Archived: Kingsfield Care Centre

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.

Kingsfield Care Centre is one of 14 care homes in Tameside owned by Meridian Healthcare, part of the organisation HcOne, and is situated in Ashton-under-Lyne. The home provides care, support and accommodation for up to 54 people who require personal care without nursing.

The home is a single storey, purpose built care home and all rooms provide single accommodation, many of which are en-suite. Communal bathrooms and toilet facilities are available throughout the home. Bedrooms are located along four corridors and people have access to a large combined lounge and dining room with an attached conservatory. The large kitchen is attached to the dining room. The home has a separate laundry area and a room named the sun room; this area is equipped with sun lamps, deck chairs and is decorated to resemble a beach. Staff told us this room was not in operation and had not been used for some time. There is a quadrangle garden and patio area in the middle of the building that is accessible to people who use the service. Kingsfield Care Centre has an attached unit, known as the Windsor Suite, where people living with dementia and higher support needs are cared for.

At the time of our inspection there were 37 people living at Kingsfield.

At the last inspection the service did not have 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. The previous registered manager had left in June 2016 and the provider had deployed a number of relief managers in the period up to our previous inspection in July 2016. Since our last inspection the provider had placed one consistent relief manager in the home and a new home manager had been employed in the three weeks prior to this inspection.

The service was previously inspected on 26, 27 and 28 July 2016 when breaches of eight legal requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were found. We took enforcement action and Kingsfield Care Centre was placed into special measures. We took action and asked the registered provider to make improvements which included ensuring people were involved in their plan of care, people were treated with dignity and compassion, people were given choice and consent was always obtained, infection control issues were addressed, staff were trained to move people safely, people were able to call for assistance when required, accidents were analysed and acted upon, people’s medical needs were promptly and appropriately met, people had their nutritional and hydration needs met, sufficient staffing levels were in place and to ensure adequate and consistent leadership of the home.

The Care Quality Commission has met regularly with the provider as a result of the July inspection to seek assurances that concerns identified have been addressed. We received a series of monthly action plans that stated all actions would be completed by the end of October 2016 and the provider confirmed to us that action had been taken to address the shortfalls in care and support we identified in July 2016.

During this inspection we found a number of improvements had been made around appropriate staffing levels, the moving and handling of people, the environment, access to call bells and levels of dignity and respect shown to people. However, although some improvement had been seen during the inspection, we also found a continuation of breaches of legal requirements. These continued breaches were regarding meeting people’s nutritional and hydration needs, involving people in care planning, timely response to people’s care and medical needs, consent, staff training and supervision, and management of the service.

We identified breaches of seven of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is ‘Requires improvement’. However, we are continuing to place the service 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 in the same question at each of these inspections for us to continue to place services in special measures.

During the last inspection we found that there were not always enough staff available to meet people’s needs. On our return we found an increased presence of and more attentive staff. However, we observed instances where people did not always receive care and support in a timely way.

Staff told us communication, direction and support from management had improved. One staff member told us, “A big improvement overall. The biggest has been morale of the staff and residents.”

Care plans and risk assessments were in place; however, we found these were not always being followed to ensure safe and effective care delivery.

We did not see evidence of people or their representative’s involvement in their plan of care or descriptions of how people would like their care needs met. However, we saw records of a newly introduced scheme ‘resident of the day’ where people would have an individual full review of all care and support needs.

We found that records of the administration of medicines were mostly in order. Documentation at the home showed us that people mostly received appropriate input from health care professionals, such as district nursing and their general practitioner (GP), to ensure they received the care and support they needed. However, we found one person to be in need of medical attention that had not been sought and we had to intervene to ensure they received the required assistance.

We found people were not always appropriately supported to ensure they had their individual nutritional and hydration needs met, such as, the texture of the food. Associated documentation was not always accurately completed. We made observations that the dining experience for some people was not always enjoyable and some people were left without support to eat their meal.

During our observations, we found that people were moved and handled in a safe way and in accordance with individual assessments. People were assisted to move by staff who were kind, caring and provided reassurance.

During our initial tour of Kingsfield Care Centre on the first morning of this inspection, we noted that the previous malodour had improved but was still evident in some areas. We found improvements in infection control measures throughout the home; however, we found a number of issues still needed addressing, such as hand washing facilities in people’s bedrooms and access to hot water in one area of the building.

Audits and checks for building and equipment safety were in place and up to date.

At our previous inspection we raised several safeguarding alerts with the local authority about our concerns relating to care and support practices; specifically lack of medical attention, people’s dignity and unsafe moving and handling of people. We also reported our initial findings to the local authority commissioning team. The local authority have maintained links with the home since the last inspection and have reported improvements with some aspects of care; however, some concerns still remain which correlate with the findings of this inspection.

Due to our findings on the previous inspection the provider invoked voluntary suspension on new admissions to the home until the issues we had identified had been resolved. This was still in place during this inspection.

The service was previously inspected on 14 June 2013 when no breaches of legal requirements were found.

Kingsfield is one of 31 care homes owned by Meridian Healthcare and is situated in the Ashton-under-Lyne area of Tameside. The home provides care, support and accommodation for up to 54 people who require personal care without nursing.

The home is a single storey, purpose built care home and all rooms provide single accommodation, many of which are en-suite. Communal bathrooms and toilet facilities are available throughout the home. Bedrooms are located around four corridors and people have access to a large combined lounge and dining room with an attached conservatory. The large kitchen is attached to the dining room. The home has a separate laundry area and a room named the sun room; this area is equipped with sun lamps, deck chairs and is decorated to resemble a beach. There is a quadrangle garden and patio area in the middle of the building that is accessible to people who use the service. Kingsfield had an attached unit, known as the Windsor Suite, where people living with dementia and higher support needs were cared for. However, this unit had been closed for redecoration and the people who were usually cared for in the unit were spending their days in the conservatory of the main lounge during our inspection.

At the time of our inspection there were 39 people living at Kingsfield.

The service did not have 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. The previous manager had left in June 2016 and the provider had deployed a number of relief managers in the period up to our inspection.

We carried out this inspection in response to information we received from the Health and Safety Executive (HSE) regarding a person who had fallen at the home and had sustained a serious injury.

We identified eight 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 report. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We have made one recommendation about the preparation and service of food for people who require a specific diet.

During this inspection we found that there were not always enough staff available to meet people’s needs. Unsafe staffing levels were reported to us by staff and inaccurate rotas meant that we were unable to make a judgement about whether calculated staffing levels were adhered to. Throughout our inspection we saw many examples where people were left unattended or did not receive support in a timely way.

People were supported by staff who were mostly kind and caring, however, the majority of interactions between people and the staff who cared for them, were task-based and observations we made showed us consent was not always sought before care was provided. We saw a number of instances where people were not treated safely or with dignity and respect and we reported staff members’ actions to senior management during the inspection visit.

Staff told us they did not receive communication, direction or support from management.

Care plans and risk assessments were in place; however, they did not always accurately reflect people’s current care needs. Inaccurate records placed people at risk of receiving inappropriate or unsafe care and support.

We did not see evidence of people or their representative’s involvement in their plan of care or descriptions of how people would like their care needs met.

We found that records of the administration of medicines were in order. Documentation at the home showed us that people mostly received appropriate input from health care professionals, such as district nursing and their general practitioner (GP), to ensure they received the care and support they needed. However, we found one person was visibly suffering from infections and required medical attention that had not been sought, one person who had an untreated wound and one person who, because they were not being repositioned as stated in their care plan, placed them at a higher risk of developing pressure ulcers.

We found people were not always appropriately supported to ensure they had their nutritional needs met in a specifically prescribed way and documentation was not always accurately completed. We made observations that the dining experience for some people was not enjoyable due to insufficient numbers of staff being available to support people.

Staff we spoke with understood how to safeguard people and were able to demonstrate their knowledge around safeguarding procedures and how to inform the relevant authorities if they suspected anyone was at risk from harm. However, not all staff demonstrated an understanding of the legal safeguards around mental capacity. We found that people had not always been protected and staff had not reported improper treatment as we found during the inspection.

During our observations we found that people were not always moved and handled in a safe way or in accordance with individual assessments.

During our initial tour of Kingsfield on the first morning of our inspection, we noted that some areas of the home had a malodour and we identified issues with infection control in a number of areas of the building.

We found that people could not easily call for assistance; call bells in communal areas did not have attached cords and we found one person’s bedroom call bell broken. People who had a sensor mat in their bedroom did not have access to a call bell, because there was only one socket which was either used for the sensor mat or the call bell. Therefore people in these rooms were not able to call for assistance.

Audits and checks for building and equipment safety were in place and up to date.

During our inspection we raised a safeguarding alert with the local authority about our concerns relating to care and support practices; specifically lack of medical attention, people’s dignity and unsafe moving and handling of people. We also reported our initial findings to the local authority commissioning team.

We found concerns regarding the high level needs of people at the home and asked for clinical assessments of people to be carried out during the inspection visits.

Due to our findings on the first day of our inspection the provider invoked a 4-week minimum, voluntary suspension on new admissions to the home until the issues we had identified had been resolved.

People told us that they liked the staff team and that nothing was too much trouble for them.

We spoke with some visitors who were there to see their relatives. One person we spoke with said, " We always find the staff to be very approachable. When we visit we can see that the residents are their priority. There's always a good relaxed atmosphere and there are always staff around to deal with things".

We saw that there were care plans in place to support the staff in providing appropriate care and support to the people living in the home.

When we looked aroung the home, we found all areas to be clean and tidy and staff had a good understanding of infection control procedures.

During our visit we saw that staff supported people in a way that promoted their dignity.