Kingsleigh is owned and operated by Care UK Community Partnerships Ltd. It provides accommodation and personal care for up to 67 older people, who may also be living with dementia. The facilities are purpose built and organised into five, ground floor units with level access from the car park. On the day of our inspection 57 people were living at the service. This inspection was carried out over two dates, both of which were unannounced. The first inspection was undertaken in the early hours of 28 September 2017. We then returned to the service on 10 October 2017.
The home had a registered manager. 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.
We last carried out a comprehensive inspection of this service on 3 November 2016 when we rated the service as Good.
This inspection was brought forward in response to concerns we had received about the care being provided at Kingsleigh. Due to the nature of the concerns that were raised, we inspected the service in the early hours of the morning. Following the first inspection date, we made contact with the provider to discuss our findings, in particular the concerns we had about staffing levels at night. As a result of the issues we shared with them, the provider sent us an initial action plan which outlined the immediate steps taken to improve the safety of the service. The second inspection visit was to assess the impact of the action plan and to review the overall rating of the service.
The findings from this inspection highlighted significant concerns about the leadership of the service. The management team had failed to respond to concerns repeatedly highlighted by staff that staffing levels were not sufficient and that people’s needs were not being met. Internal auditing and monitoring had further failed to identify that the service was not providing good outcomes to people. Complaints made by relatives had not been listened to and acted on. As a result of our findings we found five 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 the report.
Until very recently, staffing levels at Kingsleigh were so insufficient that the service was not safe. In response to the concerns raised, the provider allocated a management support team to the service and took immediate steps to increase the number of staff on duty. Staffing levels were raised and agency staff were brought in whilst permanent staff were being recruited. On our second inspection day, staff reported that staffing levels had significantly improved and that consequently they now felt able to support people safely. Due to the current reliance on agency staff, the provider is sending us weekly rotas to demonstrate that safe levels continue to be maintained.
Risks to people were not always managed safely. The management team had failed to appropriately respond to incidents that were occurring and consequently a service was being offered to some people whose needs were unable to be met. Staff were not sufficiently trained or supported to manage these people’s specialist needs. The escalating behaviours of some people and the poor management of this placed people at risk of harm. Following our inspection, urgent steps were taken to find more suitable placements for some of the people who were living at Kingsleigh.
The environment was not used effectively to support people living with dementia. There were little points of reference to orientate and engage people in their surroundings and consequently this further increased people’s anxiety and behaviours. Bedrooms were not easily identifiable and people spend time in rooms that did not belong to them.
The management support team had recognised that care had been provided in a task based way and had taken immediate and effective steps to enable staff to deliver a more personalised approach to care. Care plans were being updated and reviewed to ensure they accurately reflected the support people required. Group activities were enjoyed by those who participated. Opportunities were however missed to deliver meaningful activities and engagement to people on a one to one basis throughout the day.
The management support team were working closely with other professionals to ensure people’s health care needs were being met. Staff understanding of the Mental Capacity Act was varied and assessments of people’s capacity were not always completed in a person-centred way. Staff did however understand the principle of providing support to people in the least restrictive way.
Staff had a good understanding of their personal roles and responsibilities in safeguarding people from abuse. Staff advocated strongly on behalf of people and took steps to ensure any concerns about abuse were reported and dealt with quickly. Appropriate recruitment checks were carried out to ensure suitable new staff were employed. Staff received regular supervision and appraisal, but these were not always effective in furthering their professional development.
Medicines were managed safely and people received their medicines as prescribed. Our first inspection highlighted that some people did not have appropriate guidelines in place to support the administration of occasional medicines, such as pain relief. By our second inspection date, many of these guidelines had been implemented and team leaders had a good knowledge of people, so they received their medicines when needed.
People had choice over their meals and appropriate action had begun to ensure people were effectively supported to maintain a healthy and balanced diet. A staff member had recently been appointed as a designated champion for nutrition. This meant that they were starting to have a better oversight of people’s weights and nutrition risks. Food and fluid charts were being used to monitor those people identified as being at high risk of malnutrition or dehydration.
Staff remained caring and compassionate towards people, despite working in very difficult conditions themselves. Staff had a good knowledge of people’s lives and used this information to support people with empathy and understanding. End of life care was provided with dignity and humility with staff supporting people to live their last days peacefully and in the presence of their loved ones.
The provider was open and transparent about the shortfalls within the service and committed to taking swift action to improve the service. Staff felt motivated and well supported by the management support team and they were all working together to move the service forwards.