Archived: Kingsfield Care Centre

The service provided modern, purpose built accommodation. Staff provided personal and nursing care for up to 90 older people. The accommodation spanned three floors and offered various room size options for people. Bedrooms had on-suite facilities. There were plenty of communal areas and lifts were available for people to travel between floors. There were 56 people living in the service when we inspected, 39 people were accommodated in part of the service which was designed for people who needed nursing care or were living with developed dementia. The other parts of the service provided residential accommodation and nursing care to 17 people living with non-complex dementia. Nursing staff and care staff assisted people to manage chronic and longer-term health issues associated with ageing or after an accident or illness.

We carried out our last announced comprehensive inspection of this service on 25, 26 and 27 July 2016. Breaches of legal requirements were found. Accurate and complete records were not being kept, staff were not deployed in sufficient numbers and staff had not been receiving supervision. We also made a recommendation about the levels of staff training for end of life care. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches of Regulation 17 and Regulation 18 of the Health and Social Care Act Regulated Activities Regulations 2014, Good Governance and Fit and proper persons employed. The provider sent us an action plan, this told us they had already taken action and were now meeting the regulation. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Kingsfield Care Centre on our website at www.cqc.org.uk.

There was not a registered manager employed at the service. The person who had been registered left the service on 15 September 2017. 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. However, the provider was in the process of employing a manager. At the time of this inspection the service was being managed by the deputy manager (Acting manager).

At this inspection we found that some improvements had been made. Staff had been keeping up to date and accurate records of the care provided to people. Recruitment of new nursing and care staff had taken place, but the new staff had only just started their induction. However, the majority of people who gave us feedback about the service told us their experiences of the care and the management continued to be poor. Concerns remained about the stability of the management structures in the service and the consistent deployment of regular qualified nursing staff. At the time of this inspection the local authority in Kent had issued a safeguarding and poor practice warning against Kingfield Care Centre. This meant that the service still required improvement. We have made a recommendation about this.

The provider understood the challenges and issues faced by the service and had taken steps to improve people’s experiences of the care. However, the provider needed to do more to improve the outcomes for people in the service.

Staff received training that related to the needs of the people they were caring for. During the inspection all three of the nurses leading the day staff were agency nurses. The acting manager told us that five new nurses had been recruited and four new nurses had started their induction on the first day of our inspection.

The provider had a system in place to assess people’s needs and to work out the required staffing levels. However, we could not fully assess the staffing levels impact on the service because the provider was still in the process of recruiting and training staff and there were 24 vacant rooms in the service, which was not running at full capacity.

The leadership in the services had not been stable. People, their relatives and external health and social care professionals could not always tell us that they experienced well-led safe care.

Staff supervisions had improved, but were not consistent having been affected by large movements of staff out of and into the service. We could not fully assess if the current management structure in the service could effectively sustain staff meetings and supervisions with a designated line manager to discuss their work performance. We have made a recommendation about this.

There were systems in place to monitor the quality of the service, which included gaining the views of people and their relatives. People felt confident to raise a concern or complaint, but were not always sure their concerns would be acted on.

All staff understood their responsibilities to protect people from harm and were encouraged and supported to raise any concerns.

Records about the care people had received were now up to date and completed.

Agency nursing staff had the skills and experience to advise care staff and to meet people’s needs. The acting manager provided nurses with clinical training and development.

The provider and acting manager had contingency plans in place to reduce the impact on people’s care from foreseeable emergencies. Equipment and the environment were maintained, checked and tested to minimise the risks of potential harm.

There were policies in place for the safe administration of medicines. Nurses and accredited staff were trained in the safe administration of medicines, gained people’s consent before giving a person their medicines and appropriate records were kept.

People's care plans and risk assessments contained information about their personal history and support needs that enabled staff to support them safely. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or make sure people were protected from harm. Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced.

The environment was clean and some of the design features benefitted people living with dementia including themed areas and signage. The service planned to make further provision to improve outcomes for people living with dementia.

People had their health and nutritional needs assessed and monitored and referrals were made to health professionals when their needs changed. People were offered a choice at mealtimes which took into consideration their dietary requirements.

New staff received an induction which included shadowing existing staff. They were provided with a regular programme of training in areas essential to their role. Staff had received training in the Mental Capacity Act 2005 and understood its main principles. CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The acting manager had submitted and monitored DoLS applications so that people were not deprived of their liberty unlawfully.

Staff communicated with people in a kind manner and treated them with compassion, dignity and respect. Staff had developed positive and valued relationships with people and their family members.

A plan of care was developed for each person to guide staff on how to support people’s individual needs. Information had been gained about people’s likes, and what was important to them. These were regularly reviewed so that they contained the right information for staff to be able to support people.

People were offered a range of activities which included sensory activities that took into consideration the needs of people living with dementia.

The service provided modern, purpose built accommodation. Staff provided personal and nursing care for up to 90 older people. The accommodation spanned three floors and offered various room size options for people. Bedrooms had on-suite facilities. There were plenty of communal areas and lifts were available for people to travel between floors. There were 76 people living in the service when we inspected. Nineteen people were accommodated in part of the service which was designed for people who needed nursing care. Nursing staff and care staff assisted people to manage chronic and longer-term health issues associated with aging or after an accident or illness. This included compassionate end of life care. The other parts of the service provided residential accommodation and nursing care to 55 people living with non-complex dementia.

This inspection was brought forward due to concerns we had received about the quality of care in the service. At a previous inspection on 10 and 14 September 2015, we identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to people’s care needs not being kept up to date. At this inspection improvements had been made and people’s care plans reflected the most recent information about them. We also made a recommendation about improving the way the computerised and paper based records system operated.

There was not a registered manager employed at the service. 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. However, the provider had appointed a person into the registered manager role.

During the process of transition between registered managers the service had been managed by an experienced manager from another home in the same organisation.

Staff received training that related to the needs of the people they were caring for and nurses were supported to develop their professional skills maintaining their registration with the Nursing and Midwifery Council (NMC). However, staff delivering end of life care had not received any end of life care training. We have made a recommendation about staff training.

The provider had a system in place to assess people’s needs and to work out the required staffing levels. However, our observations indicted that the provider had not ensured that they employed enough nursing and care staff to meet people’s assessed needs at all times. Not all staff absences were covered so that people could experience consistent care delivery. For example, activities or timely staff responses to their request for care.

Staff were not consistently meeting with their line managers to discuss their work performance and the system in place for staff supervisions and appraisals was not up to date.

Records about the care people had received were not always up to date or fully completed.

Nursing staff had the skills and experience to lead care staff and to meet people’s needs and the deputy manager provided nurses with clinical training and development. There was an appointed nurse with responsibility for infection control. However, nursing staff morale was low due to on-going changes to the way nurses were deployed within the service. Nurses could be deployed on different floors on different days. This had led to situations where communications between nurses had not been followed up. For example, messages left for the next nurse on that floor to follow-up had not been acted on.

The provider and manager ensured that they had planned for foreseeable emergencies, so that should emergencies happen, people’s care needs would continue to be met. Equipment in the service had been tested and maintained. However, there was a lack of clarity around who was responsible for ensuring that risk within the environment were properly managed. For example, not all of the recommendations from the most recent review of the fire risk assessment in September 2015 had been implemented or assessed.

There were policies in place for the safe administration of medicines. Nursing staff were aware of these policies and had been trained to administer medicines safely.

Nursing staff assessed people’s needs and planned people’s care. They worked closely with other staff to ensure the assessed care was delivered. General and individual risks were assessed, recorded and reviewed. Infection risks were assessed and control protocols were in place and understood by staff to ensure that infections were contained if they occurred.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. Restrictions imposed on people were only considered after their ability to make individual decisions had been assessed as required under the Mental Capacity Act (2005) Code of Practice. The manager understood when an application should be made. Decisions people made about their care or medical treatment were dealt with lawfully and fully recorded.

People were supported to eat and drink enough to maintain their health and wellbeing. They had access to good quality foods and staff ensured people had access to food, snacks and drinks during the day and at night.

Staff had received training about protecting people from abuse and showed a good understanding of what their roles and responsibilities were in preventing abuse. Nursing staff understood their professional responsibility to safeguard people. The manager responded quickly to safeguarding concerns and learnt from these to prevent them happening again.

Incidents and accidents were recorded and checked by the manager to see what steps could be taken to prevent these happening again. The risk was assessed and the steps to be taken to minimise them were understood by staff.

People had access to qualified nursing staff who monitored their general health, for example by testing people's blood pressure. Also, people had regular access to their GP to ensure their health and wellbeing was supported by prompt referrals and access to medical care if they became unwell.

Recruitment policies were in place. Safe recruitment practices had been followed before staff started working at the service. This included checking nurse’s professional registration.

We observed staff that were welcoming and friendly. People and their relatives described staff that were friendly and compassionate. Staff delivered care and support calmly and confidently. People were encouraged to get involved in how their care was planned and delivered. Staff upheld people’s right to choose who was involved in their care and people’s right to do things for themselves was respected.

If people complained they were listened to and the manager made changes or suggested solutions that people were happy with. Actions taken were fed back to people at residents and relatives meetings. The provider collated formal feedback from people, their relatives and staff to drive improvements within the service.

The manager of the service and other senior managers were experienced and understood the issues and challenges the service was facing and had been working to correct these. They were assessing and reviewing the action plans they had implemented to improve the quality of the service. The progress of the action plans had been communicated up to the provider organisation through its internal quality monitoring systems. This was reflected in the changes they had already made within the service.

We found 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 this report.

The report is based on our observations during the inspection, talking with four staff who worked in the home, and reviewing records. We also talked with the deputy manager.

Kingsfield Care Centre includes three different units catering for people with specific needs such as dementia and nursing care.

During this inspection we set out to answer one question; Is the service effective?

Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service effective?

We saw the home had a training plan for all staff that worked in the home. The training plan showed that some staff had not undertaken training which would support them to safely meet people's documented care needs.

Staff said that they felt well supported by the management team. This included practical support. For example, support to use computers to undertake e-learning courses.

We will inspect the home again to ensure that the training that was planned had been completed, to ensure that people receive care and support from staff with the appropriate training, skills and knowledge.

The report is based on our observations during the inspection, talking with ten people who used the service, four relatives, five staff who were working in the home, and reviewing records. We also talked with the manager and the deputy manager.

Kingsfield Care Centre includes three different units catering for people with specific needs such as dementia and nursing care.

During this inspection we set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

Staff told us that they understood their responsibilities for reporting concerns and we saw that appropriate training and guidance was in place to ensure that people were protected from harm. We saw that a whistleblowing policy was in place and information about this was on display.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We spoke with the manager about the applications they had made to the court of protection under the Deprivation of Liberty Safeguards. They demonstrated a sound understanding of the circumstances that would mean an application needed to be made. This meant that appropriate applications were made when necessary.

Is the service effective?

We saw that people's needs were assessed and care was delivered to meet their documented care needs. Staff we spoke with understood people's care needs and demonstrated that they knew how to meet people's needs and what to do if they noticed any changes or concerns. We found that the home worked proactively to meet the needs of a range of people. Not all of the staff had received training relevant to their roles, many staff required update training.

Is the service caring?

People were supported by staff who were kind and attentive. We saw positive interactions between staff and the people they supported. People were supported to eat and drink at their own pace. People with mobility difficulties were also supported by staff to move at their own pace around the home. People who lived in the home told us they were well cared for and staff listened to them.

Is the service responsive?

We found that the managers of the home acted to address concerns as soon as they were noted. When referrals to other professionals were required these were made in a timely manner. People had access to activities they enjoyed and they were able to make suggestions concerning what they would like to do at residents' meetings. People were given forums for making their views known and suggestions were acted on when possible.

Is the service well-led?

Staff we spoke with told us that the managers of the home were approachable and they were able to seek advice and guidance whenever it was required. We looked at the way the quality of the service was assessed and monitored. We found that a number of audits, visits and checks were made by the managers within the home. This meant that home was overseen to ensure the service was well-led and meet the needs of the people who lived there.

We found that there were processes in place to discuss people's care plans with them, and to arrange for them to consent to different aspects of their care and support.

The staff ensured that people's health needs were met, and contacted other health professionals appropriately.

People said there were lots of activities and entertainment in the home.

We saw that the home was visibly clean in all areas, and there were reliable procedures in place for the ongoing cleanliness of the premises and equipment.

We found that staff were noticeably present throughout the home, and responded promptly when people called. There were sufficient numbers of staff to meet people's needs.

The service had systems in place to obtain people's views on a regular basis, and to monitor the way in which the service was being carried out.

We found that the complaints procedure was available for people to access; and that concerns and complaints were properly investigated and responded to.

Relatives' comments included:' The home is brilliant, the staff are brilliant. I have no concerns at all. The care is very good.' And 'I feel really confident that when I go home I am leaving my relative in safe hands. They look after her very well.'

People said that the food was 'very good' and they had plenty of choice. One said 'The only problem I have with the food is that it is sometimes too good and I eat too much!'

We found that recruitment [procedures were satisfactory, but that action needed to be taken to bring two areas up to date. The staff started to implement this during our visit. The home was reliable in carrying out ongoing staff training for mandatory subjects, and for dementia care.

People said that they were asked for their views, and felt that these were taken into account. They said that they could speak to the nurses on duty or the manager, and felt sure that action would be taken to address any concerns.