About the service:

Kingsleigh House is a residential care home that is registered to provide care and accommodation for a maximum of 30 older people. 27 people were using the service at the time of the inspection, some of those experienced dementia. There was a registered manager who was present during 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 2008 and associated Regulations about how the service is run.

People’s experience of using this service:

Whilst some audits were in place there was not enough detail provided to give a clear overview of any patterns or trends. We did not always receive notifications as required to enable us to see what action the provider took to keep people safe.

Checks were carried out on people’s satisfaction with their care using questionnaires. People knew the registered manager and felt they were visible around the home and were approachable.

People were supported by staff to remain safe. There were enough staff available to people and people’s needs were attended to in a timely manner. Risk assessments were in place to minimise any potential risk to people’s wellbeing. Staff were recruited in a safe way. People received their medicines as expected.

People felt that staff assisting them knew their needs. Staff received training and had been provided with an induction, and felt able to approach the registered manager with any concerns. Meals were nutritious and people were kept hydrated. People were supported to maintain their health. People were supported to have choice and control over their lives and staff understood that they should support them in the least restrictive way possible; the policies and systems in the service supported this practice.

People felt that staff were kind and caring. Staff maintained people’s confidentiality and privacy and dignity. People were encouraged to be independent.

People's care plans reflected their needs and preferences and staff could explain specific care that people required. Activities were planned and people participated in them as they wished. Complaints were dealt with appropriately in line with the complaints procedure. People participated in activities that were tailored to their needs. End of life plans were considered when required.

Rating at last inspection: The rating for the service at our last inspection was ‘Requires Improvement’ with breaches of Regulation 13 and 17 with our last report published on 08 September 2017.

Why we inspected: This was a planned comprehensive inspection that was due based on our scheduling targets. At the last inspection the key questions around Safe, Caring, Responsive and Well led were rated ‘requires improvement’. This was due to concerns around reporting of safeguarding concerns, management of medicines, staff not being deployed effectively and recruitment processes not always being robust. Other issues included, people not being supported to have their views and concerns heard, concerns around staff whether staff maintained people’s privacy and dignity consistently, complaints not being addressed in a robust manner and concerns that checks and audits not carried out effectively. At this inspection we found that there had been some improvements, but further changes were required.

Enforcement:

No enforcement action was required.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This inspection took place on 04 July 2017 and was unannounced. We last inspected Kingsleigh House in March 2015 and found that the service was meeting regulations and was rated as good.

Kingsleigh House provides accommodation with care and support for up to 30 older people. At the time of our inspection there were 27 people living at the home. There was a registered manager who was present during 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 2008 and associated Regulations about how the service is run.

We brought this inspection of Kingsleigh House forward due in part to notification of an incident where a person living at the home was exposed to risk of serious harm. We found that some action was planned and underway to address the provider’s failings and shortfalls in areas relating to this incident and safeguarding practices at the home. Staff we spoke with were not always aware of how to identify all types of abuse although recent training had been provided in this area.

People and relatives told us that people were safe living at the home. People were supported to manage their risks safely by staff who understood people’s support needs. People were satisfied with the support they received with their medicines although we identified that further areas of improvement were required. Staff recruitment processes were not robust and staff were not deployed effectively to ensure that people’s needs were always met in a timely way.

People’s needs were met by staff who told us they felt supported in their roles. People’s choices and decisions were respected and promoted. Staff demonstrated an understanding of the Mental Capacity Act (2005). People were supported to seek further healthcare support as needed to remain well.

We observed that people and staff had positive rapport and people were involved in their care decisions. Feedback and processes showed however that people were not always supported by caring staff and people’s views about their experience of the home were not always addressed. Systems were not robust to capture and improve all people’s experiences at the home.

People had access to a range of activities in the home and within the community of interest to them. Almost all people at the home followed the same religious beliefs and practices. This created a sense of unity and informed some activities and routines at the home, which people valued. People’s choices in relation to this were respected.

There was a complaints process in place. Whilst people told us that complaints had been dealt with to their satisfaction, complaints were not always investigated in a timely or appropriate way. Quality assurance processes had not identified and addressed all concerns and ensured the quality and safety of the service.

Additional support had recently been arranged by the registered provider to help drive improvements and build on the positive experiences of people living at the home. The home was supported by visitors and volunteers in the local community.

During this inspection, we identified two breaches of legal requirements. You can see what action we told the provider to take at the back of the full version of the report, in respect of one of those breaches of regulation. We are still considering what action we are taking in relation to the identified breach of another regulation and we will issue a supplementary report once this decision has been finalised.

This report provides details from two separate inspection visits which took place months apart. The first inspection was on12 March 2015 and the second inspection visit was on 7 October 2015. We were unable to provide a report from the first visit but felt it valuable to provide summaries of both visits together with the judgements from the most recent inspection visit in October 2015. Both visits were unannounced. Prior to the March 2015 visit we had last inspected this service in December 2013 where it met all the regulations we looked at.

Kingsleigh House is a care home providing personal care for up to 30 older people who may have physical disabilities or dementia. At the time of our March visit there were 28 people living in the home. The home provides care and support within a Christadelphian setting and is situated next to a Christadelphian church.

There was a registered manager in place. 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 were kept safe from the risk of harm. Staff knew how to recognise signs of abuse and to report any concerns to their managers and external agencies. Staff followed specific instructions to minimise known risks to people’s health and well being and people were shown how they could assist in minimising risks of harm. Staff supported people to take their prescribed medicines well. Improvements were made in the administration of medicinal creams and liquid medicines and the recording of these administrations between our two visits.

People were supported by enough staff to meet their care needs. Where it was identified that more staff were needed to ensure that people had their care needs responded to in a timely way more staff had been recruited. Staff only started work following appropriate checks and an interview had been completed to ensure they were suitable to work with people who lived in the home. Staff had the skills and knowledge to ensure people were supported in line with their care needs and best practice. Management of the home were working to ensure that staff’s induction continued to improve.

The care manager and staff we spoke with were knowledgeable of the requirements of the Mental Capacity Act 2005. Staff sought consent from people before providing personal care and supported them if they did not want treatment.

People were supported to eat and drink enough suitable food to maintain their health. Where necessary health professionals were consulted to identify changes needed to people’s care. Records showed that any instructions from health professionals were put into the individual concerned care plan and these were followed.

People we spoke with, their relatives and our observations told us that staff treated people with respect and were appreciative of staff’s care. We observed that people were given choices, involved in making decisions about their care and informed about the day to day news of the home. People had opportunities to be with other people who lived in the home or spend time privately in their bedrooms.

People were asked their views about the care they received on regular basis, through monthly discussions, visits from a trustee and from the provider’s annual quality checks. They told us they felt able to speak with staff and managers about any complaints that they had and these would be dealt with. People and their relatives told us that the manager led the staff team well and that the home had a good atmosphere.

People that we spoke with made positive comments about their experience of the service, "I am very well looked after and happy here. The staff are very good."; "The staff here have a great deal of patience with us." People looked well groomed and well looked after by staff. We noted that many people were actively engaged in the life of the home.

People's needs were assessed to establish the care that they needed and each person had written care plans that covered a range of their needs. Risks presented by people's needs or condition were identified and assessed by the service and a plan to manage those risks was put in place. People's health was monitored and they had access to their GP's and other health care professionals when they needed it.

We found that people who were paying fees directly to the provider had a written contract that was signed by the person or their representative. There were clear terms and conditions and these included what the fees covered.

The service has a written statement of purpose. This had been reviewed and the provider has sent us a copy so we know what service is being offered. During our inspection we found that the services provided at the home reflected those described in the statement of purpose.

We found that any incidents or accidents were properly recorded and people who use the service can be confident we are notified about specified incidents that affect their health, safety and welfare so that action can be taken.

We specifically focussed on the care of three people who used the service and spoke with five people. We spent three and a half hours in the communal areas of the home observing how staff cared for people who were not able to give us their views.

We found that people were supported to understand the care choices available to them; express their views and be involved in making decisions about their care and treatment. People had their privacy, dignity and independence respected and care staff encouraged people to continue to do as much for themselves as they were able to.

People's needs were assessed to establish the care they needed and reviewed to make sure any changes were quickly identified. Each person had written plans of care; care staff knew people well and provided care according to those plans. One person told us "The girls [care workers] are very good, do what they can to help."

We found that people were cared for in a clean, hygienic environment. There were good systems in place to manage and monitor the prevention and control of infection including ongoing records of checks and cleaning schedules.

There were sufficient numbers of appropriate staff on duty to meet people's needs and people told us that staff at the home were kind and competent.

People’s personal records including daily welfare records were accurate and fit for purpose. Records concerning the safety of the building and equipment were up to date and available when we asked for them.

Twenty-eight people were living in the home when we visited. We talked with three of them and the relatives of some of them about their experience of living there.

People and their relatives told us that they were happy with the quality of the care provided. One person said “Everyone is very kind.” Relatives told us “I can’t think how they could be more loving and caring.”

People told us they were involved in the assessment of their needs and the planning of the care and support they needed. One person who had moved into the home within the previous seven months said they “talked about what I wanted help with.”

People and their relatives told us staff treated them with respect.

People told us they had the chance to give feedback on the care provided. One person said staff went through their care plan “about every three months.” They said that things were sometimes changed and they were “accommodating.”

People were given the opportunity to influence how the service was run. They said “We can ask questions.”

People said they could raise concerns if they were not happy about anything. One person told us they took things up “straight away”. Sometimes they did not agree with things but these were “minor” things.