Kings Manor Care Home

Updated 6 October 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection team consisted of two inspectors and a member of the medicines team on the inspection visit. An Expert by Experience assisted the team with phone calls to people using the service and relatives. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Kings Manor is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Notice of inspection

This inspection visit to the service was unannounced. The phone calls to people and relatives were planned with agreed times. We also provided a video call feedback session to the registered manager and the providers representative.

What we did before the inspection

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service.

During the inspection-

We spoke with 12 staff including, nurse lead, senior carers, housekeeping staff, cook and hospitality staff as well as the registered manager and the operations manager.

We spoke with six people on the day of the inspection and four others by phone after the inspection visit. We also spoke with eight relatives by phone.

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 with us.

We reviewed three recruitment files, training records and supervision records. We also looked at three care plans and risk assessments and 11 medicine records. We also reviewed and discussed with the registered manager a range of quality assurance records and audits.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We sought feedback from two professionals who regularly visit the service and received information from one.

Updated 6 October 2021

About the service

Kings Manor is a residential care home providing personal and nursing care to 54 people aged 65 and over at the time of the inspection. The service can support up to 66 people.

Kings Manor accommodates people in one purpose-built building set over three floors. Each floor has a dining room and at least one lounge area. Each bedroom has its own en-suite and some rooms are interconnecting for couples who choose to stay together.

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

People said they felt happy, safe and well cared for. Comments included, “I feel very safe here, the staff know how to look after you” and “I am happy, and I feel safe”.

Some people said getting help and support at key times was more difficult and they sometimes had to wait. One person said, for example, “It can be difficult getting them at times as we are all wanting then at the same time, but they come as quick as they can. They are very good at understanding me though, like yesterday, I didn’t want to get dressed as I didn’t feel well, and they looked after me”. Staffing levels were sufficient, but like all care providers there had been key times during the pandemic and lockdown when staffing levels had fallen slightly below the providers preferred numbers. This had not compromised anyone’s safety but did mean that care and support may be delayed slightly for some people at peak busy times.

During the inspection visit we observed staff being observant to people’s needs and wishes. Even during a medical emergency, staff remained calm and dealt with this in a professional and compassionate manner. Staff understood people’s needs and responded to them patiently and were warm and friendly at all times.

Relatives said the care and support was good but three mentioned that there were occasions when their relatives personal care was not as good as they had expected such as dirty or long fingernails. We fed this back to the registered manager and operations manager who said they had not been made aware of these issues from family members. They planned to hold some additional evening meetings for families and said this would be an opportunity to gain peoples’ views and ask for direct feedback for ongoing improvement.

There was sufficient staff with the right skills and competencies to provide safe and effective care to people at the time of the inspection. The registered manager said this was kept under review using a dependency tool to help them assess the right numbers and right deployment of staff for each floor. She explained that the top floor was mainly complex nursing, middle floor for people living with dementia and bottom floor for those who were more able. The whole service is registered as a care home with nursing so although nurses were based mainly on the top floor, their support was used across all floors for people assessed as needing nursing support.

Staff training and support was seen as key to providing high quality care and support. In discussion with the registered manager, we identified that staff had not yet received training in working with people with complex dementia care where diffusion and breakaway techniques may be needed. By the second day of inspection activity, the registered manager confirmed this training had now been sourced and booked for staff.

Staff were positive about the support and training they received. One staff member said they were being supported to complete a nursing qualification. Another said, “This is the best training I have ever had since working in care.” The training matrix showed staff had a wide range of training in all aspects of their work.

People were kept safe because risks for individuals and the environment were completed and reviewed when needed. Staff understood about abuse and who to report any concerns to. Staff recruitment was robust and ensured new staff only started employment once all their checks were in place to show they were suitable to work with vulnerable people.

People were supported to have a varied diet and snacks and drinks were offered throughout the day and evening. One person said they were not offered anything after teatime. We fed this back to the registered manager who said she would ensure people were made aware they could access food and drink 24/7 if they wished, and that there was a later supper trolley available with hot drinks, cakes and sandwiches. People said the meals and choices were good. Comments included “The food is very good, I enjoy everything they give me, especially the puddings.”

Where people were at risk of poor hydration or nutrition, staff supported them to encourage additional drinks and snacks and their daily intake was monitored.

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.

Systems and audits were effectively used to ensure the quality of care and support as well as the environment was being monitored and to help drive up improvement. An action plan was used to review areas identified for improvement.

Some relatives said that communication was not always consistent and three said they would like more regular contact from the service about their loved one. This had been fed back to the provider who agreed to look into how they could make improvements to this.

The service employed a liaison person whose role included forging links with the local community. Prior to the pandemic this was working really well with local groups coming to use the facilities, such as the ground floor, coffee bar area for things such as will writing sessions. People using the service were also able to join in these groups.

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

Rating at last inspection– This service was registered with us on June 2019 and this is the first rating inspection.

Why we inspected

This was a planned inspection based on the fact the service had been registered for over 12 months and had not yet had a 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.