The inspection took place on 05 April 2017 and was unannounced.

Kingfisher Nursing Home provides residential nursing care for up to 22 older people, some of who may live with dementia. On the day of this inspection 17 people were using the service.

The home did not have a registered manager at the time of this inspection however; there was a recently recruited manager in post who had started the process of registering with the Care Quality Commission (CQC). A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

When we last inspected the service on 03 October 2016 we found breaches of regulations 9 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider had failed to ensure that the staff team had the skills and knowledge necessary to meet people’s specific health needs. The provider’s governance and monitoring systems had failed to identify and address concerns about the lack of training for staff to meet people’s specific health conditions, that people’s privacy and confidentiality was not respected and the use of institutional terminology by staff members.

Following the comprehensive inspection, the provider wrote to us to tell us how they would make the required improvements to meet the legal requirements. At this inspection we found that the provider had made the necessary improvements and therefore improved the quality of the service provided at Kingfisher Nursing Home.

People felt safe living at Kingfisher Nursing Home. Staff understood how to keep people safe and risks to people's safety and well-being were identified and managed. The home was calm and people's needs were met in a timely manner by sufficient numbers of skilled and experienced staff. The provider operated robust recruitment processes which helped to ensure that staff employed to provide care and support for people were fit to do so. People's medicines were managed safely.

Staff received regular one to one supervision from a member of the management team which made them feel supported and valued. People received the support they needed to eat and drink sufficient quantities and their health needs were well catered for with appropriate referrals made to external health professionals when needed.

People and their relatives complimented the staff team for being kind and caring. Staff were knowledgeable about individuals' care and support needs and preferences and people had been involved in the planning of their care where they were able. Visitors to the home were encouraged at any time of the day.

The provider had arrangements to receive feedback from people who used the service, their relatives, external stakeholders and staff members about the services provided. People were confident to raise anything that concerned them with staff or management and were satisfied that they would be listened to.

There was an open and respectful culture in the home and relatives and staff were comfortable to speak with the manager if they had a concern. The provider had arrangements in place to regularly monitor health and safety and the quality of the care and support provided for people who used the service.

The inspection took place on 03 October 2016 and was unannounced.

Kingfisher Nursing Home provides residential nursing care for up to 22 older people, some of who may live with dementia. There were 20 people accommodated at the home at the time of this inspection.

There had not been a registered manager at Kingfisher Nursing Home since July 2011. A new manager had been in post for twelve weeks at the time of this inspection and had started the process of applying to become registered with CQC. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

When we last inspected the service on 04 April 2016 the service was in breach of regulations 09, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider had failed to provide people with opportunities for engagement and stimulation and there were concerns relating to the management of medicines, the management of pressure area care and diabetes care. The provider’s governance and quality monitoring systems had not been effective in identifying these areas.

Following the comprehensive inspection in April, the provider wrote to us to tell us how they would make the required improvements to meet the legal requirements. At this inspection we found that the provider had made the necessary improvements to meet the previously identified shortfalls however, further areas for improvement have been identified during the course of this inspection.

Staff had not received the training necessary to give them the skills and knowledge to support people’s individual health conditions. The provider had arrangements to regularly monitor the quality of the care and support provided for people who used the service however; this was not always effective in identifying areas of shortfall.

People and their relatives complimented the staff team for being kind and caring. However, we found that the staff spoke of tasks they did for people in terms that did not honour people’s dignity. People’s personal and private information was not always maintained securely to promote their confidentiality; however the provider has made plans to secure the area where people’s personal and private information is stored. The environment was tired and in need of refurbishment in order to provide a dignified home for people. The provider has acknowledged this and an extensive refurbishment plan is in place to commence this month.

People felt safe living at Kingfisher Nursing Home. Staff understood how to keep people safe and risks to people's safety and well-being were identified and managed. The home was calm and people's needs were met in a timely manner by sufficient numbers of skilled and experienced staff. The provider operated robust recruitment processes which helped to ensure that staff employed to provide care and support for people were fit to do so. People's medicines were managed safely.

Staff received regular one to one supervision from a member of the management team which made them feel supported and valued. People received support they needed to eat and drink sufficient quantities and their health needs were well catered for with appropriate referrals made to external health professionals when needed.

Staff were knowledgeable about individuals' basic care and support needs and preferences and people had been involved in the planning of their care where they were able. Visitors to the home were encouraged at any time of the day.

The provider had arrangements to receive feedback from people who used the service, their relatives, external stakeholders and staff members about the services provided.

The inspection took place on 04 April 2016 and was unannounced.

Kingfisher Nursing Home provides residential nursing care for up to 22 older people, some of who may live with dementia. There were 13 people accommodated at the home at the time of this inspection.

We last inspected the service on 11 April 2014 and found the service was meeting the required standards that we inspected at that time.

There had not been a registered manager at Kingfisher Nursing Home since the service had registered with the Care Quality Commission (CQC) under the Health and Social Care Act 2008 in February 2011. A new manager had been in post for six weeks at the time of this inspection and had started the process of applying to become registered with CQC. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 found the service to be in breach of the Health and Social Care Act (Regulated Activities) 2014 Regulations. You can see what action we took at the back of our report.

People felt safe living at Kingfisher Nursing Home. Staff knew how to keep people safe however, they were not always clear of how to report any concerns to outside agencies. Risks to people’s safety and well-being were identified however, we found that some areas of identified risks did not have management plans in place to mitigate risk and promote safe care and treatment. People’s medicines were not always managed safely.

People and their relatives were not satisfied with the opportunities for engagement and stimulation that were provided. This matter had been raised with the management team by relatives however, had not improved. Record keeping in the home did not support staff to provide safe and consistent care.

The home was calm during the day of the inspection and people’s needs were seen to be met in a timely manner. People told us that their needs were met in a timely manner during the daytime when there were more staff available; they were less satisfied with the staffing levels during the night. The provider operated robust recruitment processes which helped to ensure that staff members employed to support people were fit to do so.

Staff had the skills and knowledge necessary to be able to provide people with safe and effective care and support. Staff received regular support from management which made them feel supported and valued. People were supported to make their own decisions as much as possible. People received support to eat and drink sufficient quantities. People’s health needs were well catered for because appropriate referrals were made to health professionals when needed.

People were complimentary about the care and kindness demonstrated by the staff team. Staff were knowledgeable about individual’s needs and preferences and people were involved in the planning of their care where they were able. Visitors to the home were encouraged at any time of the day and people’s privacy and dignity was promoted.

The provider had arrangements in place to receive feedback from people who used the service, their relatives, external stakeholders and staff members about the services provided. People were confident to raise anything that concerned them with staff or management. The manager was new in post so people could not confirm to us at this time if they felt confident they would be listened to.

The provider had arrangements in place to regularly monitor health and safety and the quality of the care and support provided for people who used the service.

At the time of our inspection Kingfisher Nursing home did not have a manager who was registered with the Care Quality Commission as they are required to do. We have taken action against the provider Westgate Healthcare Limited.

We inspected Kingfisher Nursing Home and gathered evidence to help answer our five key questions; Is the service safe? Is the service effective? Is the service caring, Is the service responsive? Is the service well led?

Below is a summary of what we found based on the evidence gathered during our inspection carried out on 11 April 2014. This included speaking with people who used the service, their relatives, and members of staff and by looking at records.

The detailed evidence that supports our findings can be read in the full report below.

Is the service safe?

We looked at records which showed that people’s care and support needs had been assessed, documented and reviewed. They gave staff clear guidance on how to deliver safe and appropriate care that met people’s individual needs. One person who used the service we spoke with told us, “I feel safer here than I did either at home or in hospital.”

We saw from records we looked at that staff had received training in relation to protecting people from harm. Staff we spoke with demonstrated their awareness of types of abuse, and explained the process they followed to raise any concerns appropriately.

Records we looked at and staff we spoke with demonstrated that effective recruitment policies and procedures had been put in place. This helped to ensure that staff employed at the home were of good character and appropriately skilled to meet people’s needs. This included carrying out appropriate checks before staff began work.

Is the service effective?

We saw that people had been involved in the assessment of their individual needs and in the planning, delivery and reviews of the care and support they received. However we also found that details in relation to a person’s background and preferences did not always record sufficient detail. Staff we spoke with were knowledgeable about people’s preferences, however new staff may not have this information available to them.

Is the service caring?

During our inspection on 11 April 2014 we observed that staff treated people with respect and kindness while delivering appropriate levels of care and support. Staff took time to encourage people to maintain their independence and supported people in a manner that promoted their dignity.

We also saw that care was delivered in a way that met people’s individual needs and requirements and involved them in the planning of their care. One person's relative we spoke with told us, "If anything changes for [relative] not only do they call me, but we all sit down together to talk through the options."

People who lived at the home and their relatives were very positive and complimentary about the levels of care provided and the care staff who supported them. One person’s relative we spoke with told us, “The carers here are one hundred percent, the absolute tops. They have nursed my [relative] back to health and done it in such a caring, warm and understanding manner.”

Is the service responsive?

People’s care records we looked at demonstrated that people’s nutritional intake was monitored and reviewed. Where a person’s needs changed and they were at risk of malnutrition or dehydration, staff took the appropriate actions to manage this.

We noted that there had been no complaints received by the home however; people told us they were aware of how to make a complaint should they need to.

Is the service well led?

We found that effective systems had been put in place to assess and monitor the quality of services provided and to identify, assess and manage risks posed to the health, welfare and safety of people who lived at the home.

People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. We saw the last survey completed by people’s relatives was positive, and indicated that the home provided satisfactory levels of care.

Staff told us that in the absence of the home manager, the provider and interim manager had been supportive, visible and approachable. Staff we spoke with told us they had not experienced any decline in support during the interim management arrangements.

During our inspection in November 2012 and again in June 2013, we found shortfalls in the administration and management of medicines. It was unclear, from both the medication records and people's daily records, whether medicines had been omitted and the reason not recorded, or medicines had been given and not signed for. Furthermore, medicines did not reconcile with the number in stock despite audits stating that they did.

In June 2013, our inspection identified shortfalls with regards to cleanliness and the control of infection. We found that although Kingfisher Nursing Home had a system of audits in place to ensure cleanliness, some equipment and parts of the home were dirty.

We judged both these deficits to have a minor impact on people living at Kingfisher Nursing Home and asked the provider to send an action plan outlining how they would remedy this situation.

When we carried out an inspection on 19 November 2013, we found that the provider was able to demonstrate that they had taken steps to address the identified shortfalls. We found evidence that the home was clean and the recording of medication was consistent and clear.

During our last inspection on 08 November 2012 we found shortfalls in the administration and management of medicines. We also found shortfalls in the ongoing support and development of staff. We issued compliance actions and asked the provider for an action plan setting out how they would meet these standards. The action plan submitted by the provider stated that regular medication audits would be completed and documented and staff support and supervision had commenced. The provider said that they would be compliant by December 2012. During our inspection on 14 June 2013 we found improvements, with regard to staff support, however, there were still concerns regarding medicines management.

During our inspection, we found evidence that care staff identified and acted on the wishes of people who lived there.

People told us that they were very happy with the care that they or their relative received. One person told us, "The staff are very nice to us. I left another home because of the staff. They are really kind here." We noticed that staff spoke kindly to people and were considerate towards their individual needs.

Although we found that people’s rooms and communal areas were clean, the bathrooms, treatment rooms and some equipment was visibly dirty. There were cleaning schedules in place, but these had not been thoroughly adhered to.

A new manager had started to work at the home on the week of our visit. They told us that their priorities were to ensure that all care plans and risk assessments were up to date. They had audited staff training records and booked training for all staff who had not had updates of the mandatory health and safety training. The manager had also started a programme of appraisals of each member of staff’s work and development needs.

We used a number of different methods to help us understand the experiences of people using the service, because many of the people using the service had complex needs which meant they were not able to tell us their experiences. We observed how staff interacted with people in the lounge and dining room, and we spoke with people who were able to discuss their experiences with us.

One person told us, “They (the staff) are very good. They know how I like to be helped.” They named one particular member of staff who took time to come and talk with them. We also spoke to visiting relatives of this person. They said, “The staff are good and kind. Our relative is well treated and well cared for.”

We observed how staff interacted with people in the lounge and dining room. The care workers spoke to people while they were assisting them and treated them with respect.

Nursing staff carried out daily audits of the medicines that were administered to people in the home. However the audits did not identify errors in a way that they could be addressed.