Kingscourt Nursing Home is a purpose built three-storey property on the outskirts of Chester city centre and close to local shops, doctor's surgery and other amenities in Hoole. The home provides care for up to 37 older people, some of whom require nursing care. All of the rooms are single occupancy and some have en-suite facilities. Thirty four people were living there at the time of our visit.

This inspection took place on the 7th and 8th of August 2017 and was unannounced.

Our last visit to the service was held in July 2015. Following that inspection we rated the service as Good. No breaches of regulation were identified during that visit.

The service did not have a registered manager. Our records found that whilst a manager had been in place since our last visit, they had not registered with the Care Quality Commission to become the 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. The last manager had left earlier in 2017 and an interim manager was put in place to ensure continuity of the service. A new manager had been identified and their appointment was imminent. The registered provider must ensure that an application for registration is submitted to the Care Quality Commission.

Not all staff received regular supervision and group supervision through staff meetings had not occurred. This meant that individual accountability and progress in their role had not been discussed with all staff. We have made a recommendation about all staff receiving supervision.

Staff received training appropriate to their role.

The service was not providing a structured activities programme. While one had been in place in the past, people told us that there was not much to do in the day and in some cases relied on their own preferences or their families to assist in keeping active. We have made a recommendation in respect of reinstating a regular activities programme.

The interior of the building was in need of redecoration and refurbishment as wear and tear to internal doors and walls were noted. No firm plans were in place for when this would be achieved.

People felt safe living at Kingscourt. This view was echoed by relatives we spoke with. The premises were well maintained and this included items such as fire detection systems, lifting equipment and portable appliances. The premises were hygienic and clean.

A staff rota was in place. Staffing levels were maintained with annual leave and sickness being covered by members of the registered provider’s own bank staff pool. It was anticipated that this use of bank staff was temporary. Dependency levels were assessed by the manager and outlined that dependency levels were increasing within the service. This view was echoed by staff and relatives who were aware that people were becoming more dependent on staff to ensure that their needs were met.

Risk assessments were in place for people who used the service. These related to those risks faced by people in their daily lives such as malnutrition or pressure ulcers. All these had been completed and reviewed on a monthly basis. Where people were at risk from malnutrition for example, people had been referred to dieticians with weight monitoring increased.

Staff had a good understanding of the types of abuse that could occur and the action they would need to take if such incidents occurred. They had received training in this and were aware of how to raise concerns with external agencies.

Medication was safely managed. Medication was stored appropriately and audits in place to ensure that systems continued to be safely managed.

The recruitment of new staff was robust. Appropriate checks had been made on people’s suitability for the r

This was an unannounced inspection that took place on the 21st of July 2015.

Our last inspection in September 2013 found that the provider was meeting all the regulations assessed.

Kingscourt Nursing Home is a purpose built three-storey property on the outskirts of Chester city centre and close to local shops, doctor's surgery and other amenities in Hoole. The home provides care for up to 37 older people, some of whom require nursing care. All of the rooms are single occupancy and some have en-suite facilities. At the time of our visit there were 36 people using the service.

The service does not currently have a registered manager. The manager in post at present has applied to become registered. 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.

People we spoke with during our visit had different experiences of the quality of the support they received. Many people we spoke with were complimentary about all aspects of the care and felt that they received dignified and respectful support from the staff team. They felt safe, well looked after and happy with the staff team. Some comments we received suggested that staff were not always as attentive as they should be, that people were supported in a rushed manner and did not always promote people’s privacy.

We observed care being provided to people in a dignified and positive manner. People had their points of view listened to when they made suggestions. Staff practice was centred on the needs of people and in particular their preferences and interests. A comprehensive activities calendar was in place and people told us that they had particularly enjoyed recent outings.

We observed that staff interacted well with those who had limited verbal communication. Staff were patient in their approach and understood what people were telling them. The independence of people was taken into account through the design of the building as well as the mobility aids that people used. People were free to move throughout the building with staff discreetly supervising them to ensure that this movement was safe.

We spoke to three relatives of people who lived at Kingscourt at the time of our visit. Comments were positive about the way the registered provider kept people informed of their issues affecting their relations. They were satisfied that the health of people were monitored on a daily basis and that action was taken to ensure that their relation remained healthy.

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We have made a recommendation about the regular review of personal evacuation plans for people using the service.

We spoke to four people who lived at Kingscourt and three relatives. They commented:

"They are friendly and very helpful"

"I feel safe here"

"I always get my tablets on time"

"It is like a hotel"

"It is good on the whole"

"They act promptly if I am not well"

"The manager is very efficient"

"I am quite happy and satisfied. The staff respond to me well and are prompt. If I had a complaint, which I do not, I would speak to the manager and she would act"

"It is better here than my previous experience. There is always someone to talk to. The staff are lovely and they come to me quickly if I use my call alarm. I am safer here than before. I have no complaints"

"Staff are excellent, I am really pleased with the care my mother gets. They sorted out a health problem she had when she came to live here and it has improved her quality of life"

"Staff are watchful and there are always enough of them"

"They are always on top of things"

"They always tell me how my relation is doing, they are good and there is always enough staff"

"They look after her well"

We found on this visit that people living at Kingscourt had their needs met by sufficient staff in a safe environment. The management of medications promoted their health and welfare and people were confident that any concerns they had would be appropriately addressed.

We found that people were able to express their views and were involved in making decisions about their care and treatment. We spoke with five people who used the service who confirmed they had been involved in the implementation of their support plans. We found that people were supported with their independence and community involvement. One person who used the service told us “They (the staff) are really attentive I can’t fault them”.

We looked at five care records and all had assessments of their health and social needs completed. There were individual support plans and risk assessments in place. There was evidence to show they were evaluated on a regular basis. This meant the service could demonstrate they could meet people's needs and maintain their health and wellbeing.

We found that there was enough qualified, skilled and experienced staff to meet people’s needs.

We saw that there was an effective complaints system available. Comments and complaints people made were responded to appropriately.

We have received two safeguarding concerns in relation to the service since our last inspection in January 2012. We saw that the provider responded in a way that protected people from harm or injury.

The people who were able to say told us that they were being treated well by the staff members supporting them. One person said “ this is a good place to live.” Another said “ We get a good choice of what to do and what to eat”

The people living at Kingscourt who were able to tell us said that they were happy living in the home. One person told us “ the staff are very kind “ and other comments made were “ The meals are good and you get choice;” “the girls look after me really well. ” I am involved in my care.”

People we spoke with said that they like living in the home and know who to speak to if they had concerns. One person said “ the staff are very supportive, I could speak to any of them and they would help me “

They were positive about the quality of the staff at the home and said “ the staff are lovely” “ the buzzers are answered quickly at most times during the day, you may have to wait longer if they are very busy such as first thing in the morning.” “ Staff are really nice” and “ the staff attitude is positive” were other comments made.