Archived: Kingsmead Lodge

At the previous inspection of Kingsmead lodge on 10, 11 and 12 June 2014 we had found that the service had not been complying with the following regulations:

' Care and welfare

' Safeguarding

' Cleanliness and infection control

' Management of medicines

' Assessing and monitoring the quality of the service

We told the provider that they must take action to ensure that improvements were made and they supplied a detailed action plan.

We visited Kingsmead Lodge on 23 and 29 September 2014 in order to check on the actions that had been taken. This helped us to answer these questions during this inspection:

' Is the service effective?

' Is the service safe?

During this inspection we looked at seven people's care plans and five care records to see if the improvements had been made. We also spoke with five relatives, nine people who used the service and ten members of staff that included the registered manager and senior nursing staff.

Below is a summary of what we found.

Is it effective?

We found that improvements had been made and the service was complying with the regulations in relation to care and welfare, infection control and assessing and monitoring of the service.

People's care plans were completed and were reflective of their current support needs. Infection control guidelines were being followed and effective audits and monitoring of the service took place on a regular basis. People could now be assured systems were in place that ensured their care plans were reflective of their current needs and regular monitoring of the service took place.

Is it safe?

People we spoke with told us they felt safe with the staff in the home. One person told us 'they are nice people they try very hard. Yes they know how to help me safely'. We found that some improvements had been made in relation to safeguarding adults. Potential safeguarding concerns were reported to the local authority and the Care Quality Commission (CQC) in a timely manner and investigated.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (Dols). A Deprivation of Liberty Safeguards authorisation ensures people are looked after in such a way that does not inappropriately restrict their freedom. People are only deprived of their liberty when it is in the person's best interests and there is no other way of looking after them in line with the Mental Capacity Act 2005. We discussed the processes that were in place to make referrals with staff. They demonstrated a good understanding of this process, who to contact and how to support people who may be subject to such an authorisation.

We found some areas of medicines management were not complying with the regulation. For example, medications for some people were not available as they were prescribed. We were told this was because the home had difficulties in receiving further supplies. We also found the recording of some people's medication was not always as per instructions from their General Practitioner (GP).

We told the provider and the registered manager that they must take action to ensure that improvements were made.

The inspection team consisted of four inspectors, a pharmacist and an expert by experience. This is a person who has had personal experience of using or caring for someone who used this type of care service. This person gained the views of people living in the home and their experiences.

There is currently no registered manager in place at Kingsmead Lodge. However an acting manager is in place and we have been informed their application to be registered is in progress.

We set out to answer our five questions during our inspection; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, the staff supporting them and looking at records.

Is it safe?

People we spoke with told us they felt safe living in the home and told us if they had any concerns they would tell the manager or a member of staff. One person told us 'Yes I couldn't be safer here they are really good here'. One relative told us 'X is very safe and happy as they can be. If they weren't I would definitely go to the nurse and tell them'.

Safeguarding procedures were in place and most staff understood their role in safeguarding the people they supported. However not all safeguarding concerns had been reported to the local authority or the Care Quality Commission (CQC) in a timely manner. Not all staff were up to date with safeguarding training. This meant people were not fully safeguarded from abuse. The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (Dols) It was confirmed an application was being made for one person but no assessment has taken place as yet. We discussed the processes that were in place to make referrals and the staff we spoke with demonstrated an understanding of this process and who to contact.

Medicine management systems were not robust. The home did not have suitable arrangements in place to identify these risks and act quickly to ensure a continuity of supplies of medicines.

Is it caring?

People were supported by sensitive and attentive staff and people told us they were treated with dignity and respect in relation to their care routines. People comments included: 'I am more than happy here. It couldn't be better. They are lovely to me'. 'They are kind here, no complaints staff are good, food is okay and enough of it'. One person told us "I am happy here; everybody is helpful and kind; they will come when I want them; I get up and go to bed when I am ready; I wouldn't want to be anywhere else".

One visiting professional told us they visited the home on a regular basis and commented that they found the home to be happy and friendly with a caring atmosphere. They said "Staff seem busy but they respond to people brightly and straight away".

We saw that care staff showed patience and gave encouragement when they supported people. We spent time in the communal areas of the home observing how staff supported people that used the service. The observations we made demonstrated staff supported people in a calm unhurried manner, using communication methods conducive with their individual assessed needs.

Is it effective?

We spoke with a relative who told us 'I think it's good now, I haven't got any complaints. I don't come in the evenings, but I came once when my relative went to hospital. No-one went to hospital with them, they don't do that. However someone in the hospital told me that the notes they sent with my relative were excellent. This meant information was shared effectively when people moved between services. Another relative told of their relatives on going health requirements that were being effectively managed by the service.

We found people's health and care needs were assessed and most had been reviewed regularly. Some people we spoke with confirmed their involvement and one relative told us 'Yes I am asked if I want to give my feedback on the care X is given'. Care plans provided guidance for staff to follow that ensured people's individual specific needs were met.

Most care documentation that we viewed was reflective of people's current level of need. However some recording charts for the administration of people's creams and moisturisers were not completed fully. This meant there was a risk people were not being given the creams and moisturisers they required for their health conditions.

It was clear from our observations and from speaking with staff that they had a good understanding of people's care and support needs and that they knew them well.

Is it responsive?

People's needs had been assessed before they moved into the service. Documentation that we viewed evidenced that people were involved with the planning of their care. However when some people experienced a change in their needs, for example, some required further medication or supplements due to weight loss; supplies were not always received in a timely manner. This meant the service did not have robust systems in place that ensured people's changing needs were responded to swiftly.

People received co-ordinated care. We saw evidence in people's care plans that demonstrated people had been visited by their GP and other health care professionals. For example people's files held information and advice sought from the community mental health team when a person's cognitive decline was noted by staff.

Is it well-led?

The service does not currently have a registered manager in post. However a manager from another home has transferred to Kingsmead Lodge and we have been informed they will be making an application to become the registered manager.

People we spoke with confirmed they felt listened to by staff and knew how to raise a complaint if they needed to. One person told us 'I can tell the staff if I am unhappy with anything'. One relative told us 'the staff are very easy to talk to and I would have no hesitation to complain if I needed to'.

People that used the service, their relatives and external professionals completed a satisfaction survey once a year. The clinical lead told us if any concerns were raised these would be addressed promptly.

The service had a quality assurance system in place. However when we viewed the documentation we found that not all of the shortfalls we identified, had been highlighted within the provider's audits. For example not all care plans that we saw had been completed fully and no action or progress plans were available to ensure improvements were made.. The system in place was not being used robustly to ensure shortfalls were addressed and acted on promptly.

We found that improvements had been met and the service was now meeting the essential standards of staffing and involving people in their care and support.

People, relatives and staff told us that staffing levels had improved in the home. Staff told us that they had enough time to support people effectively. Relatives told us there were more staff around and staff seemed more relaxed and not so rushed.

We observed support being provided to people in a respectful way. Staff we spoke with had a good understanding of how to support people living with dementia effectively.

We found that staffing levels were based on the needs of people living in the service. Staffing rota's viewed demonstrated that staffing levels were consistent. Staff absence was covered by agency staff who worked regularly at the home.

The induction process for new staff and overall training for staff had improved. Staff told us that they had enjoyed the training and it had enabled them to improve the support that they gave people. Staff told us that the atmosphere at the home had improved and the staff were working well as a team.

Relatives told us they had met with the manager to discuss the support of their relative and any concerns raised were effectively dealt with.

We found that not all the people living in the home were involved in making decisions about their care and support. Since the new provider took over the home, people's needs had been reassessed. There was little evidence in people's records that people or their relatives had been involved in these assessments.

Care records showed that care plans were regularly reviewed and updated when people's needs changed.

Staff were aware of how to report safeguarding concerns both within the organisation and externally to other organisations such as the local safeguarding adults authority.

Staffing levels in the home were not always maintained at minimum levels set by the home. We reviewed staffing rotas and saw that on two occasions a nurse had worked a night shift and remained on shift to work the following morning. The home had ten vacancies for care staff and three for nurses.

The home was in the process of recruiting staff. However, the provider did not have suitable arrangements to ensure that staffing was maintained at the levels they had identified to meet people's needs.

The provider was in the process of implementing their quality audit system into the home. We found that the provider had ensured that the quality of the service was monitored during this interim period.