Archived: Kingston Nursing Home

Kingston Nursing Home is a residential care home providing personal and nursing care to 22 people aged 65 and over, at the time of the inspection. The service can support up to 47 people.

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

Following the last inspection in August 2020 improvements had been made to the care people received. The new manager and clinical lead with the support of the provider had made significant improvements in a short space of time. Whilst improvements had been made in a short amount of time and the service is no longer rated inadequate, the provider had yet to evidence sustained and continued improvements over a longer period of time.

Systems and processes had been introduced to ensure the service continued to improve. Numerous audits were regularly taking place to monitor the service. Policies and procedures had been put in place to ensure staff knew what was expected of them. Accidents or incidents were recorded and monitored, and learning was identified to reduce the risk of them happening again.

A refurbishment programme was underway at the location. The environment people lived in was improving which positively impacted on their experience of care. We have made a recommendation in relation to the environment.

People were protected from abuse and were treated with respect and dignity. Staff told us staffing levels

were good and were at a level where they could meet people's needs.

Improvements had been made to the management of medicines. People were supported by staff who had been trained to administer medicines.

Staff described the atmosphere and culture at the home as positive and enjoyed coming to work. They said they had observed the positive impact on people who they reported as ‘happier.’

Infection control procedures were in place and the home followed current government guidance to ensure people were protected from the transmission of infection. PPE stations were in place and staff had been trained to don and doff personal protective equipment. Cleaning staff knew how to ensure products were to be used to ensure effectiveness. Cleaning rotas and schedules were in place to ensure risks to people were minimised. Storage of excess PPE was an issue which the manager was looking into.

Rating at last inspection (and update)

The last rating for this service was inadequate (published 26 September 2020). This service has been in Special Measures since 26 September 2020. 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 inspected. Therefore, this service is no longer in Special Measures.

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 a focussed inspection of this service between18 and 24 August 2020. Breaches of legal requirements were found. 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 refer to 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 changed from inadequate to requires improvement. This is based on the findings at this inspection. This inspection was carried out to follow up on action we told the provider to take at the last inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Kingston Nursing Home on our website at www.cqc.org.uk.

Follow up We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Kingston Nursing Home is a care home registered to provide personal and nursing care for up to 47 people aged 65 and over, some of whom are living with dementia. During our visit there were 29 people living at the home.

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

People did not always receive safe care. Before and during this inspection we identified and reported safeguarding concerns. People’s medication was not always administered safely and we could not be sure all staff administering prescribed medication were competent to do so. Risks to people’s care were not always managed safely and staff’s knowledge was not robust. During this inspection, we could not be sure people would always be appropriately supported in the event of a fire. The environment was not always clean and free of odours. Staff were not recruited safely.

We identified concerns around staffing levels. People and relatives told us staff were kind but did not have time to be involved in activities. People told us they felt “bored.” This could be a risk to people’s mental health.

We found widespread shortfalls in the way the service was managed. There was a risk of people receiving inappropriate care. Records were not always accurate or complete. Some people's care plans lacked information about people's needs, which meant staff were not provided with clear guidance to support and care for people.

There was no registered manager but an interim manager was in post and a new home manager had recently been recruited. The nominated individual did not always have good oversight of the day to day running of the service.

Quality assurance processes were not effective in identifying and addressing all the issues found at this inspection and in driving improvements.

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 (published 4 October 2018).

Why we inspected

Before our inspection we received information of concern in relation to people losing weight and timely action not being taken; risks to people’s care not managed safely including management of medication; and environmental safety risks and governance. Before the inspection, we discussed concerns with the provider and completed an Emergency Support Framework assessment but were not sufficiently assured. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We found evidence during this inspection that people could be at risk of harm. We reported these concerns to the provider who took immediate action to make improvements and promote people's safety. We also informed the local authority, clinical commissioning group (CCG) and the local fire authority of our concerns. We found the actions taken by the provider had been effective in mitigating urgent risks, however further improvements were required. Please see the Safe and Well Led sections of this full report.

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 rating for the service has changed from Good to Inadequate. This is based on the findings at this inspection.

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 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 breaches in relation to safe care and treatment and good governance.

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 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.

Kingston Nursing Home provides 47 beds for older people who require nursing care, some people were living with dementia. It is situated close to Roundhay Park in North Leeds.

At our last inspection in January 2016 we rated the service 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 ongoing 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.

This inspection took place on 4 and 5 September 2018.

Systems and processes were in place to keep people safe and risks associated with people’s care needs had been assessed. There were sufficient staff to meet people’s needs and recruitment processes and procedures were robust.

Medicines were managed safely. People’s nutritional and healthcare needs were met.

Staff received appropriate induction, training and supervision to provide safe and effective care. The registered manager worked in partnership with other organisations to support people’s needs.

Staff knew people well and care plans were, detailed and provided staff with guidance on how to meets people’s needs. Observations showed staff were caring and patient. The registered manager and staff explained they knew people well and were in the process of recording, where necessary, people’s end of life wishes. Staff respected people privacy and dignity and encouraged people to remain independent. A range of activities were available for people to take part in.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People and relatives could express their views about the running of the home. They said the registered manager was approachable and listened. Staff said the home was well-run and the registered manager was supportive.

Complaints and concerns were managed appropriately and outcomes were actioned. People and relatives knew how to make a complaint. Infection control management was robust. There was evidence of effective checks being carried out to assess and monitor the quality of the service provided.

Further information is in the detailed findings below.

There was a registered manager 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 and associated Regulations about how the service is run.

Overall, people told us they felt safe and well looked after. Staff had a good understanding of safeguarding vulnerable adults and knew what to do to keep people safe. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines safely. We found there were systems in place to protect people from risk of harm and appropriate recruitment procedures were in place.

There were policies and procedures in place in relation to the Mental Capacity Act 2005. Staff were trained in the principles of the Mental Capacity Act (2005), and could describe how people were supported to make decisions; and where people did not have the capacity; decisions were made in their best interests.

There were enough staff to keep people safe. Staff training and support provided staff with the knowledge and skills to support people safely. People were supported by staff who treated them with kindness and were respectful of their privacy and dignity.

People told us they got the support they needed with meals and healthcare. However, some improvements were needed to ensure the meal time experience was positive for all people who used the service. Health, care and support needs were assessed and met by regular contact with health professionals who spoke highly of the service.

People were provided with social activities and development of personalised activities were underway.

There were systems in place to ensure complaints and concerns were fully investigated. People had the opportunity to say what they thought about the service and the feedback gave the provider an opportunity for learning and improvement.

People were not put at risk because systems for monitoring quality were now effective. Where improvements were needed, these were addressed and followed up to ensure continuous improvement.

We saw that people were comfortable and at ease with staff and were supported to make choices to enhance their independence. We saw that staff were responsive to people's needs and requests for assistance.

We spoke with six people who used the service or their relative. They said they were satisfied with the home and enjoyed life there. They were also very complimentary about the food. Comments included:

'I am treated very well here, very well looked after thank you.'

'I like it here, suits me very well.'

'I enjoy the entertainers we have and the singing service.'

'The food is very good and plenty of it, they are always coming round with something.'

'The meals are very good and we can have a drink whenever we want one.'

We spoke with seven members of staff; this included the provider and Registered Manager. Staff said the home was well managed and they had enough staff to meet people's needs well and with dignity.

People were protected from unsafe or unsuitable equipment because the provider had systems in place to make sure equipment was properly maintained, suitable for its purpose and used correctly. Staff and people who used the service said they had all the equipment they needed.

People who used the service said there were enough staff to meet their needs. They spoke highly of the staff and how they were treated by them. Comments included:

'I find all the staff very nice and pleasant.'

'They are friendly and polite.'

There were systems in place to ensure people were protected because accurate and appropriate records were maintained.

'We all get on so well here, like one big happy family.'

'The staff are wonderful, treat us very well.'

'I am so happy here, always plenty going on, staff are wonderful.'

'There's a lovely, lively atmosphere here, plenty of staff and always so helpful to everyone.'

People we spoke with or their relatives said they understood their care and support plans and that staff had explained things well to them. One relative said they felt very involved and communication from the service was very good.

People looked well cared for and were responded to promptly when they asked for any support or assistance. We saw staff interacting with people in a respectful and caring manner. They showed warmth and patience. People said they received their medication when they needed it. One person said, 'They always bring it to you and wait with you while you take it.'

People who used the service and their relatives were complimentary about the staff. One said, 'The staff are wonderful and always so cheerful.'

People said they were aware of how to make a complaint if they needed to do so.