This inspection took place on 25 and 26 April 2018 and was unannounced. Kingswood Court Nursing Home is registered to provide care for up to 66 people. At the time of our visit there were 54 people were living at the service. 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.

There was a registered manager who had been in post for a year. 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.

At the inspection of May 2017, we rated the service overall as Requires Improvement. At that inspection, we found breaches of Regulations 9 and 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because medicines were not managed safely and people were not receiving meaningful activities that met their personal preferences.

Following the inspection, we told the provider to send us an action plan detailing how they would ensure they met the requirements of those regulations. At this inspection, we saw the provider had taken action as identified in their action plan. In addition, they had sustained previous good practice. As a result of this inspection, the service has an overall rating of Good.

Why the service is rated Good

The appointment of the registered manager had significantly helped rectify previous poor management of the service. It was evident they were confident and committed to embrace new challenges and to continue to improve the service. An increase in the provider’s oversight meant that a number of improvements had been made to help ensure that people were safe and received quality care.

Improvements had been made to help ensure people were protected from the risk of poor management of medicines. The registered manager and staff followed procedures, which reduced the risk of people being harmed. Staff understood what constituted abuse and what action they should take if they suspected this had occurred. Staff had considered actual and potential risks to people, plans were in place about how to manage, monitor and review these. People were supported by the service’s recruitment policy and practices to help ensure that staff were suitable.

Staff had the knowledge and skills they needed to carry out their roles effectively. They felt supported by the registered manager and deputy at all times. They had a good understanding of the Mental Capacity Act 2005 (MCA). The care staff understood its principles and the importance of supporting people to make decisions and protect their rights. People enjoyed a healthy balanced diet based on personal preferences.

People and their relatives felt staff were caring and kind. Staff had a good awareness of individuals' needs and treated people in a warm and respectful manner. People received a service that was based on their personal needs and wishes. Changes in people’s needs were quickly identified and their care amended to meet their changing needs. The service was flexible and responded positively to people’s requests. People who used the service felt able to make requests and express their opinions and views.

People benefitted from a service that was well led. The vision, values and culture of the service were clearly communicated to and understood by staff. The registered manager had implemented a programme of ‘planned growth’ that had been well managed and they were committed to continuous improvement. The provider and registered manager understood the importance of effective quality assurance systems. There were processes in place to monitor quality and understand the experiences of people

This inspection took place on 15, 16 and 20 March 2017 and was unannounced. This service was previously inspected in October 2016. At that time we found there were areas that required improvement and we made recommendations to the provider in order to achieve this. Kingswood Court Nursing Home provides accommodation and nursing care for up to 66 people. At the time of our visit there were 63 people living at the service.

A vacancy for a registered manager had recently become available at the service and someone had been recruited to commence their post mid-April. There had been a history of unsettlement around consistency in management and leadership. Because of this a significant number of improvements were required to ensure that people were kept safe and received quality care. The provider acknowledged the deterioration in the service provision over the last year. 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.

An action plan had been developed highlighting areas for improvement. We were able to see where action had been completed and where other areas were being addressed. Work had been prioritised and realistic timescales had been put in place so that the quality of work and further development had not been compromised. The service had been supported by various health and social care professionals and this had been embraced by the management and staff. They acknowledged shortfalls, learnt lessons and took action to resolve issues. It was evident progress had been made and working progress continued.

At this inspection we could not be satisfied that medicines were managed safely and this was being investigated by the service with support from the local authority safeguarding team.

We could not be assured that people received appropriate care and support because there were not effective systems in place to assess, plan, implement, monitor and evaluate people's needs. People had not always been involved throughout these processes but this was improving. This was paramount to ensure their needs were clearly identified and the support they received was meaningful and personalised. We needed further evidence to ensure people experienced a lifestyle which met their individual expectations, capacity and preferences.

People and visitors we spoke with told us they were happy and things were improving. Despite the areas for improvement, people said things were satisfactory and staff always did the best they could. We read comments from relatives who had recently completed a questionnaire. They wrote, “The staff on the top floor work well together as a team and there is a friendly, welcome feel. From the moment I come through the front door I always have a good welcome by whoever answers the door”, “The staff are very friendly, helpful and professional” and “Myself and my family are really happy and the staff are very nice”.

Staff were knowledgeable in safeguarding procedures and how to identify and report abuse. People were supported by the recruitment policy and practices to help ensure that staff were suitable. The manager and staff were able to demonstrate there were sufficient numbers of staff with a combined skill mix on each shift. Despite staff vacancies, every effort was made to ensure continuity when using agency staff.

A training programme had been developed for all staff and good progress had been made rolling this out to staff. Staff acknowledged the training had been useful and effective. People were helped to exercise choices and control over their lives wherever possible. The deputy understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS

We carried out an unannounced focused inspection of this service because we had received some information of concern and we wanted to investigate this. We have only looked at the areas of Safe, Effective and Responsive as the concerns sat within these areas.

This report only covers our findings in relation to these specific areas. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Kingswood Court’ on our website at www.cqc.org.uk.

Kingswood Court Care Home is a care home with nursing for up to 66 predominately older people. At the time of this inspection the service was supporting 53 people . The service had a registered manager who had worked at the home for 4 months. 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.

At this inspection we looked at risk assessments, staffing levels, protecting people from harm and abuse, staff training and the nutritional needs of people. In addition to this we looked at people’s care plans and whether these were person centred and whether staff were providing care in a manner which maintained people’s dignity and respect. We also looked at whether there were sufficient activities for people and if complaints had been dealt with appropriately.

Improvements were required with how risk assessments were recorded and how risks to people were managed. The use and training of agency staff required reviewing. This was to ensure people received care which was safe, from staff who knew them well and the potential for risks being mismanaged was reduced.

Improvements were required with how the service trained staff to ensure they were aware of what the provision of person centred care entailed and to ensure people were supported in accordance with their preferences. We found people had sufficient levels of food and drink and had choice as to what they wanted to eat at meal times.

Improvements were required to ensure people’s care files were complete and contained relevant information which was current to enable staff to fully understand people and provide a high level of person centred care to meet their needs. Improvements were required to ensure staff fully understood what is meant by dignity and respect and enable them to provide a service where they maintain people’s dignity and respect. Improvements were required to ensure activities were suitable and people found these to be fulfilling. We looked at the complaints procedure and felt this was appropriate.

You can see what action we told the provider to take at the back of the full version of the report.

We were introduced to people, visitors and staff throughout the visit and we were welcomed. Everyone we spoke with shared positive experiences about living in the home and the care they received. There were 57 people living in the home at the time of the inspection.

People looked well, were relaxed and happy when we visited. People were spending time in the lounges and dining rooms reading papers, talking with friends or taking part in activities. Some people were enjoying the day in the privacy of their own room and receiving visitors.

We spent time in various parts of the home, including communal areas and individual bedrooms so that we could observe the direct care, attention and support that people who lived at the home received.

The manager was available throughout the day and they were knowledgeable about people in their care, the policies, procedures and systems in place to ensure the continued smooth running of the home. The manager had been in post for a year and had made significant improvements following the previous inspection of February 2012.

People shared with us their experiences about living in the home. We spoke with five people and one visitor at length. Everyone expressed positive comments and these are detailed throughout the report.

We spent time in various parts of the home, including communal areas and individual bedrooms so that we could observe the direct care, attention and support that people received.

We observed and joined people in a game of indoor skittles. The attendance was good and people appeared happy spending time together.

Staff told us that there had been ‘great improvements’ in the last year and that the manager was ‘approachable, supportive and wanted the very best for people in their care’. Staff felt that ‘morale was good’, ‘team working was effective’ and that they were ‘proud’ to work there.

We spoke with five people who lived in the home. Two people told us they were bored. People who used the service told us that staff were good and helpful. One person told us "I'm well looked after". The people we spoke with told us they felt safe.

We found that people were included in decisions about their care but full assessments of their needs were not always completed. There were no documented assessments of people's capacity to make decisions about their care within the care records. Care plans were, however, person centred and contained details of people's preferences.

We found that most staff had knowledge of how to safeguard people from the risks of abuse or harm but not about the Mental Capacity Act or the Deprivation of Liberty Safeguards.

We found that there were systems in place to assess and monitor the service and that where issues were identified actions were planned and taken.

The manager of the home had only been in post since November 2011 and had undertaken a review of the service and had identified some of the issues we found during our visit.

This inspection took place on 16 and 21 April 2015 and was unannounced. The previous inspection of Kingswood Court Care Home was on 21 October 2013. There were no breaches of the legal requirements at that time.

Kingswood Court Care Home is a care home with nursing for up to 66 predominately older people. At the time of our inspection there were 59 people in residence. 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were looked after with their safety in mind. Staff received safeguarding adults training and were knowledgeable about safeguarding issues. They knew what to do if concerns were raised and who to report the concerns to. Pre-employment checks were robust and ensured that unsuitable workers could not be employed to work in the service. Some improvements in the respect of the management of medicines has already been implemented by the registered manager.

Any risks to people’s health and welfare were assessed and appropriate management plans were in place where needed. The staffing numbers on duty each shift were continually reviewed and increased when necessary to ensure that each person’s care and support needs could be met.

Staff were trained to enable them to carry out their roles and responsibilities. New staff had an induction training programme to complete and there was a programme of refresher training for the rest of the staff. Care staff were encouraged to complete nationally recognised qualifications in health and social care.

People were supported to make their own choices and decisions where possible. Staff understood the need for consent and what to do where people lacked the capacity to make decisions. We found the home to be meeting the requirements of the Deprivation of Liberty Safeguards.

People were provided with sufficient food and drink. There were measures in place to reduce or eliminate the risk of malnutrition or dehydration. Arrangements were made for people to see their GP and other healthcare professionals as and when they needed to do so. People were administered their medicines as prescribed by their GP.

People received a service that was caring and which met their needs. They and their relatives said they were well looked after. The staff team had good friendly relationships with the people they were looking after. People were able to participate in a range of different activities.

Care records were kept for each person and provided information about how the planned care was to be provided. People were involved in having a say how they were looked after and were encouraged to raise any concerns they may have.

Various systems were in place to audit and monitor the quality and safety of the service. Action plans were developed were improvements and changes were required. The regional manager visited the service on a monthly basis and also conducted a quarterly audit of the service. These measures ensured that any improvement actions were followed up and implemented.