This inspection took place on 21 January 2019 and was unannounced. This meant the staff and provider did not know we would be visiting.

Kingfield Holt is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Kingfield Holt is registered to provide accommodation and personal care for up to 23 people. Accommodation is provided over two floors, accessed by stairs or a passenger lift. Communal lounges and dining areas are provided. The home is a detached period building with a large garden close to local amenities. The care provided is for people who have needs associated with those of older people. On the day of our inspection there were 15 people living at the home.

Our last inspection at Kingfield Holt took place on 25 and 26 January 2018. We found the service was in breach of three of the regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014. Regulation 11, Need for consent, Regulation 12, Safe care and treatment, and Regulation 17, Good governance.

Following the last inspection, we asked the provider to complete an action plan to show what they would do, and by when, to improve the key questions asking if the service was safe, effective, and well led, to at least good. The registered provider sent us an action plan detailing how they were going to make improvements. At this inspection we checked the improvements the registered provider had made. We found sufficient improvements had been made to meet the requirements of the Regulations.

There was an acting manager at the service. The previous registered manager had very recently retired from 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 and associated Regulations about how the service is run.

People living at Kingfield Holt told us they felt safe and they liked the staff. Staff confirmed they had been provided with safeguarding vulnerable adults training, so they understood their responsibilities to protect people from harm.

Regular checks of the building were carried out to keep people safe and the service well maintained.

There were sufficient numbers of staff available to keep people safe. The staff recruitment procedures and checks in operation promoted people’s safety.

We found systems were in place to make sure people received their medicines safely.

Staff were provided with relevant training and supervision to make sure they had the right skills and knowledge to support people.

Staff gave people as much choice and control as possible.

People enjoyed the food provided and were supported by staff to receive adequate food and drink to remain healthy.

We found the home was clean, bright and well maintained.

People had access to a range of health care professionals to help maintain their health.

People were treated with dignity and respect and their privacy was protected. People and health professionals we spoke with made positive comments about the care provided by staff.

A range of activities were available to provide people with leisure opportunities.

People were confident in reporting concerns to the acting manager or staff and felt they would be listened to and their concerns would be addressed.

There were effective systems in place to monitor and improve the quality of the service provided. Regular checks and audits were undertaken to make sure full and safe procedures were adhered to.

Staff told us they felt they had a very good team. Staff and people said the acting manager was approachable and communication had improved within the service.

The inspection took place on 25 and 26 January 2018 and was unannounced.

Kingfield Holt is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Kingfield Holt is registered to provide accommodation and personal care for up to 23 people. Accommodation is provided over two floors, accessed by stairs or a passenger lift. Communal lounges and dining areas are provided. The home is a detached period building with a large garden close to local amenities. The care provided is for people who have needs associated with those of older people. On the days of our inspection there were 16 people living at the home.

The service 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.

At the last Inspection in December 2015 we rated the service ‘Good’. During this inspection, we found that the service had not sustained the previous Good rating. The overall rating was now Requires Improvement. The key questions Safe, Effective, Responsive and Well-led were rated Requires Improvement. We found breaches of Regulation 12: Safe care and treatment, Regulation 11: Need for consent, 17: Good Governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Improvements were required in the systems for the safe management of medicines. We inspected the registered provider's ‘Medications Management Policy and Procedure’ document and found this was in need of further review. Individual risk assessments were not completed to find out how much support a person needed with managing and taking their medicines. People did not have PRN protocols in place.

We have made a recommendation that the service consider the National Institute for Health and Clinical Excellence (NICE) best practice guidelines on good practice for managing medicines in care homes.

Risk assessments looked at the associated risk in carrying out an activity however, they did not contain measures to reduce the potential risks. Risk assessments contained 'scores' for each aspect of the person's pressure care. However, there was nothing to indicate the significance of each score, how the information was calculated and how the risk was mitigated.

We recommend that a risk assessment is completed which describes what measures are in place to control the risk and consider any additional measures that could be put in place to remove or reduce the likelihood of the risk causing harm to the person or staff member.

We found the service was not always meeting the requirements of the Mental Capacity Act 2005 Staff we spoke with understood the principles of the MCA and provided examples of how the MCA would apply to the people they provided support to. However, we found improvements could be made to ensure the person who lacks capacity is at the heart of the decision making process.

We have made a recommendation about further training around assessing people’s capacity and acting in people’s best interest.

Quality assurance systems, which helped the provider and the registered manager to identify shortfalls, were not robust and required improvement.

Staff were provided with training and supervision to make sure they had the right skills and knowledge to support people although there were gaps in training around the safe management of medicines. This meant staff had not been provided with relevant training to update and maintain their skills and knowledge to meet people's needs

The registered provider had a safeguarding procedure to ensure systems were in place to protect peopl

Kingfield Holt is registered to provide accommodation and personal care for up to 25 older people. Accommodation is provided over two floors, accessed by a passenger lift. Communal lounges and dining areas are provided. The home is a detached period building with a large garden close to local amenities.

There was a manager at the service who was registered with CQC. 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.

Our last inspection at Kingfield Holt took place on 7 October 2013. The home was found to be meeting the requirements of the regulations we inspected at that time.

This inspection took place on 2 November 2015 and was unannounced. This meant the people who lived at Kingfield Holt and the staff who worked there did not know we were coming. On the day of our inspection there were 16 people living at Kingfield Holt.

People spoken with were positive about their experience of living at Kingfield Holt. They told us they felt safe and they could talk to staff and if they had any worries or concerns.

A healthcare professional spoken with told us, “Kingfield Holt is a really nice home. I have no concerns at all.”

We found systems were in place to make sure people received their medicines safely.

Staff recruitment procedures were thorough and ensured people’s safety was promoted.

Staff were provided with relevant induction and training to make sure they had the right skills and knowledge for their role. Staff understood their role and what was expected of them. The service followed the requirements of the Mental Capacity Act 2005 (MCA) Code of practice and Deprivation of Liberty Safeguards (DoLS). This helped to protect the rights of people who may not be able to make important decisions themselves.

People had access to a range of health care professionals to help maintain their health. A varied and nutritious diet was provided to people that took into account dietary needs and preferences so their health was promoted and choices could be respected.

People said they could speak with staff if they had any worries or concerns and they would be listened to.

People were provided with some leisure activities to join in as they chose.

There were effective systems in place to monitor and improve the quality of the service provided. Regular checks and audits were undertaken to make sure full and safe procedures were adhered to. People using the service and their relatives had been asked their opinion via surveys, the results of these had been audited to identify any areas for improvement.

We spoke with six people and they told us that they were treated with respect. They also told us that their opinions were sought so that they were involved in decisions and that they had choice. Their comments included the following: “I can choose when I get up and what to wear” and “I choose to have my meals in my room”.

People we spoke with made positive comments about the staff and were satisfied with the quality of care that they had received. Their comments included: “I have my medication when I need it”, “they (staff) are very good” and “I don’t think you will find a better place”.

People told us that they felt “safe”. They told us that they did not have any concerns and if they did they would speak to their relative or a staff member.

We spoke with three members of staff. All staff spoken with were clear about what their roles and responsibilities were and the action they would take if they saw or suspected any abuse.

Staff told us that they felt supported and made positive comments of about the senior staff and staff team. One staff member commented: “any problems I can speak to any member of staff”.

The provider had a system in place to regularly assess and monitor the quality of service that people receive.

We saw that where people were able they signed their care plans. We spoke with one relative who told us that they had signed the care plan documentation on behalf of their relative. They told us they were involved in their relatives care planning.

We observed staff providing reassurance, care and concern to people. We spoke to six people who told us that they were satisfied with the quality of care provided. Their comments included: “Very satisfactory, very good.” “Night staff are very good.” “The carers are very friendly and polite.” “I would definitely recommend Kingfield.”

We saw that people in the home benefited from equipment that was comfortable and met their needs.

We found that the unavailability of staff to cover for unexpected absence had resulted in staff working long hours but people did not have any concerns about the quality of care they had received as a result of this.

We found that staff had received training and were supervised. We saw evidence that staff had the opportunity to develop and improve their skills.

We saw that the home had a system in place to deal with comments and complaints. We also saw that the home had provided people with information about this system. All the people we spoke with told us that if they had a concern they would speak to staff. They all felt that their concern would be treated seriously

People who used the service told us they were happy with the care provided and were involved in decisions about their care and welfare needs. One person told us they were able to choose what time they got up and went to bed and if they wanted to join in the activities. Four people told us they had not read their care plan but that was their choice.

We spoke with two relatives during our inspection who told us they had not been involved in the development of their relatives care plan, but this had been their choice. However, they told us they were able to make changes to their relatives care if they wished. They also told us their relative’s dignity was respected and confidentiality was always maintained.

People who used the service told us they were happy living at the home and they were well looked after. Two people told us“. I am very well looked after and all my needs are met” and “Would not change where I live for anything, you can have a laugh here”. Another person told us, “It was wonderful living here, it’s home”. Staff were described as, excellent, very good, friendly and caring. One person said staff were, “absolutely wonderful”.

We spoke with two relatives who confirmed they would talk to the manager if they had any concerns. People told us that they felt safe at the home and they would tell staff or the manager if they were worried about anything.