Archived: Kingsmead Lodge

Updated 9 October 2020

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.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted as part of our Thematic Review of infection control and prevention in care homes.

Inspection team

The inspection took place over two days on the 18 and 19 August 2020. The inspection was undertaken by two inspectors.

Service and service type

Kingsmead Lodge 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.

The service had a manager employed but did not have a manager registered with the Care Quality Commission (CQC). At inspection, the manager had applied to CQC to be the registered manager for the service and their application was being processed. This means the provider held sole legal responsibility for how the service is run and for the quality and safety of the care provided.

Notice of inspection

We gave a short period notice of the inspection. This was because of the COVID-19 pandemic. We wanted to check if anyone was displaying any symptoms of the virus and to be aware of the provider’s infection control procedures.

What we did before the inspection

We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections.

We reviewed information we had received about the service since the last inspection. We spoke to professionals and relatives who have regular contact with the service. We used all of this information to plan our inspection.

During the inspection

We engaged with and observed seven people who used the service and received feedback from five relatives about their experience of the care provided. We spoke with 11 members of staff including the manager, seven care and auxiliary staff and three registered nurses. We spoke with three other people employed by the provider including a clinical nurse specialist, quality support manager and the chief executive officer (CEO) for Sussex Healthcare.

We reviewed a range of records. This included five people’s care and medication records. We viewed a variety of records relating to the management of the service, agency nursing profiles and training, quality audits and accident and incident records.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We continued to receive feedback from staff and health and social care professionals about the service.

Updated 9 October 2020

About the service

Kingsmead Lodge is a residential care service that is registered to provide accommodation, nursing and personal care for up to 20 people. Care and support was provided to people living with a learning disability or autistic spectrum disorder, physical disabilities and younger adults. At the time of this inspection Kingsmead Lodge was providing support for seven people.

Kingsmead Lodge is owned and operated by the provider Sussex Healthcare. Services operated by Sussex Healthcare have been subject to a period of increased monitoring and support by local authority commissioners. Due to concerns raised about the provider, Sussex Healthcare is currently subject to a police investigation. The investigation is on-going, and no conclusions have yet been reached.

Kingsmead Lodge had been built and registered before the Care Quality Commission (CQC) policy for providers of learning disability or autism services 'Registering the Right Support' (RRS) had been published. The guidance and values included in the RRS policy advocate choice and promotion of independence and inclusion, so people using learning disability or autism services can live as ordinary a life as any other citizen

The service was not operating in line with the values that underpin the 'Registering the Right Support' and other best practice guidance. Kingsmead Lodge is a purpose built care home for people with learning disabilities. It provides ground floor accommodation for up to 20 people. The internal features of the service did not reflect a domestic style property. For example, there were several offices close to the communal areas and people’s bedrooms, there was an industrial style kitchen and signage around the service indicated that people were living in a care home. Nursing and care staff wore uniforms which clearly identified they were employed to support people. The buildings design did not fit into the local residential area and there was external signage that identified it as a care home.

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

Risks to people's health and wellbeing were not consistently managed. People did not always receive safe support in relation to their epilepsy and complex eating and drinking needs. Systems used to monitor people’s health were not always applied consistently.

Processes in place for assessing and monitoring the quality of the service had failed to identify that people were not always protected from avoidable harm. People’s epilepsy was not always managed safely, and staff practice did not always ensure people received safe care. Safe care practices were not always recorded accurately within people’s care records.

People did not always receive support to meet their assessed mobility needs. This was due to a lack of partnership working between Kingsmead Lodge and physiotherapy services operated by Sussex Health Care. There was a lack of clinical oversight and agency nursing staff had not received regular clinical supervision.

People had received support to stay safe during the current national pandemic of COVID-19 and the service demonstrated good infection control procedures. Personal COVID-19 risk assessments had not been undertaken with staff to ensure their safety. We have made a recommendation to the provider about this.

Medicines were managed safely. Staff used positive behaviour support strategies to enable people to understand and manage their behaviour’s that may challenge. People were observed to be engaging positively with staff supporting them. The environment was bright, spacious and personalised and people’s craft and artwork were displayed. Visitors to the service provided consistently positive feedback about the manager and the service people received.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the following reasons; People did not always receive personalised care.

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

We last inspected this service in January 2020. The service was rated requires improvement (published 7 July 2020) and there were four breaches of regulations. At this inspection not enough improvement had been made and the provider was still in breach of regulations.

The service remains rated as requires improvement. This service has been rated as requires improvement for the last two consecutive inspections.

This service had been in Special Measures since September 2018. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

We carried out an unannounced comprehensive inspection of this service on 14 and 15 January 2020. Breaches of legal requirements were found in relation to Regulations 9 (Person Centred Care), 12 (Safe Care and Treatment),Regulation 18 (Staffing) and 17 (Good Governance). On 23 March 2020 we imposed conditions on the provider’s registration detailing that Kingsmead Lodge must submit a monthly report addressing actions taken to improve epilepsy care, the amount of clinical oversight at the service and actions to improve the use of NEWS and behaviours which challenge.

In January 2018 the Care Quality Commission imposed provider wide conditions on the provider's registration. The conditions are therefore imposed at each service operated by the provider. CQC imposed the conditions due to repeated and significant concerns about the quality and safety of care at a number of services operated by the provider.

The conditions mean that the provider must send to the CQC, monthly information about incidents and accidents, unplanned hospital admissions and staffing. We will use this information to help us review and monitor the provider's services and actions to improve, and to inform our inspections.

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. We looked at the previous breaches of Regulation 12 -Safe Care and Treatment and Regulation 17 -Good Governance. Not enough improvement had been made and the provider remained in breach of Regulation 12 and 17.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained requires improvement. 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 Kingsmead Lodge 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 have identified continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to Regulation 12- Safe Care and Treatment and Regulation 17- Good 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

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.