About the service: Kingsley House is a residential nursing home. Kingsley House provides accommodation, personal care and nursing care for up to 35 people with physical disabilities or age-related frailty. At the time of the inspection there were 27 people living at the service.

People’s experience of using this service:

• People’s risks had been identified and appropriate safety measures were in place. People were supported by a consistent team of staff who were kind and caring.

• Staff had good relationships with people and knew them well. People told us they liked living at the service and were happy with the staff who supported them.

• People received their medicines as prescribed and medicines were managed safely.

• People could see healthcare professionals when needed and supported to live healthy lives.

• Staff knowledge in relation to people’s conditions, their needs, and how to support them was thorough.

• Care plans were person centred and included people’s personal preferences. This meant people received a service which was tailored to their individual needs.

• People were supported to take part in various activities such as arts and crafts, live entertainment and seasonal activities.

• People’s independence was promoted by positive risk-taking approaches. This meant people could maintain life skills and enjoy a community presence.

• There was an open culture where staff and people could raise concerns or issues. People told us they felt safe at the service and felt happy to speak up.

• People, relatives and staff told us the service was well-led. The registered manager was a visible presence and knew people and their relatives well.

• People’s feedback was encouraged and used to shape the service.

The service met the characteristics of Good overall; more information is available in the full report below.

Rating at last inspection: At the last inspection the service was rated Requires Improvement (This report was published on 16 March 2018).

The overall rating for the service has improved from Requires Improvement to Good.

Why we inspected: We inspected this service as part of our ongoing Adult Social Care inspection programme. This was a planned inspection based on the previous Requires Improvement rating. We followed up on progress against agreed action plans, to address six breaches in regulation found at our previous inspection. Previous CQC ratings and the time since the last inspection were also taken into consideration.

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

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This unannounced comprehensive inspection took place on 10, 12 and 17 January 2018.

Kingsley House 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.

Kingsley House provides residential and nursing care for up to 37 people. At the time of our inspection there were 29 people living there, some people were living with dementia. Kingsley house accommodates people in one home over four floors and has five large bedrooms where people can choose to share.

There was 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.

We previously inspected the service on 11 and 12 June 2015 and rated the service ‘Good’ overall. At this inspection we found a number of concerns and the service was rated ‘Requires Improvement’ overall. Following the inspection, the registered manager informed us about some of the measures they had implemented immediately following our inspection to drive improvement. This included reviewing people’s choking risk assessments.

People told us they felt safe. However we found improvements were needed to ensure people would always receive the care they required to remain safe. Medicine management and the use of thickening agents for people with swallowing difficulties required improvement. Some people’s care plans required updating to provide correct information for staff to follow with regard to choking risk assessments.

Quality monitoring of the service was not always effective when care plans were not checked for their accuracy and accidents were not always reflected upon to prevent further occurrences and this required improvement. People were treated with compassion and kindness but they did not always understand staff whose first language was not English. This could make people feel not listened to and not always engaged in their care.

People's care and support needs were assessed to monitor the staffing levels required. Sufficient staffing levels were maintained and the recent recruitment of an activity organiser would improve people’s choice of activities and add additional individual engagement.

People made most decisions and choices about their care when possible. When people did not have the capacity to make decisions staff followed the Mental Capacity Act guidance to protect them. People had access to healthcare professionals and their health and welfare was monitored by them.

People told us staff were kind when they supported them with their care. People were supported by staff that had access to training and supervision to develop their knowledge.

Some people joined in with activities provided which included musical entertainment, crafts and exercises. People had some access to the community. Improvements were needed to ensure all people had opportunities to remain active and pursue their interests.

The registered manager was approachable with relatives and people. People and their relative's concerns were taken seriously and acted upon by the registered manager. The registered manager wanted to ensure the service continued to improve and were keen to take action to ensure good care was provided to people. The staff felt well supported by the registered manager and staff meetings had increased to monthly.

We found three 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 the report.

At the time of our visit there were 31 people living at the home. The registered manager was available for the whole period of our visit. Staff on duty included the deputy manager, one registered general nurse, seven care staff and housekeeping staff. Staff we spoke with told us “Staffing levels are very good here” and “Staffing levels increase when a person’s needs change”.

People had their comments and complaints listened to and acted on, without the fear that they would be discriminated against for making a complaint. People told us "If I was unhappy I would tell the staff here or the manager”.

People living at the home told us "I chose this home as it was near my family and I have settled in well" and “I feel I am cared for very well” and “Staff are attentive”.

When we visited this home in August 2012 we found concerns in a number of areas. We made a follow up visit to check that improvements had been made. We did not speak with people who used services at this visit.

At our last visit we found that people were not always involved in decision making about their care. We thought that this impacted on their dignity and independence. In particular we found that staff had not followed correct procedures to ensure that people's consent was obtained for the use of bedrails. At our follow up visit we saw that people who had bed rails in place had given their consent to their use. We were satisfied that they understood the risks and benefits of their use and had been given the opportunity to express their choice.

We previously raised concerns about the lack of organised activities in the home. We saw little evidence that people who did not engage in group activities were given opportunities to engage in one to one activities. These people were at risk of social isolation. At our recent visit we saw that a greater range of activities was provided. Records had improved so that we could be assured that everybody had opportunities to engage in some sort of stimulating activity.

Care plans had been re written and records provided better evidence that people's care needs were met. A comprehensive programme of audit was in place and there was evidence that audit and other indicators were being used to monitor and improve standards.

We previously visited this home in January 2012. At that time we had concerns in a number of areas. There had been a failure to follow correct procedures to ensure that people’s consent was obtained for the use of bed rails. This affected people’s dignity. There was a failure to follow correct safeguarding procedures, a lack of staff supervision, and inadequate quality assurance processes. We were also concerned that there were few activities organised for people. The provider submitted an action plan which detailed the actions they had taken to achieve compliance in these areas. We made a return visit to check their progress with this.

We did not speak with people living in the home as part of this review. We spoke with the deputy manager on the day of our visit as the registered manager was on leave. We also spoke with the registered manager over the telephone on her return from leave.

We saw inconsistent practice and documentation in relation to obtaining consent for the use of bedrails and we were concerned to find the term ‘cot sides’ was still in use.

We were satisfied that safeguarding responsibilities were documented and understood. The provider had updated its safeguarding policy and it was clear that any allegations of abuse should be reported to the appropriate authorities.

The deputy manager told us that all staff were now receiving regular supervision and we saw some evidence of this. However the meetings were not recorded.

We saw that risk assessments had been undertaken to ensure that people were protected from harm. Care plans detailed the safeguards required to keep people safe but records of care did not provide sufficient detail to demonstrate that the care prescribed was provided or people’s needs were being met.

We looked at records of activities organised in the home but we felt provision was still inadequate, although there were plans to increase provision by the employment of a volunteer.

We were pleased to see that the home had started to undertake audit, although systems were not well developed to provide assurance of quality and safety.

People we spoke with made a number of positive comments about the quality of care they receive at Kingsley House Nursing Home. These included:

"staff have been extremely kind to me", "I like it here, staff treat me well and the food is good","staff are very caring", "staff look after me". "if you have to be in a home this is a good one".

A relative we spoke with told us: "I am always made to feel welcome, its a friendly home". They told us that they always felt informed about how their relative was and always made to feel they could talk to the staff or manager at any time if they had concerns or worries.

The home had received a number of letters from relatives and we looked at some of these. Comments included:

"our relative was treated with compassion and dignity at all times"

"received loving and truly faultless care"

"our relative was treated with great respect, dignity and gentle loving care"

"when I think how frail she was when they first came to stay and how well they became, as a result of the kindness and compassion from you all. It is a testament to your philosophy of care".

We note that some of these comments relate to people being treated with dignity and

respect. From our observations of care staff we have commented on the professional

behaviour in relation to this area of their work. However we also noted that there were

failures in the home's practices about the use of bedrails and issues of obtaining consent. This is an area which impacts on respect and dignity and we have taken action so that the home addresses these concerns.

This inspection took place on 11 and 12 June 2015 and was unannounced. The previous inspection was carried out on 30 November 2013 and there had been no breaches of legal requirements at that time. We had no previous concerns prior to this inspection.

Kingsley House provides accommodation and nursing care for up to 37 people. At the time of our visit there were 31 people living at the service.

There was a registered manager in post. 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The registered manager and staff understood their role and responsibilities to protect people from harm. Risks had been assessed and appropriate assessments were in place to reduce or eliminate the risk. Staffing numbers on each shift were sufficient to ensure people were kept safe.

All medicines were stored, administered and disposed of safely. The service had policies and procedures for dealing with medicines and these were adhered to.

The service was meeting the requirements of the Deprivation of Liberty Safeguards. Staff had received appropriate training, and had a good understanding of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People were supported with their dietary and nutritional needs. People had access to a range of healthcare professionals when they required specialist help. Care records showed advice had been sought from a range of health and social care professionals.

The registered manager assessed and monitored the quality of the service provided for people. Systems were in place to check on the standards within the service. These included regular audits of care records, medicine management, health and safety, infection control and staff training and supervision.