This inspection took place on 18 June 2015 and was unannounced.
Kings Court is a care home for up to 38 people. It provides care and support to people over the age of 65 years living with dementia. At the time of our inspection there were 19 people living at the service. The service is purpose built, arranged over three floors accessed by a passenger lift, and situated in Horsham. Five of the bedrooms had adjoining en suite facilities. Long term care and respite care was provided.
There was a registered manager for 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.
At the last inspection in September 2014, the provider was in breach of Regulation 22 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. This was because there were not sufficient numbers of suitably qualified, skilled and experienced staff employed to ensure the health, safety and welfare of people living in the service. The provider provided the Care Quality Commission with an action plan as to how they would address these issues. We looked at the improvements made as part of this inspection and judged that they were now meeting this requirement.
Since the last inspection there have been a number of changes to the service. The name of the service has been changed as this service was previously called Hazelhurst. The regulated activities being run from this service has also changed from a care home providing nursing care, to a care home providing residential care only for people living with dementia. The service has been subject to a significant refurbishment programme to improve the environment that people lived in. Advice and support has been taken to ensure the changes to the environment considered the needs of people living with dementia. Staff spoke of a significant period of change that they were still working through. The service was only at half occupancy at the time of our inspection. There had been a high turnover of staff which had led to a high use of agency staff to help cover the staff rota. The changeover of staff had affected the continuity and number of staff attending specialist training (such as dementia care) provided to enhance staff skills.
Senior staff and representatives of the provider carried out a range of internal audits, including care planning, checks that people were receiving the care they needed, for example for the completion of care plan and risk assessments, medication, and health and safety. However, they were not able to show us in all instances that following the audits any areas identified for improvement had been collated in to an action plan and how and when these had been addressed. There was no evidence of learning from any complaints or incidents and accidents in the service. This was to ensure the continuous improvement and development of the care provided.
The provider had detailed policies and procedures in place to direct staff and for staff to reference. However, these had not been regularly reviewed to ensure that current guidance had been considered. This was to ensure that staff had up-to-date guidance of the practices to follow.
People and their representatives had limited opportunities to give formal feedback on the care provided though meetings and the use of questionnaires. The provider had not actively sought the views of a wide range of stakeholders to analyse and use the information to improve the service.
The registered manager monitored peoples dependency in relation to the level of staffing needed to ensure people’s care and support needs were met. Staff told us they were supported to develop their skills and knowledge by receiving training which helped them to carry out their roles and responsibilities effectively. Training records were kept up-to-date, plans were in place to promote good practice and develop the knowledge and skills of staff.
People were cared for by staff who had been recruited through safe procedures. Recruitment checks such as a criminal records check and two written references had been received prior to new staff working in the service.
The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. Staff had policies and procedures to follow and demonstrated an awareness of where to get support and guidance when making a DoLS application. A number of applications had been made we found that people could freely move around the service when they wished to.
Medicines were stored correctly and there were systems to manage medicine safely regular audits and stock checks were completed to ensure people received their medicines as prescribed.
There was a maintenance programme in place which ensured repairs were carried out in a timely way.
People's individual care and support needs were assessed before they moved into the service. Care and support provided was personalised and based on the identified needs of each individual. People’s care and support plans and risk assessments were detailed and reviewed regularly giving clear guidance for care staff to follow. Peoples healthcare needs were monitored and they had access to health care professionals when they needed to.
People were treated with respect and dignity by the staff. They were spoken with and supported in a sensitive, respectful and professional manner.
Visitors told us they felt people were safe. They knew who they could talk with if they had any concerns. They felt it was somewhere where they could raise concerns and they would be listened to.
People said the food was good. Staff told us that an individual’s dietary requirements formed part of their pre-admission assessment and people were regularly consulted about their food preferences.
Staff told us that communication throughout the service was good and included comprehensive handovers at the beginning of each shift and regular staff meetings. They confirmed that they felt valued and supported by the manager, who they described as very approachable.
We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.You can see what action we have asked the provider to take at the back of this report.