Kings Lodge Care Centre is a care home with nursing for a maximum of 42 older people, some of whom are living with dementia and/or sensory impairment. There were 35 people living at the home at the time of our inspection.

The inspection took place on 31 March 2017 and was unannounced.

There was no registered manager at the time of our inspection but the home manager had applied for registration with the Care Quality Commission (CQC) and their application was being assessed. A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run.

At our last inspection in 22 January 2016, we found the provider was breaching legal requirements in relation to infection control and treating people with respect. Some areas of the home were not adequately clean and staff did not always follow good infection control practice, which presented a risk of infection. Some staff did not respect people's privacy or treat them in a way that maintained their dignity. The provider sent us an action plan setting out the action they planned to take to improve standards in these areas.

At this inspection we found the provider had taken action to meet these legal requirements. There was a cleaning schedule in place, which ensured the home was clean and hygienic. People were protected from the risk of infection because staff maintained safe infection control practice. Staff demonstrated compassion in their approach and treated people with dignity and respect. People had developed positive relationships with the staff who cared for them and relatives told us staff were kind and caring.

People felt safe at the service and when staff provided their care. There were enough staff on each shift to meet people’s needs but staff were not deployed effectively at all times during our inspection. The manager responded promptly to address this issue, allocating an additional member of staff in one part of the home and introducing a checklist to evidence that appropriate checks were carried out.

Risks to people had been assessed and staff implemented measures to reduce these risks. Staff understood safeguarding procedures and were aware of their responsibilities should they suspect abuse was taking place. People were protected by the provider’s recruitment procedures. There were plans in place to ensure people would continue to receive their care in the event of an emergency. Health and safety checks were carried out regularly to keep the premises and equipment safe for use. People’s medicines were managed safely.

People were supported by staff that had the skills and experience they needed to provide effective care. Relatives said staff knew their family members’ needs well and provided consistent care. Staff had an induction when they started work and access to ongoing training, supervision and support.

During our inspection we found some inconsistencies in the recording of mental capacity assessments. After the inspection, the manager provided evidence that appropriate procedures had been followed when decisions that affected people were made. Where people did not have the capacity to make decisions, relevant people had been involved in making the decision in the person’s best interests. Applications for DoLS authorisations had been submitted where restrictions were imposed upon people to keep them safe

People were supported to have a balanced diet and enjoyed the food at the service. People’s nutritional needs had been assessed and were kept under review. The service had access to healthcare professionals if people developed nutritional needs that required specialist input. People’s healthcare needs were monitored effectively and they were supported to obtain treatment if they needed it.

The service was

The inspection took place on 22 January 2016.

Kings Lodge Care Centre provides accommodation, nursing and personal care for up to 42 older people, some of whom are living with dementia. There were 34 people living at the service at the time of our inspection.

At the last inspection on 13, 14 and 20 May 2015, we found the provider was breaching legal requirements in relation to staffing levels, the management of medicines, obtaining consent, the support provided to eat and drink, activities and the quality of recording. The service had not been well-led. There was no registered manager in place and the high turnover of previous managers had led to a lack of effective leadership. Relatives told us that there was no consistency in how the service was run and staff said they had not been adequately supported. The provider submitted an action plan telling us how they would make improvements in order to meet the relevant legal requirements.

At this inspection we found the provider had taken action to meet these legal requirements and to improve the quality of care people received. There was a registered manager in post, who had greatly improved the leadership and management of 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.

The number of staff deployed on each shift had increased, which meant that people were safe and had access to staff support when they needed it. The registered manager had improved the training, supervision and support provided to staff. All new staff attended an induction and training for all staff had been introduced in key areas.

Medicines were managed safely and records demonstrated that people’s consent to their care had been obtained. People received the support they needed to eat and drink. The availability of activities had increased and the quality of recording had improved, which meant the care people received was accurately recorded.

Some areas of the service were not adequately clean and staff did not always follow good infection control practice, which presented a risk of infection. Some staff did not respect people’s privacy or treat them in a way that maintained their dignity.

Staff understood safeguarding procedures and were aware of how to report their concerns if they suspected abuse. The provider made appropriate checks on staff before they started work, which helped to ensure only suitable applicants were employed. Risk assessments had been carried out to minimise the likelihood of harm to people and there were plans in place to ensure that people’s care would not be interrupted in the event of an emergency.

People told us they enjoyed the food provided. They said they were consulted about the menu and that their preferences were known and respected. Relatives told us their family members had access to a range of meal choices and that staff offered people alternatives when they needed encouragement to eat. People were supported to stay healthy and to obtain treatment if they needed it. Staff monitored people’s healthcare needs and took appropriate action if they became unwell.

People told us that staff were friendly and helpful. They said they had good relationships with the staff who supported them. We observed examples of staff showing people genuine kindness and compassion. For example we saw staff reassuring people when they became anxious and providing emotional support to people who were distressed. Relatives told us that staff encouraged people to maintain their independence and supported people in a way that promoted this.

The registered manager had demonstrated effective leadership of the service and led by example in their values and commitment to improvement. They had made

The inspection took place on 13, 14 and 20 May 2015 and was unannounced.

The service provides accommodation, nursing and personal care for up to 42 older people, some of whom are living with dementia. There were 31 people living at the service at the time of our inspection.

There was no registered manager in post at the time of our inspection. 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.

The previous registered manager had resigned in February 2015. A peripatetic manager had been appointed by the provider to support the service but had left the day before our inspection.

People told us that they had seen several managers join the service and leave shortly afterwards, which meant there was no consistent leadership for staff or direction for the service. Morale amongst permanent staff was low. One member of staff told us, “Managers have changed so often. It’s not good, we need stability” and a relative said, “My father’s been here less than a year and we’ve seen four managers in that time. There’s no consistency.”

People told us that the peripatetic manager had improved the leadership and support provided to staff and, as a result, the care people received. Staff said the peripatetic manager had introduced supervisions and encouraged them to raise any concerns they had. One member of staff told us, “She made sure things were running properly. I felt confident going to her if I had a problem. She listened and tried to help. She was really for the residents.” Another member of staff said, “She was very good, she really knew what she was doing. Things were starting to improve under her.” Relatives and care staff expressed concern that the improvements begun by the peripatetic manager would not be continued following her departure. One relative told us, “She was starting to turn things around. I’m very worried to hear that she’s gone.”

The area manager said a new permanent manager had been appointed and would start work in June 2015. The area manager told us that, until then, management cover for the service would be provided by two managers of other registered care services operated by the provider and the provider’s operations director.

There were not enough staff available to keep people safe and meet their needs in a timely way. People routinely had to wait for long periods when they needed care or support and during our visit insufficient staffing levels put one person at risk of harm.

There was a heavy reliance on agency staff, which meant that people did not receive consistent care from staff who knew their needs well. Some staff did not have sufficient knowledge of people’s needs to ensure that they received the care they required. Medicines were not managed safely.

People had not always given their consent to the care they received and the provider had not consulted relevant others to ensure that decisions were made in people’s best interests. Staff did not have an adequate knowledge of their responsibilities in relation to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

Some people had to wait a long time to be served their meals and hot meals were sometimes cold by the time they were served. There were not enough staff on duty to support all the people who needed assistance with eating. This resulted in one person almost choking as they ate their meal unsupervised. Staff were not always aware of guidelines for supporting people with eating.

People did not have sufficient opportunities to take part in activities. The premises had not been adapted to meet the needs of people living with dementia.

We identified a number of 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 this report.