Archived: Kingfishers Nursing Home

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.

We spoke with five people. They said they were happy living in the home. They praised the "very kind" staff and the "approachable and organised" manager. One person also told us how pleased he was with the new Activities Co-ordinator and said she was "doing a fine job."

We saw that improvements had been made to the home since our visit last year. This meant there were no hazards that would pose a risk to people who lived or worked there.

People expressed confidence in the skills and abilities of staff, and said they felt well-cared for, although they occasionally had to wait for someone to come to them. Staff told us they felt supported by their new manager, and that their training needs were met.

The manager showed us a comprehensive list of the checks she made to ensure the quality of the care provided was maintained. This demonstrated that the manager had systems in place to monitor and regularly assess the quality of the service delivered to people who live there.

Records accurately described the care provided. They were stored securely and in accordance with good practice.

People's needs had been assessed before a placement at the home had begun. This ensured their needs could be met appropriately. A comprehensive pre admission assessment was undertaken and included risk and needs assessments. Care plans addressed people's individual needs, were detailed, reviewed and updated regularly.

Daily activities were provided to those who wished to take part. These included trips out into the community as well as in house activities. One to one activities were provided to people who were nursed in bed.

The home was clean and tidy and people's bedrooms had been personalised.

Improvements had been made to the environment to ensure people were not at risk of tripping. However, we found some hazards that posed a risk to people who lived and worked in the home. For example inappropriate storage of an electrical iron and the exposure of some wires in the hairdressing salon.

The provider had systems in place to monitor and regularly assess the quality of service that people received.