Archived: Kingfishers Nursing Home

Updated 18 May 2017

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.

The inspection took place on 4 January 2016 and 5 January 2016 and was unannounced. The inspection was undertaken by one adult social care inspector, two specialist advisors and an Expert by Experience. One specialist advisor was a registered nurse and the other was a health and safety consultant. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

For this inspection we asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We reviewed information we already held about the service. This included previous inspection reports and notifications we had received. A notification is information about important events which the service is required to send us by law. We asked the local authority teams, clinical commissioning groups (CCG), fire authority and environmental health officer for information to aid planning of our inspection. We checked information held at Companies House and the Information Commissioner’s Office.

We spoke with five people who used the service and three relatives. We spoke with the nominated individual, operations manager, home manager, deputy manager and two administrators. We spoke with two registered nurses, nine care workers, an activities coordinator, two cleaners and the chef. Outside of the inspection we spoke with a GP and a social worker.

We looked at eight sets of records related to people’s individual care needs. These included care plans, risk assessments and daily monitoring records. We also looked at four personnel file and records associated with the management of the service, including quality audits. We asked the provider to send further documents after the inspection. The provider sent documents to us after the inspection for use as additional evidence.

We looked throughout the premises and observed care practices and people’s interactions with staff during the inspection.

Updated 18 May 2017

Kingfishers Nursing Home is a care home with nursing located in a quiet residential area of Bourne End. The provider operates only this location as a condition of their registration. The service provides accommodation and nursing care to older adults, some with dementia-type diagnoses. This is a house that has been converted into a care home. The location is registered to accommodate up to 46 people. At the time of the inspection, 33 people used the service.

At the time of the inspection, there was no registered manager. 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 new home manager had commenced processes to enable her to register with us.

Since transitional registration under the Health and Social Care Act 2008 in October 2010, Kingfishers Nursing Home has not always maintained compliance with the relevant regulations at each inspection by us. The most recent inspection was a comprehensive visit on 28 October 2015 and 29 October 2015 under the Health and Social Care Act (Regulated Activities) Regulations 2014. The inspection resulted in an overall rating of requires improvement, with requires improvement in key questions safe, effective and responsive. There were breaches of two regulations: Regulation 15 (safety and suitability of premises) and Regulation 18 (staffing). Requirements were issued. No action plan was requested from us.

This inspection was the second visit under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the second comprehensive rating. The purpose of the inspection was to determine whether the provider had reached compliance with the outstanding breaches of regulations and to determine the quality and safety of care. The dates of this inspection were planned in accordance with our current methodology of visiting a service one year after any prior overall rating of requires improvement.

People were safeguarded from abuse and neglect. There was a system in place to ensure that people’s safety was maintained.

People’s risks were assessed, mitigated, documented and reviewed. Appropriate records were kept and readily available to demonstrate this to us at the inspection.

The safety of the premises and equipment were inadequately assessed and managed which placed people, staff and visitors at risk. There were poor infection prevention and control processes in place.

Recruitment processes failed to comply with the relevant regulation and schedule of information required in staff personnel files.

Enough staff were deployed to support people. Staff we spoke with were satisfied that there was sufficient staff and that they did not place people at risk when they were busy. Our observations showed that the service was busy at certain times, but overall calm and relaxed and staff were dedicated to the people they supported. We made a recommendation about the deployment of staff.

Medicines were usually well-managed. We examined the handling of people’s medicines during our inspection and found that people were safe from harm. Storage of some medicines was incorrect. We referred our findings to the clinical commissioning group (CCG) so that pharmacist support could be provided. We made a recommendation about the use of medicines best practice procedures.

Staff were knowledgeable and competent. They received appropriate levels of training and supervisions. More focus was required on completion of staff performance appraisals.

The service followed the requirements of the Mental Capacity Act 2005 (MCA). The recording of consent and best interest decisions meant the service complied with the MCA codes of practice. There was clear information at the service regarding people’s applications, reviews and expiry dates for standard DoLS authorisations.

People received nutritious food which they enjoyed. Hydration was offered to people to ensure they did not become dehydrated. Snacks and treats were available if people wanted or chose to have them. We made a recommendation about displaying alternative menu choices for people.

We found the service was caring. People and relatives complimented the care. We observed staff were warm and friendly. As staff had worked with most people over an extended period of time, they had come to know each person well.

Responsive care was not always provided to people. On some occasions, staff were observed to be focussed on personal care tasks rather than the individual they were with. Their wishes, preferences, likes and dislikes were considered and accommodated. The service’s complaints procedure was not robust and required improvement.

The workplace culture at the service was good. Staff described a positive place to work and care for people. Staff told us they enjoyed their roles and found management approachable and reasonable. Limited audits of the service were conducted to check the safety and quality of the care. We made a recommendation regarding the scope and frequency of audits. The duty of candour process required full implementation in line with the relevant regulation. We made a recommendation about his in the report.

We found three 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.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

You can see what action we told the provider to take at the back of the full version of the report.