Archived: Kingsmead Care Centre

The service was registered for the support of up to 34 people. At the time of the inspection 19 people were using the service. The service consisted of one building. There was a designated part of the building called Kingsmead Haven, where all the people using the service with learning disabilities or autistic spectrum disorder lived. The service was in a residential street on the outskirts of a large town.

Kingsmead Care Centre 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.

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

There was unsafe assessment, monitoring and management of risk for people with support needs regarding constipation, behaviours that may challenge, aspiration, respiration, skin integrity, mobility and posture.

Staff practice regarding risks associated with people’s deteriorating health was not consistent to ensure that people’s well-being was being monitored and any concerns acted on.

Medicines were not always managed safely. People had not always received their medicines as intended when they needed them.

Staff practice, and reporting systems to safeguard people from abuse, were not always effective to ensure people were safe from harm. Lessons were not always learnt, and actions not taken to investigate safety incidents and prevent them re-occurring. Staff did not always have the required competencies or knowledge to meet people’s individual needs safely.

Service management and the provider’s wider quality assurance and governance systems had not always ensured actions were taken to address any issues and risks in a timely manner. People’s care records were not always up to date or accurate.

The provider had failed to act upon known areas of concern, non-compliance and risk to improve the quality of care for people at Kingsmead Care Centre. This had exposed people to on-going poor care and risk of avoidable harm.

The provider had acted to manage infections during the Covid-19 pandemic. Additional infection prevention and control measures in line with Department of Health and Social care guidelines had been put in place to ensure people’s safety.

Staff always wore personal preventative equipment (PPE) when supporting people. The provider had ensured there were adequate stocks and supplies of PPE available.

Staff had alerted appropriate external agencies in when they had displayed signs and symptoms of Covid-19. This had helped prevent infection and maintain people’s health and well-being.

A relative told us, “The manager has kept the place safe during Covid-19 they are incredibly strict about infection control and the home is always very clean all time”.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

The model of care and setting did not maximise people’s choice, control and

independence.

The model of care delivery at the service focused on people’s medical, rather than their social support needs.

The location of the service was not geographically isolated. However, people relied exclusively on staff to be able to leave. Opportunities for people to access the local community were limited.

Staff wore uniforms and name badges to say they were care staff when supporting people inside and outside the service.

The size of the service was larger than current best practice guidance. There were identifying signs on the road before the service’s private drive, the service grounds and on the exterior of Kingsmead Haven and Kingsmead Care Centre to indicate it was a care home.

Right care:

Care was not always person-centred or promoted people’s dignity, privacy and human

Rights.

Staff did not always respond in a timely or compassionate or appropriate way when people experienced pain or distress.

Right culture:

The provider told us they planned to make changes to ensure they could provide compassionate and inclusive support that promoted people’s choice and independence.

Staff and the manager said they cared about any issues affecting people living at the service and wanted to make improvements. We observed staff supporting some people in a positive manner during our inspection visits

However, significant work was still needed to change the existing culture, ethos, attitude and practice of staff at Kingsmead Care Centre in order to achieve this vision.

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 Requires Improvement (published 13 February 2020). The service has been rated requires improvement or inadequate for the last four consecutive inspections.

At the last inspection we found multiple breaches of regulations. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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 coronavirus and other infection outbreaks effectively.

We carried out an unannounced comprehensive inspection of this service on 3 and 5 September 2019. Breaches of legal requirements were found. We undertook this focused inspection to confirm the provider now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

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 not changed. 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 Care Centre 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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 regulations 12, 13, 17, 18 in relation to: safe care and treatment, safeguarding people from abuse, good governance and staffing.

We have also identified a breach of Care Quality Commission (Registration) Regulations 2009 in relation to failing to notify CQC of incidents regarding abuse or allegations of abuse in relation to service users.

We took enforcement action to issue a Notice of Decision to vary a condition of the provider's registration and remove this location. The Kingsmead Care Centre is now de-registered and the provider is no longer able to provide regulated activities at or from this location.

Follow up

We will continue to monitor information we receive about the service until we return to visit. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service remains 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 act 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.

Kingsmead Care Centre is a care home providing personal and nursing care to people with a range of needs in two units, both of which are located in one building. Kingsmead Haven provides nursing care and accommodation for people with a learning disability, physical disability and/or acquired brain injury and other complex needs. The nursing unit provides nursing care and accommodation for older people with a variety of healthcare needs and physical frailties including some people living with dementia. At the time of the inspection, nine people were receiving care in Kingsmead Haven and 11 people were receiving care in the nursing unit. The support can support up to 34 people.

Kingsmead Care Centre 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. This does not include Kingsmead Care Centre, but the investigation is on-going, and no conclusions have yet been reached.

Kingsmead Care Centre had been built and registered before the 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.

Kingsmead Care Centre requires further development to be able to deliver support for people that is consistent with the values that underpin RRS. For example, the care planning process did not always consider people’s goals, aspirations or promotion of independence.

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

Risks to people were not always assessed and mitigated. For example, risks associated with behaviours which challenge and moving and handling. People were not always supported to have maximum choice and control of their lives. The application of the Mental Capacity 2005 was inconsistent and capacity assessments were not always completed in line with legislation or in a person-centred way.

The provision of activities required further development. Activities were not consistently meaningful or tailored to people’s needs. The care planning process required further development to ensure people’s social and emotional needs were understood and met. Further work was required to ensure information about people’s care and treatment was always made available in the most accessible way. Staff were responsive to people’s needs, however, we observed an interaction whereby staff failed to recognise that a person was in distress.

Quality assurance frameworks were in place; however, these were not consistently effective in driving improvement or identifying shortfalls. Accurate documentation was not consistently maintained.

People told us that they felt safe living at Kingsmead Care Centre. Staff had received training on safeguarding adults and understood their roles and responsibilities to safeguard people from harm or abuse. The manager worked in partnership with healthcare professionals and learning was derived from incident, accidents and safeguarding concerns.

Staff felt supported and had access to a range of training. People’s nutritional needs were met and people spoke highly of the food provided. Risks associated with catheter care, constipation and diabetes were managed well. People had ongoing access to healthcare professionals and staff recognised and responded well to signs that a person’s health might be deteriorating.

Staff knew people well and demonstrated warmth towards the people they supported. People were involved in day to day decisions about their care and relatives could visit at any time.

A complaints policy was available in an accessible format and people told us that they would have no hesitations in making a formal complaint. People and staff spoke highly of the manager and the manager was compassionate about ensuring people received high quality care.

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

Rating at last inspection:

The service was last inspected in September 2018 and was rated as Requires Improvement (report published 4 February 2019). The provider was found to be in breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) 2014. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough, improvement had not been made and the provider was still in breach of regulations.

The last rating for this service was Requires Improvement (published 4 February 2019). The service remains rated Requires Improvement. This service has been rated Requires Improvement for the last three consecutive inspections.

Why we inspected:

This was a planned inspection based on the previous rating. You can see what action we have asked the provider to take at the end of this full report.

Enforcement:

We imposed conditions on the provider's registration, due to repeated and significant concerns about the quality and safety of care at several services they operate. The conditions are therefore imposed at each service operated by the provider, including Kingsmead Care Centre.

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 have identified breaches in relation to Regulation 12 (Safe Care and Treatment), Regulation 17 (Good Governance), Regulation 9 (Person Centred Care) and Regulation 11 (Need for consent)

Full information about the Care Quality Commission's (CQC) regulatory response to more serious concerns found in inspections and appeals is added to reports after any representation and appeals have been concluded.

Follow up:

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Kingsmead Care Centre 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.

Kingsmead Care Centre provides accommodation and nursing care to people with a range of needs in two units, both of which are located in one building. Haven provides nursing care and accommodation for people with a learning disability, physical disability and/or acquired brain injury and other complex needs. The nursing home provides nursing care and accommodation for older people with a variety of healthcare needs and physical frailties including some people living with dementia. Kingsmead Care Centre is registered to provide nursing care and accommodation for up to nine people in Haven and up to 25 people in the nursing home. There were nine people living in Haven and ten people living in the nursing home.

There was a well-established registered manager in post. A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run.

Kingsmead Care Centre has not been operated and developed in line with all the values that underpin the Registering the Right Support and other best practice guidance. Kingsmead Care Centre was designed, built and registered before this guidance was published. However, the provider has not developed or adapted Kingsmead Care Centre in response to changes in best practice guidance. Had the provider applied to register Kingsmead Care Centre today, the application would be unlikely to be granted. The model and scale of care provided is not in keeping with the cultural and professional changes to how services for people with a

learning disability and/or Autism should be operated to meet their needs. People with learning disabilities using the service should be able to live as ordinary a life as any citizen.

Services operated by the provider had been subject to a period of increased monitoring and support by commissioners. As a result of concerns raised, the provider is currently subject to a police investigation. The investigation is on-going and no conclusions have been made. We used the information of concern raised by partner agencies to plan what areas we would inspect and to judge the safety and quality of the service at the time of the inspection. Between May 2017 and July 2018, we have inspected a number of Sussex Health Care locations in relation to concerns about variation in quality and safety across their services and will report on what we find.

At our last inspection in June 2017 we rated the service Requires Improvement overall and the service was found to be in breach of legal requirements. At that inspection we found systems to assess and monitor the service were in place but these had not been sufficiently robust as they had not identified a lack of consistency and gaps within agency nurse training on specific subjects such as PEG management and learning disability training. Whilst people's risks had been assessed, identified and mostly managed appropriately, there had been a lack of guidance available for staff regarding people’s specific health needs such as asthma. We had also found that there was a lack of personalised activities provided.

This inspection found that improvements had been made and the breaches of Regulation 18 and 17 met, but there were still improvements to be made to fully meet Regulation 9. The overall rating has remained as Requires Improvement.

We found the activities and stimulation opportunities provided to people were still inconsistent across the home. People had activity plans in place however we found that not all people had received their specific activities as stated in their care plans. The provision of activities did not consistently meet people's needs and reflect their preferences. This is a continued breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

Whilst the provider had progressed quality assurance systems to review the support and care provided, there was a need to further embed and develop some areas of practice that the existing quality assurance systems had missed. This included updating care plans when an identified need or directive of care changed.

A number of audits had been developed, including those for accidents and incidents, care plans, medicines and health and safety. Maintenance records for equipment and the environment were up to date, such as fire safety equipment and hoists. Policies and procedures had been reviewed and updated and were available for staff to refer to as required. Staff said they were encouraged to suggest improvements to the service. Relatives told us they could visit at any time and, they were always made to feel welcome and involved in the care provided.

People spoke positively of the home and commented they felt safe. Our own observations and the records we looked at reflected the positive comments people made. Care plans reflected people’s assessed level of care needs and care delivery was person specific, holistic and based on people's preferences. Risk assessments included falls, skin damage, behaviours that distress, nutritional risks including swallowing problems and risk of choking, and moving and handling. For example, pressure relieving mattresses and cushions were in place for those who were susceptible to skin damage and pressure ulcers. The care plans also highlighted health risks such as diabetes and epilepsy. There were systems for the management of medicines and people received their medicines in a safe way. Staff and relatives felt there were enough staff working in the home and relatives said staff were available to support people when they needed assistance. The provider was actively seeking new staff, nurses and care staff, to ensure there was a sufficient number with the right skills when people moved into the home.

All staff had attended safeguarding training. They demonstrated a clear understanding of abuse; they said they would talk to the management or external bodies immediately if they had any concerns. Staff had a clear understanding of making referrals to the local authority and CQC. Pre-employment checks for staff were completed, which meant only suitable staff were working in the home. People said they felt comfortable and at ease with staff and relatives felt people were safe.

Nurses and care staff were involved in developing the care plans and all staff were expected to record the care and support provided and any changes in people's needs. The registered manager said all staff were being supported to do this and additional training was given if identified as required. People were supported to eat healthy and nutritious diets. Food and fluid charts were completed when risk of poor eating and drinking had been identified and showed people were supported to eat and drink.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service. This included the care of people with specific health needs such as swallowing difficulties (dysphagia), learning disabilities, acquired brain injury. Staff had formal personal development plans, including two monthly supervisions and annual appraisals. People were supported to make decisions in their best interests. The provider assessed people's capacity to make their own decisions if there was a reason to question their capacity. Staff and the registered manager had a good understanding of the Mental Capacity Act. Where possible, they supported people to make their own decisions and sought consent before delivering care and support. Where people's care plans contained restrictions on their liberty, applications for legal authorisation had been sent to the relevant authorities as required by the legislation.

Staff had a good understanding of people's needs and treated them with respect and protected their dignity when supporting them. People we spoke with were very complimentary about the caring nature of staff. People told us care staff were kind and compassionate. Staff interactions demonstrated staff had built rapport with people and they responded to staff with smiles. People previously isolated in their rooms were seen in communal lounges for activities, meetings and meal times and enjoyed the atmosphere and stimulation.

Further ideas for the prevention of social isolation were being discussed by the management team, such as sensory table equipment that will promote engagement with individual people. Staff had received training in end of life care and were supported by the Local Hospice team. Visits from healthcare professionals were recorded in the care plans, with information about any changes and guidance for staff to ensure people's needs were met. The service worked well with allied health professionals.

Staff said the management team was fair and approachable, care meetings were held every morning to discuss people's changing needs and how staff would meet these. Staff meetings were held monthly and staff were able to contribute to the meetings and make suggestions. Relatives said the management was very good; the registered manager was always available and they would be happy to talk to them if they had any concerns.

At this inspection we found a breach of regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We imposed 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

Since the previous inspection of Kingsmead Care Centre in October 2016, services operated by the provider had been subject to a period of increased monitoring and support by commissioners. Kingsmead Care Centre had been the subject of one safeguarding concern about person-centred care delivery. As a result of concerns raised across the provider’s 19 locations, the provider is currently subject to a police investigation. Our inspection did not examine specific incidents and safeguarding allegations which have formed part of these investigations. However, we used the information of concern raised by partner agencies to plan what areas we would inspect and to judge the safety and quality of the service at the time of the inspection. Between May and September 2017, we have inspected a number of Sussex Health Care locations in relation to concerns about variation in quality and safety across their services and will report on what we find.

Kingsmead Care Centre provides accommodation and nursing care to people with a range of needs in two units, both of which are located in one building. Haven provides nursing care and accommodation for people with a learning disability, physical disability and/or acquired brain injury and other complex needs. The nursing home provides nursing care and accommodation for older people with a variety of healthcare needs and physical frailties including some people living with dementia. Kingsmead Care Centre is registered to provide nursing care and accommodation for up to nine people in Haven and up to 25 people in the nursing home. At the time of our inspection the home had no vacancies. All rooms are of single occupancy, including two double rooms in the nursing home. In Haven, there is a large community room which is utilised for activities and as a sitting and dining area. In the nursing home, there is a large sitting room with activities area and a separate dining room.

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.

At the last inspection on 18 and 19 October 2016 the service was found to be complying with legal requirements and was given a rating of ‘Good’. However, at this inspection we found the quality of care and safety had deteriorated and we identified breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection we found systems to assess and monitor the service were in place but these were not sufficiently robust as they had not identified what we highlighted at this inspection such as a lack of consistency and gaps within agency nurse training on specific subjects such as PEG management and learning disability training.

At the last inspection we spoke with the provider about the need to ensure all staff received training on specific subjects relating to the needs of the people living at the home. Training opportunities had been provided since the last inspection however a significant amount of staff still needed to attend. At the last inspection in we found improvements were needed to ensure all staff received consistent supervision from their line manager. At this inspection we found improvements had been made and all staff were happy with the support they received and records confirmed this.

People's risks were assessed, identified and mostly managed appropriately. However, we found a lack of guidance available for staff regarding the support one person needed with their asthma. Other risk assessments were contained within people's care plans and were reviewed monthly or, as needed, following an incident or accident.

We found the activities and stimulation opportunities provided to people were inconsistent across the home. People had activity plans in place however on the day of the inspection there was a lack of personalised activities accessible for people living in the Haven Unit. We acknowledged the provider had recognised this gap. However, based on our observations this area required improvement to ensure activities offered are in line with all people’s abilities, needs and their wishes.

Staff had been trained to recognise the signs of potential abuse and people told us they felt safe living at the home. Staffing levels were assessed based on people's needs using a dependency tool. There were enough suitable staff available to meet people’s needs safely. Medicines were managed safely.

Staff understood how to gain people's consent to their care and treatment and had an understanding of the Mental Capacity Act 2005. People felt there was a good choice of food on offer and they were involved in menu planning at residents' meetings. People were supported to maintain good health and had access to a range of healthcare professionals and services.

Individual rooms were personalised in line with people's tastes and preferences. People were looked after by kind and caring staff who knew them well and how to meet their needs. People's personal histories, preferences, likes and dislikes were identified and included in their care plans. Relatives and friends could visit people freely and people were encouraged to maintain contact with them. Complaints were managed effectively and in line with the provider’s policy.

People were supported to express their views and to be involved in making decisions about their care. They were treated with dignity and respect.

Staff spoke positively and valued the support they received from the management team. The care staff team understood their role and responsibilities.

The registered manager was ‘hands on’ in their approach and knew people living at the home well. They understood their role in working alongside external agencies such as the West Sussex safeguarding team and the Commission. The registered manager was open to making improvements regarding what we had identified at this inspection to ensure people received safe and effective care.

At this inspection we found the service was in breach of three regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The last inspection took place in August 2015. As a result of this inspection, we found the provider in breach of a regulation relating to safe care and treatment and asked them to submit an action plan on how they would address this breach. An action plan was submitted by the provider which identified the steps that would be taken. At this inspection, we found that the provider and registered manager had taken appropriate action and the regulation had been met.

Kingsmead Care Centre provides accommodation and nursing care to people with a range of needs in two units, both of which are located in one building. Haven provides nursing care and accommodation for people with a learning disability, physical disability and/or acquired brain injury and other complex needs. The nursing home provides nursing care and accommodation for older people with a variety of healthcare needs and physical frailties; some people have associated dementia needs. Kingsmead Care Centre is a modern, purpose-built nursing home, situated in its own grounds, with gardens and dedicated parking. It is registered to provide nursing care and accommodation for up to nine people in Haven and up to 25 people in the nursing home. At the time of our inspection, nine people were living in Haven and 23 in the nursing home. Two of the beds in the nursing home are reserved for people who require short breaks or care and support that enables them to move back to their own home or into other care settings. All rooms are of single occupancy, including two double rooms in the nursing home. In Haven, there is a large community room which is utilised for activities and as a sitting and dining area. In the nursing home, there is a large sitting room with activities area and a separate dining room.

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.

People’s risks were assessed, identified and managed appropriately. A range of risk assessments were contained within people’s care plans and were reviewed monthly or, as needed, following an incident or accident. Staff had been trained to recognise the signs of potential abuse and people told us they felt safe living at the home. Staffing levels were assessed based on people’s needs using a dependency tool. In the nursing home, some staff felt rushed in delivering personalised care to people and that some people might have to wait for staff to attend to them, especially at busy times of the day. New staff were recruited following appropriate checks on their suitability. Medicines were managed safely.

Staff completed training in a range of areas and new staff followed the Care Certificate, a universally recognised qualification. Staff were required to attend supervision meetings three times a year and to have an annual appraisal. However, not all staff had received supervisions with this regularity and the provider had identified this as an area for improvement. Team meetings were organised. Staff understood how to gain people’s consent to their care and treatment, but some staff did not have a thorough understanding of the Mental Capacity Act 2005. People felt there was a good choice of food on offer and they were involved in menu planning at residents’ meetings. People were supported to maintain good health and had access to a range of healthcare professionals and services. Individual rooms were personalised in line with people’s tastes and preferences.

People were looked after by kind and caring staff who knew them well and how to meet their needs. People’s personal histories, preferences, likes and dislikes were identified and included in their care plans. Relatives and friends could visit people freely and people were encouraged to maintain contact with them. People were supported to express their views and to be involved in making decisions about their care. They were treated with dignity and respect. At the end of their lives, people’s wishes were taken account of and they were supported by trained staff to have a comfortable, dignified and pain-free death.

Care plans provided advice and guidance to staff on people’s care needs and the support they required. People were involved in reviewing their care plans. Activities were planned in Haven and in the nursing home. People in Haven often went out during the day and participated in a range of interests. Complaints were managed in line with the provider’s policy.

Residents’ meetings were organised so people could share their views about the home and discuss issues, for example, in relation to activities and menu planning. Formal surveys were also sent out to gather the views of people, their relatives and staff. Staff were positive about working at Kingsmead Care Centre and relatives were complimentary about the quality of care on offer. People and staff felt the home was well managed and that any concerns they had would be listened to. A range of audits measured and monitored the quality of care delivered and any improvements identified were acted upon.