Archived: Kingswood Lodge Residential Care Home

Kingswood Lodge Residential Care Home provides accommodation and personal care for up to 21 older people, some of whom are living with dementia. The accommodation is set over two floors. There were seven people using the service at the time of our inspection.

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

This was our third inspection where the provider and registered manager did not have effective systems or processes in place to assess the quality and safety of the service. The principles of good quality assurance were not understood and there was little or no evidence of learning and service improvement. Audits were incomplete or non-existent.

Care plans and risk assessments remained a concern. They did not always reflect people’s current care and support needs. They had not always been updated following accidents and incidents. The information in some of them was incorrect or missing. This put people at risk of unsafe care.

Some medicines were still stored unsafely. Medicines records were incomplete, and the quality of recording was poor. A person’s turning chart had not been fully completed and we could not be sure they had been repositioned as required.

The condition of the premises remained a concern. Although the provider had made some improvements, we found broken and stained tiles in a bathroom, water damage in a person’s bedroom, an unsafe, unsecured cupboard in another person’s bedroom, and other hazards and unhygienic areas throughout the premises.

Staff training was still an issue. The registered manager was unwilling or unable to share the staff training matrix with us so we could not be sure that staff had had the training they needed to provide safe, good quality care.

Some relatives thought the service was safe, but others had concerns about falls management, the quality of the care and support provided, and communication. A relative said, “Care plans are wrong and a mess. No activities. No trips out. Poor communication with management.”

During our inspection we asked the registered manager to provide us with records to demonstrate the service was running effectively. These were not sent to us. We intended to go back to the service to carry out further checks but the provider closed the service before we had the chance to do this.

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

Rating at last inspection and update.

The last rating for this service was Inadequate (report published 17 June 2022). At this inspection we found the provider remained in breach of regulations.

The overall rating for the service has remained the same. This is based on the findings at this inspection.

Why we inspected

We carried out an unannounced focused inspection of this service on 15 March 2022. Breaches of legal requirements were found. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Kingswood Lodge Residential Care Home on our website at www.cqc.org.uk.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified breaches in relation to the premises and equipment, safe care, staffing, and governance.

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

Follow-up

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measure’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe,  and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.

Kingswood Lodge Residential Care Home provides accommodation and personal care for up to 21 older people, some of whom are living with dementia. The accommodation is set over two floors. There were 14 people using the service at the time of our inspection.

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

The provider and registered manager still did not have effective systems or processes in place to assess the quality and safety of the service. The audits carried out were not always fit for purpose. This put people at risk of unsafe care.

Staff did not always have the information they needed to keep people safe. People’s care plans/risk assessments were not always updated following accidents and incidents. Staffing levels had improved, but not all staff had had the essential training they needed.

Medicines were not always stored and administered safely. The premises needed further upgrading and improving. We found ripped, worn, and stained carpets, and unsafe equipment being used at the service.

Relatives comments about the service were mixed. Most relatives said the registered manager and staff were kind, caring and approachable. Some relatives expressed concerns about the condition and safety of the premises.

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

Rating at last inspection and update.

The last rating for this service was Inadequate (report published 18 January 2022). At this inspection we found the provider remained in breach of regulations.

The overall rating for the service has remained the same. This is based on the findings at this inspection.

Why we inspected

We carried out an unannounced focused inspection of this service on 8 December 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve Safe and Well-led.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained as Inadequate.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Kingswood Lodge Residential Care Home on our website at www.cqc.org.uk.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified breaches in relation to the premises and equipment, safe care, staffing, and governance.

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

Follow-up

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measure’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe, and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.

Kingswood Lodge Residential Care Home is a residential care home providing personal care for up to 21 older people living with dementia, the accommodation is set over two floors. There were 15 people living at the service at the time of the inspection.

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

The provider and registered manager failed to have systems or processes in place to assess the quality and safety of the service. The lack of oversight in infection prevention and control, health and safety, fire safety, food safety, care plans or medicine records placed people at risk of harm.

Staff did not have current or accurate information about people’s needs as care plans and risk assessments were not up to date or reflective of people's needs.

People were at risk of not being able to summon help if required as call bells were not within people’s reach.

People did not always receive their medicines in a safe way, systems and oversight measures for medicines were not effective. This placed people at the risk of harm.

There were not enough staff deployed to meet people’s needs. The provider had failed to ensure sufficient staff were deployed to carry out cleaning or support people with activities.

Infection control risks were not assessed, and government guidance was not being followed to minimise the risk of infection to people using the service.

The provider failed to respond appropriately to concerns raised by relatives.

The provider failed to act in a timely way to safety concerns raised at our inspection visit or complete action plans set by other agencies.

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

Rating at last inspection

The last rating for this service was good last report (published 08 June 2018)

Why we inspected

We received concerns in relation to the safety and wellbeing of people using the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Kingswood Lodge Residential Care Home on our website at www.cqc.org.uk

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified breaches in relation to the safe care and treatment, premises and equipment, staffing and governance at this inspection. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We inspected Kingswood Lodge on 1 May 2018 and the visit was unannounced. This meant the staff and the provider did not know we would be visiting.

Kingswood Lodge provides personal care and accommodation for up to 21 older people. On the day of our inspection there were 16 people living at the service. At the last inspection in January 2016, the service was rated ‘Good’. At this inspection, we found the evidence continued to support the rating of ‘Good’ and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service had a 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.

People told us they felt safe living at Kingswood Lodge and felt safe with the staff team who supported them. The staff team had received training in the safeguarding of adults and knew their responsibilities for keeping people safe from avoidable harm. This included reporting their concerns to the registered manager and the management team.

People’s needs had been identified and the risks associated with their care and support had been assessed and reviewed. Action was taken and lessons learned when things went wrong. This made sure safety across the service continually improved.

Checks had been carried out on new members of staff to make sure they were suitable to work at the service and relevant training had been provided. People felt there were enough members of staff on duty each day because their care and support needs were being met. Their relatives agreed with what they told us.

The staff team felt supported by the registered manager and the management team. They were provided with the opportunity to share their views of the service through, day to day discussion, supervision and appraisals. Team meetings were also held.

People on the whole received their medicines as prescribed. Appropriate records were being kept and systems were in place to regularly audit the medicines held.

People were provided with a clean and comfortable place to live and there were appropriate spaces to enable people to either spend time on their own, or with others. Training in the prevention and control of infection had been completed by the staff team and the necessary protective personal equipment was available to use.

The registered manager had assessed people’s care and support needs prior to them moving into the service to make sure they could be met by the staff team. The staff team knew the needs of the people they were supporting because plans of care were in place which included people's personal preferences.

People's food and drink requirements had been assessed and a balanced diet was being provided. Records kept for people assessed as being at risk of not getting the food and drinks they needed to keep them well were kept up to date.

People were supported to maintain good health. They had access to relevant healthcare services such as doctors and community nurses and they received on-going healthcare support.

Staff members were aware of their responsibilities under the Mental Capacity Act 2005 and people had been involved in making day to day decisions about their care and support. The staff team understood their responsibilities with regard to gaining people's consent to their care and support.

A formal complaints process was displayed and people knew who to talk to if they had a concern of any kind. Complaints received by the registered manager and the management team had been appropriately managed and resolved.

The staff team were kind and caring and people's privacy and dignity was respected and promoted.

The staff team had received training to enable them to properly support a person at the end of their life.

Relatives and friends were encouraged to visit and they told us they were made welcome at all times by the staff team.

A business continuity plan was available to be used in the event of an emergency or untoward event and personal emergency evacuation plans were in place should people using the service need to be evacuated from the building.

Systems were in place to regularly monitor the quality of the service being provided.

Further information is in the detailed findings below.

We spoke with five people living in the home at the time of the inspection. Whilst the majority of people spoke into told staff were available when needed, there were two comments received about staffing levels not always being sufficient to meet people's needs.

This was a mixed inspection. Most people living in the home said that staffing levels were sufficient. However, the provider agreed that staffing on some daytime and evening shifts was not at a sufficient level. He has now provided us with evidence that staffing has been increased on the shifts.

There were some issues of concern. Staff need to always explain to people in a respectful manner as to why some requests cannot be met. The manager needs to assess moving and handling practice for one person to ensure this is carried out safely.

We spoke with eleven people living in the home at the time of the inspection. A large majority told us that that were satisfied with the care that staff provided them with.

A person told us that she was happy living in the home: 'Staff are good. They have always treated me properly'. Another person said: 'Most of the staff are friendly. One staff member needs to be friendlier'.

We spoke with the relatives of five people. They all told us that they thought their relatives received good care.

One relative said; 'Staff have always treated my mother well. It is much better here than the other home she was in'.

We spoke with a community nurse. She said she had never seen anything which had concerned her.

Overall this was a positive inspection. Most people living in the home and all the relatives we spoke with said that they had been satisfied with care. We saw that people received swift medical attention if they were injured.

There were some issues of concern. Staffing levels needed to be maintained at all times to ensure people did not have to wait a long time to have their care needs met. The manner of a small number of staff needed to be improved, to ensure proper respect is shown to people at all times.

A person told us that he had no problems: 'Staff come quickly if I need them'. Another person said: 'I don't like it when some staff speak down to me'.

We spoke with the relatives of two people. They all told us that they thought care was good and staff were always welcoming.

One relative said; 'I have never seen anything that concerned me'.

We received some comments of concern: four people said that the attitude of some staff was not good. They said that some staff had been abrupt and impatient.

We spoke with a community nurse. She said staff were good at alerting them as needed, they were helpful, and they used equipment appropriately. However, the manner of some of the staff was stern. They told people what to do rather than encouraged them.

This was a mixed inspection. Half the people living in the home and relatives we spoke with said that they were satisfied with care. However, the other half of the people told us that they were concerned with the attitude of some staff. The service needs to ensure that the attitude of staff is always calm and friendly and that people receive swift medical attention if they are injured.

A person told us that staff were helpful and friendly: 'Staff try their best '.

We spoke with five relatives. They all told us that the care provided was of a high standard and that staff were always friendly.

One relative said; 'I have no concerns. There is always a good atmosphere in the home '.

We received some comments of concern: three people said that some staff did not take care when moving them. They were not deliberately harmful but they could be gentler. One person said that some residents got more favourable treatment than her.

This was a mixed inspection. Most people living in the home and their relatives, said that they were satisfied or mainly satisfied with care. However, we found that most of the essential standards we inspected were not met. The service needs to ensure that care always meets people's needs, fire precautions are fully in place, proper infection control measures are always followed, and medication is properly administered. Premises need to be upgraded, all necessary equipment needs to be in place, that people's information is kept confidentially, and proper quality assurance is carried out to ensure high standards at all times.