Archived: Kingsgate Residential Home

Kingsgate is a residential care home providing personal care to people aged 65 and over at the time of the inspection. On the day of our first visit there were 24 people living in the service with one person in hospital. When we visited on the second day, 22 people were living in the service and three people were in hospital. The service can support up to 33 people.

Kingsgate is comprised of three large terraced houses and is set across three floors. People share bathing facilities and there are a number of communal lounges and a large dining room.

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

At this inspection we found the provider had not taken any action to address the concerns found at the previous inspections in March 2019, and January 2020. At this inspection in December 2020, we found continued breaches of three of the regulations.

Management of risks within the environment and to people’s individual needs were poorly managed. Serious risks within the environment which posed a risk of harm to people were not identified, and appropriately managed. Risk assessments in relation to behaviour that challenges were not in place.

Records of accidents and incidents were not detailed, nor consistently recorded. Opportunities to learn from incidents were missed due to the lack of thorough investigation of incidents.

Notifiable incidents were not always reported to the Care Quality Commission as they are required to by law

Staff compliance with training was poor, and not all staff had completed training in safeguarding. However, staff understood what constituted abuse and people felt safe living in the service.

Methods used to determine staffing levels were not thorough, and staff told us they did not always have time to spend with people outside of delivering personal care.

Some gaps were found in people’s medicine administration records. There were protocols in place for when required medicines were needed, and staffs’ competencies in relation to administering people’s medicines had been assessed.

Some equipment was found to be dirty, but action was taken to address this during the inspection visit. There was a delay in implementing increased cleaning of the home in light of the pandemic and policies and procedures in relation to COVID-19 were not sufficiently detailed.

Processes to assess and monitor the safety and quality of the service being delivered remained ineffective. The provider did not undertake any quality monitoring to gain an overview of the service.

Processes were in place to engage people who lived in the service, their relatives and staff. Meetings were held for people and staff, but sometimes information pertinent to people living in the service and the staff was not discussed.

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 28 February 2020) and there were four breaches of the regulations which were safe care and treatment, need for consent, good governance and notification of other incidents. At this inspection we found the provider remained in breach of three of these regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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

The overall rating for this service has changed from requires improvement to inadequate. This is based on the seriousness of concerns found at this inspection.

We have found evidence that the provider needs to make significant improvements. Please see the safe and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this report.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Kingsgate 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.

At this inspection we have identified breaches of regulation in relation to safe care and treatment, good governance, and notification of incidents.

Please see the action we have told the provider to take at the end of this report.

Follow up

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 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.

Following the inspection, the provider made a decision to close the service. The local authority and provider supported people to find alternative residential care homes and the last person left the service on 11 February 2021.

Kingsgate Residential Home is a residential care home providing personal care and support for 24 people aged 65 and over at the time of the inspection. The service can support up to 33 people.

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

At this inspection we found the provider had still not taken sufficient action to achieve compliance with the regulations. At our last inspection we found the provider was in breach of five of the regulations. Whilst some improvements had been made, the provider remained in breach of four of the regulations.

There was still a lack of effective quality assurance systems in place to monitor and assess all areas of the service. Some audits had been implemented, but these were still ineffective.

People’s care records did not contain enough detail and the needs of some people had not been assessed and planned for. Risks relating to people’s health and wellbeing were not managed robustly.

Reports of accidents and incidents were not detailed, and notifiable incidents had not been reported in line with the regulatory requirements.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People were cared for in a respectful way and felt involved in the planning of their care and treatment, along with their relatives. There was a lack of provision for people to take part in activities, but work was being undertaken to improve this.

There were opportunities for people and their relatives to provide feedback about the service and action plans were in place to address any concerns raised.

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 (published 8 July 2019) and there were five breaches of the regulations. 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 four of regulations.

Following the last inspection we placed conditions on the provider’s registration. This meant the provider was required to send us monthly action plans to show what action they were taking in response to the concerns we found. These conditions will remain in place as the provider has not made enough improvement.

Why we inspected

This was a planned inspection based on the previous rating.

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

Enforcement

We have identified breaches in relation to safe care and treatment, need for consent, good governance and notification of other incidents at this inspection.

Please see the action we have told the provider to take at the end of this report.

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.

Special Measures:

The overall rating for this service is ‘Requires improvement’. However, the service will remain in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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, 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.

People’s experience of using this service:

People who live at Kingsgate Residential Home were not always having their needs met by sufficient numbers of staff. Environmental risks and concerns around medicines management were identified which did not ensure people’s safety. Leadership and governance arrangements within the service were of concern, as they were not always identifying shortfalls and making changes to address them. There were breaches of regulation impacting on the quality of service provided to people.

The service was not consistently following advice from healthcare professionals. We identified gaps in recording of care tasks including repositioning people, monitoring of toileting, therefore we were unable to source assurances people’s care and support needs were always met.

People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible; policies and systems in the service were not followed to support good practice.

Service cleanliness was of a consistent standard, making the care environment comfortable. People were accessing activities and where able, people accessed the local community. Staff treated people with kindness and were polite, however did not always maintain people’s privacy and dignity.

Management plans were in place for people needing support at the end of their life. The service had good working relationships with health and social care organisations to ensure people received joined up care.

People and their relatives were encouraged to give feedback on the service, and areas for improvement through satisfaction questionnaires.

Rating at last inspection: This was the first inspection of Kingsgate Residential Home since registering as a change of provider in November 2017.

Why we inspected: We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions.

Enforcement: At this inspection, we identified breaches of regulation 11, 12, 17 and 18 and Registration regulation 18. Full information about CQC's regulatory response to any breaches of regulation found during inspections is added to reports after any representations and appeals by the provider have been concluded.

Follow up: We will continue to monitor this service and will reinspect in line with our schedule for those services rated as Inadequate. As an outcome of this inspection, the decision was made for the service to be placed in special measures.

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