inspection we spoke with 5 people that used the service, 12 relatives and nine members of staff. We also spoke with the deputy and regional manager.

We reviewed the care plans and associated records of five people who used the service and reviewed documents in relation to the quality and safety of the service, staff recruitment, training and supervision.

Updated 11 August 2015

This inspection took place on the 11 and 12 May 2015 and was unannounced. The previous comprehensive inspection took place on 23 and 29 September 2014. Following this inspection we took enforcement action and a warning notice was served in relation to Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place for the obtaining, recording and safe administration of some medicines.

A further inspection was undertaken on the 2 December 2014 in relation to the warning notice. We found the provider had still not met the legal requirements in relation to Regulation 13 but had made some improvements. . We served another warning notice in relation to Regulation 13. A warning notice was also served in relation to Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. The provider had not responded appropriately to an allegation of abuse to protect people and failed to report the safeguarding concern promptly. The provider produced an action plan identifying how the legal requirements would be met. Our recent inspection found that improvements had been made to meet the relevant requirements.

Kingsmead is registered to provide accommodation and personal care with nursing for up to 81 older people across two floors. The upper level of the home is known as Nightingale and provides nursing care and support to people. The ground floor area is known as Kingfisher and offers support to people with living with dementia. At the time of our inspection there were 44 people using the service.

There has been no registered manager in place for over 6 months. 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 service did not consistently ensure that each person received appropriate person-centred care and treatment that was based on an assessment of their needs and preferences.

Staffing levels were not adapted to respond to the changing needs and circumstances of the people using the service.

Staff treated people with kindness, but there was limited social interaction with people. Staff focussed on their tasks and did not spend time talking to people, even when they were assisting them with lunch. Feedback from relatives advised that the care was good most of the time and the carer staff really wanted to provide the best care they could. They thought that they were hampered by being short staffed at certain times.

People’s care records were not always maintained accurately and completely to ensure full information was available to enable staff to meet their needs. The service had not protected people against the risk of poor care as not all records were accurate.

Nutrition and hydration needs were not always met. One person’s chart indicated they had received no food or drinks for a 56 hour period. We found that the provision of care was not accurately recorded. The food was nutritious and served at the correct temperature and consistency, according to the person’s needs. Snacks were available throughout the day. One person commented ‘the food is good here and the drinks trolley also offers finger food”.

Staff were not consistently supported through an effective training and supervision programme. Although new staff completed an induction programme on-going training was not being maintained. The training matrix demonstrated that staff training needed to be up-dated.

Systems were not being operated effectively to assess and monitor the quality and safety of the service provided. The service had a programme of regular audits, however audits to monitor the completion and accuracy or records were not completed and other audits were not always effective.

People had their physical and mental health needs monitored. All care records that we viewed showed people had access to healthcare professionals according to their specific needs.

We saw information in people’s support plans about mental capacity and Deprivation of Liberty Safeguards (DoLS) authorisations had been applied for. These safeguards aim to protect people living in care homes from being inappropriately deprived of their liberty.

Relatives were welcomed to the service and could visit people at times that were convenient to them. People maintained contact with their family and were therefore not isolated from those people closest to them.

Maintenance, electrical, equipment and property checks were undertaken to ensure that these areas were safe for people who used the service.

Since the appointment of the manager the overall feedback had been positive and there had been a perceived notable improvement in the running of the service. Staff spoke positively about the manager. A member of staff told us ‘she is brilliant and looks after her staff properly. She has reviewed care plans, brought in the key worker system, resident of the day review system and has consulted with family members.” Relatives also told us that they had confidence in the manager. We were told that the manager was often seen ‘walking the floor’ and talking to people who use the service and their relatives.

We found multiple beaches 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.