Archived: Kingsfield Care Centre

Updated 31 January 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 4 and 6 December 2017 and was unannounced.

The inspection team comprised three adult social care inspectors and an expert-by-experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. The expert-by-experience used on this occasion had experience in older people and dementia care.

Prior to the inspection we reviewed information we held about the service, including notifications received from the provider and information from the local authority safeguarding and commissioning teams. No concerns were raised from the local authority. As part of the inspection we ask the provider to complete a provider information form (PIR). This is a document which asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

During the inspection we used a number of different methods to help us understand the experiences of people who used the service. We spoke with seven people who used the service, five relatives/visitors, two staff members, the deputy manager, the area director and the cook. We observed care and support in the communal areas of the home. On this occasion we did not use the Short Observational Framework for Inspection (SOFI). People or their relatives were able to speak with us so we gained an understanding of people’s experience through speaking with people, informal observations and reviewing records. SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We looked at six people's care records, some in detail and others to check for specific information, medication records and other records which related to the management of the service such as training records and policies and procedures.

On 6 December 2017 we spoke with four care staff and three ancillary staff on the telephone. We also asked the deputy manager to send us some information regarding a person's food and fluid chart and other people's falls risk assessments which they did in a timely manner.

Updated 31 January 2018

Our inspection of Kingsfield care Centre took place on 4 and 6 December 2017 and was unannounced.

At the last inspection on 1, 2 and 5 December 2016 we asked the provider to take action to make improvements around person centred care, consent, safe care and treatment, safeguarding, meeting people's nutritional and hydration needs, staffing and good governance. These actions had not been fully completed at this inspection. We found continued and breaches regarding meeting people's nutritional and hydration needs, safe care and treatment, person centred care, consent and good governance.

The service remains in special measures. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The 'Inadequate' rating does not need to be relating to the same question at each of these inspections for us to continue to place services in special measures. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Kingsfield Care Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Kingsfield Care Centre accommodates up to 54 people in one adapted building. At the time of our inspection there were 29 people living at the service.

The registered manager had left the service in October 2017. There had been five registered managers in post since the service registered in 2010 and other managers had left the service prior to registering with the Care Quality Commission. 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 time of our inspection the service was being managed by the deputy manager with support from the area director and three local registered managers from the provider's other services. We were concerned at the lack of sustained management at the service.

Safeguarding processes were in place and staff had been trained to recognise signs of abuse. Accidents and incidents were monitored, analysed and actions taken as a result. However, specific assessments were not always in place to mitigate risks to people.

Sufficient staff were deployed to keep people safe and training was in place to equip them with the required skills for their role. Safe recruitment processes were in place. People told us staff were kind and caring. Staff knew people well and some good relationships had developed. Although we saw some caring interactions from staff we also saw a lack of quality interaction from other staff. Staff respected people's privacy and dignity.

Medicines were not always managed safely as the staff member administering medicines on the day of our inspection left the medicines trolley unsecured during the medicines round.

The service was working within the legal requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). However, better systems needed to be in place regarding covert medicines and best interest decisions around consent.

Complaints were recorded with actions seen to be taken. People told us they knew how to complain if required and information on how to complain was displayed at the service.

Food and fluid charts were not completed in a timely manner. Dietician referrals were made where people were deemed at nutritional risk. However, we saw some fluids as prescribed by the dieticians were not offered to people or documented on food/fluid charts. The mealtime experience was noisy and we saw little evidence of staff organisation over this period.

Care records were in place. However, these did not always reflect people's current care needs accurately. We also saw care provided did not always reflect people's documented needs.

Communal areas were noisy, with two televisions and the radio playing.

A range of activities were on offer and people could choose if they participated in these.

Staff meetings were in place which discussed a range of service related topics. Although the service had organised resident/relative meetings during the year, no relatives had attended these. We saw an annual resident/relative feedback survey had been conducted with results analysed.

A range of quality assurance audits were in place to monitor and drive improvements at the service. However, these systems and processes had not identified issues we found at inspection which were continued breaches from the inspections in July 2016 and December 2016. The service had submitted action plans following these inspections. We would have expected these actions to have ensured the service was no longer in breach of Regulations.