Archived: Kingsley Nursing Home

We found the following examples of good practice:

• Staff were wearing the required levels of personal protective equipment (PPE) and they disposed of used PPE safely in line with the relevant guidance.

• The home had a testing programme in place ensuring all people living there and staff were regularly offered a test.

• Staff supported family and friends to safely visit their loved ones in accordance with the relevant guidance.

• People living at the home were supported to isolate when necessary.

• Measures were in place to minimise risk, including staff changing from their outdoor clothes at the start of a shift.

• Frequent cleaning was carried out throughout the day.

We carried out an unannounced comprehensive inspection of this service in January 2017 when a breach of legal requirement was found. We found a breach in regulation regarding the service not having suitable systems and processes in place to ensure the environment and equipment was safe and used safely. We undertook a focused inspection on 12 April 2017 to check that they had they now met legal requirements. On the inspection of 12 April 2017 we found improvements had been made and the service was now meeting requirements. While improvements had been made around monitoring the home's environment we had not revised the rating for this key question. To improve the rating too 'Good' would require a long term track record of consistent good practice. We reviewed our rating for ‘well led' at this inspection and the rating was changed to ‘Good’. The overall rating for this service is now ‘Good’.

Kingsley Nursing Home 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.

Kingsley Nursing Home is a care home in the Birkdale area of Southport. The service offers accommodation, support and nursing care for up to 25 older people. The nursing home is accommodated across two Victorian houses that are connected through an internal corridor. Car parking is available at the front of the building and there is a garden to the rear of the building.

There was a registered manager in post at the time of our 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.

People told us they felt safe living at the care home and that they received a good standard of care from a kind, approachable and caring staff team.

Staff were aware of what constituted abuse and how to respond to an actual or alleged incident. Policies and procedures were in place to protect people from abuse.

Staff we spoke with were able to describe how they protected people’s dignity and right to choose how they wanted their care delivered. Our observations showed staff provided care in accordance with assessment need. Staff were considerate and polite when supporting people.

Ways in which people communicated were recorded to help make their needs known. With regards to the people we discussed, staff had a good knowledge of how people communicated their needs and how they wished to be supported.

At the time of our inspection there were sufficient numbers of skilled and experienced staff to support people. The provider has agreed to provide extra care hours each day for staff to support people with social activities. The activities organiser had left recently and the provider had advertised this position.

Staff recruitment procedures were robust to ensure staff could work with vulnerable people.

We found the home was operating in accordance with the principles of the Mental Capacity Act 2005 [MCA]. Staff sought consent from people before providing support.

The registered manager had made appropriate referrals to the local authority applying for authorisations to support people who may be deprived of their liberty under the Deprivation of Liberty Safeguards [DoLS]. DoLS is part of the MCA and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests.

Risks to people’s health, safety and welfare were assessed and measures were put in place to reduce risk, whilst being mindful of people’s rights to independence. Risk assessments were linked to people’s plan of care.

Staff received end of life training and people’s wishes were recorded regarding the provision for end of life care.

Risk assessments, service contracts and safety checks of services, such as the gas and electric supply, and various equipment were in place. This helped to ensure the environment was safe and well maintained. A plan of refurbishment and decoration was on-going.

People had a plan of care which was based on individual need and drawn in consultation with the person concerned, their relative and/or health professional. People’s consent to their plan of care was sought and people and their relatives were involved with care reviews.

People had access to external health and social care professionals to help maintain their health and wellbeing. People told us they could see their doctor when they wanted and staff were prompt in making appointments for them.

Staff received training and support to help ensure they had the knowledge and skills required to meet people’s needs effectively and safely.

People told us they enjoyed the meals and there was plenty of choice. People’s dietary needs were assessed and dietetic advice sought appropriately.

Medicines were administered and managed safely. People had a plan of care for their medicines and this included the use of as needed [PRN] medication.

People had access to complaints’ procedure. There were no recent complaints recorded. People and their relatives felt confident in raising concerns with the registered manager.

We found the home to be clean with good adherence to the control of infection

Opportunities were available for people and relatives to provide feedback regarding the service through meetings and satisfaction questionnaires. Changes were made following feedback to help improve the service.

People and their relatives spoke positively about the overall management of the service. Quality assurance systems and processes were in place, including audits of the service. These helped to monitor standards and drive forward improvements.

Staff and the registered manager clearly understood their roles and responsibilities to provide a well-managed service.

The registered manager had notified the Care Quality Commission [CQC] of events and incidents that occurred at the service in accordance with our statutory requirements. This meant that CQC were able to monitor risks and information regarding the service.

After the comprehensive inspection, the provider wrote to us to tell us what they would do to meet legal requirements in relation to the breach. We undertook a focused inspection on 12 April 2017 to check that they had they now met legal requirements. On this inspection we found improvements had been made and the service was now meeting requirements.

This report only covers our findings in relation to the specific area / breach of regulation. This covered one question we normally asked of services; whether they are 'safe'. We made a recommendation under ‘well led’ and reviewed this domain around the future development of auditing system for monitoring standards in the environment and for equipment. We therefore reviewed this domain in respect of this recommendation.

The question 'was the service effective’, ‘was the service responsive' and ‘was the service caring' were not assessed at this inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Kingsley Nursing Home on our website at www.cqc.org.uk.

There was a registered manager in post at the time of our 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.

At the previous inspection we found a number of safety issues at the home and lack of maintenance in some areas. We saw a number of radiator covers were not securely attached and two radiators were not working correctly in people's rooms. We found in general there was poor maintenance and a lack of safety checks for the windows, for example, cracked and blown glass and some window restrictors were not working effectively.

At this inspection we viewed a number of documents in respect of safety checks on the environment and equipment. We found this breach had been met.

We reviewed the audits (checks) on the environment and equipment to ensure they were being effectively monitored. We found monitoring arrangements in respect of health and safety checks had improved. The provider was aware of the need to monitor closely standards within the environment and equipment and has appointed a member of staff to lead on health and safety following this inspection.

The Kingsley Nursing Home is a care home in the Birkdale area of Southport. The service offers accommodation, support and nursing care for up to 25 older people. The nursing home is accommodated across two Victorian houses that are connected through an internal corridor. Car parking is available at the front of the building and there is a garden to the rear of the building.

A registered manager was 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.

There were processes in place to monitor and review the safety and maintenance of the premises. We however identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulated Activities 2014 in respect of Regulation 12 of the Health and Social Care Act 2014. This was because the provider did not always have suitable systems and processes in place to ensure the environment and equipment was safe and used safely.

Quality assurance processes and systems were in place to monitor standards and to support future improvement in the home. Areas such as care medicines, staff performance and cleanliness of the premises were well monitored. The current auditing system and health and safety checks for the environment and equipment had however not identified the shortfalls we found during the inspection. For example, general maintenance and safety checks of windows and the heating, also radiator covers not secure.

The provider and registered manager took prompt action to address these areas during and following the inspection.

We recommend further development of the current auditing system for the environment and equipment to monitor standards and ensure the safety of people living at the home.

People living at the home told us they felt staff delivered safe care.

The staff in the home knew the people they were supporting and the care they needed. Staff approach was kind and supportive and people’s individual needs and preferences were respected by staff.

There were enough staff on duty to help ensure people’s care needs were met. The registered manager was however aware of the need to review people’s dependencies on a regular basis and changes were being made to the morning routine to provide more time with people.

Staff had been appropriately recruited to ensure they were suitable to work with vulnerable adults.

Staff were being provided with training and received the support they needed to undertake their job role safely and effectively.

Care plans provided information to inform staff about people's care needs and risks to people’s health and wellbeing had been assessed to ensure their safety.

The staff we spoke with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported. An adult safeguarding policy and the local authority’s safeguarding procedure was available for staff to refer to.

Staff we spoke with told us they always asked for people's consent before providing care and we observed this during the visit.

The home adhered to the principles of the Mental Capacity Act (2005). Applications to deprive people of their liberty under the Mental Capacity Act (2005) had been submitted to the local authority.

People at the home were supported by the staff and external health care professionals to maintain their health and wellbeing.

An activities organiser was introducing a varied programme of social events and activities in accordance with people’s needs and wishes. This had been well received by people living in the home.

People told us they enjoyed the meals and were able to choose what they would like to eat. People’s nutritional needs were assessed and catered for. The menus provided a good choice of well balanced meals.

People and relatives told us they were invited to give feedback about the home through meetings, surveys and daily discussions with the staff.

The culture within the service was and 'open' and transparent. Staff and people said the home was ‘well run’ and the registered manager approachable.

We observed relatives visiting during the inspection and people told us their relatives could visit at any time. The registered manager told us there were no restrictions in visiting, encouraging relationships to be maintained.

A complaints’ procedure was available and people living at the home were aware of how to raise a concern in the home.

The manager was aware of their responsibility to notify us, the Care Quality Commission (CQC), of any notifiable incidents in the home.

You can see what action we took at the back of this report.

We saw that staff knew the people using the service. They had read service users' care plans, which were signed by them or their relatives and interacted with people and their relatives cheerfully.

A relative said that the staff were, 'all excellent and very caring.'

We looked at staffing rotas for different days of the week at random dates for the last three months to see that staff numbers were consistent and we reviewed the training records for all staff and saw that they had received training appropriate for the service provided.

We talked to staff about, and saw records of comments and suggestions made by people and their relatives and saw how they were responded to. There had been no written complaints made in the last four years.

We looked at the safety and suitability of the premises and saw current safety assessments and certificates.

We spoke with three people who were visiting friends or relatives who live in the home. All were pleased with the care and support being provided. One of the relatives we spoke with said 'The care here is superb. The staff really know how to look after people' and 'We are always made to feel welcome when we visit.' Another relative said, 'We have been most impressed with the home. It is like a family. They treat everyone with love, respect and care.'

All the people we spoke with said they or their relatives were always treated with dignity and respect. We were told the food was of a good quality and there was always a choice available. One person said 'The food is lovely.' We found there was an extensive programme of activities being delivered in the home by an activities coordinator who worked four afternoons a week. People and their relatives valued this service, which included both group activities and individualised sessions in people's rooms.