Kingswood Manor

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Best practice guidelines with regards to the management of medicines and wounds was not being followed. This increased the risk of poor outcomes for people in respect of their physical and medical health conditions. People’s communication needs were not appropriately supported in accordance with the Accessible Information Standard and other associated best practice. Care staff co-ordinated and prioritised people’s support needs effectively. At our last inspection, records showed significant gaps in the care people received. At this inspection, records showed people had access to regular support from care staff in respect of their day to day needs such as continence care, nutrition, repositioning and mobility. People told us staff came quickly when they needed help. They told us they had access to a regular GP and other health professionals in support of their health and well-being. Relatives confirmed this. People said they received enough to eat and drink and there were plenty of options to choose from. People who required support at mealtimes were supported patiently by staff. Staff monitored people’s food and fluid intake to ensure they were eating and drinking enough. Special dietary requirements were supported, and advice sought from Speech and Language Therapy where there concerns about a person’s ability to eat and drink safely. At the last inspection, people’s consent for specific decisions had not always been obtained in accordance with the Mental Capacity Act 2005. At this inspection, improvements had been made and the correct process followed. We found however that there was a lack of communication tools or support systems in place to support people with communication difficulties to participate in decisions made about their care.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Since the last inspection, the provider had improved the accuracy and frequency of people’s needs based assessments. Further work was still required however to ensure staff had a holistic and detailed view of people’s needs and risks. We found however that people’s experience of care had improved, with people’s day-to-day support managed and co-ordinated much more effectively.

Staff told us they had access to information on people’s, needs, risks and care. We found however staff lacked sufficient information on some areas of people’s needs, which increased the risk of ineffective or inappropriate care being provided.

At the last inspection, the processes in place to assess and care plan people’s needs and risks was not robust. At this inspection, improvements had been made but some aspects of people’s care had still not been fully explored. For example, with regards to medical conditions, allergies, end of life care, dementia and behaviours of concern. This meant increased the risk that people’s care would not be effective in promoting positive outcomes. We also found however that people’s communication needs were not supported appropriately to enable them to express their needs and wishes. People were supported to access medical professionals as and when required, in order to ensure their health needs were met. This included access to a GP, district nurse, Speech and Language Therapist or dietitian.

People told us they felt the support they received met their needs. They felt staff knew what they were doing and did a good job. We found however that the management of people’s wounds and the administration of medicines did not correspond with evidence based best practice guidelines. For example, guidance published by CQC, The National Institute of Health Care Excellence (NICE), The Royal Pharmaceutical Society or The National Wound Care Strategy Programme.

Staff did not always have a clear understanding of people’s communication needs. One staff member told us no-one in the home had any communication difficulties. This was not accurate. Staff members told us there were no communication aids in the home to help those people who struggled to communicate their needs and wishes. The manager confirmed this. This was not in accordance with the Accessible Information Standard and associated best practice guidance.

Although improvements to the overall governance of the service had been made. the provider’s audits and processes had still not identified shortfalls in medicines management, wound management and communication processes. Care plans although improved still did not align with best practice guidelines for planning end of life care or support for people with dementia.

People told us they saw the doctor quickly if they felt unwell. Relatives told us appropriate health assessments were completed by other professionals as and when appropriate. Records confirmed this. Their comments included, “I see the doctor if they think I need to” and “They always let me know if my husband needs a GP”.

Care staff told us that certain times of the day such as morning and weekends were busier than others. They told us they prioritised and co-ordinated people’s support as a team ensure people received the care they required. Staff felt they worked well together as a team. Records showed improvements in the way in which staff worked together to provide people’s support.

Partners raised no concerns with how staff, teams and services worked together.

People were supported to access medical professionals as and when required, in order to ensure their health needs were met. This included access to a GP, district nurse, Speech and Language Therapist or dietitian.

People told us they received enough to eat and drink, and some people told us they also received nutritional supplements to boost their calorie intake. Staff monitored people’s food and fluid intake to ensure it was sufficient. They made referrals to the dietitian as and when required. People’s comments included, “He eats well…there are choices with food”; The food is good, and mum has put on 3 stone since she has been her in just over a year. She needed to put weight on as she was very frail” and “The food is good and we have different things, like Pasta with mushroom sauce and roast beef and roast potatoes”. People told us that staff supported them to be as independent as much as possible.

Records showed that nursing staff referred people to other health professional in support of their health.

There were processes in place to ensure that referrals were made appropriately to other health and social care professionals in support of people's well-being as and when required.

People’s experience of positive outcomes with regards to their health conditions was hindered by poor medicines management. People did not always receive the medicines they needed or in a safe way to promote positive outcomes.

Staff used computerised care plans and handheld devices to record the support people received. This system flagged up when specific care tasks were due. For example, repositioning support or continence care. There was also an electronic system in place to monitor the administration of medicines, however staff had not always completed accurate records to ensure medicines were given correctly and wounds managed appropriately.

There was a handover system in place between shifts to ensure staff had information on any changes in people’s health and wellbeing. A multi-disciplinary meeting took place each week with other health professionals to discuss people’s care. An internal clinical meeting also took place with nursing staff. The processes in place however had not identified that people’s health conditions were not being properly treated with medicines. We also found that the documented monthly reviews of people’s needs and care were brief and did not show people’s involvement in discussions about their own care.

People did not comment specifically on the issues of consent. However other feedback given demonstrates staff were respectful of people’s wishes.

Staff told us they always sought consent prior to provide care. They told us that if people refused support, this was respected. Their comments included, “If somebody refused care, I would not persuade them, I would encourage them, but if really did not want to I would report to manager and add to PCS (the electronic system). I always ask residents what they want, find out about them what they like” “If somebody refused care, I would leave them for a while and try again later, record on the system, I would also tell senior".

At the last inspection, where people lacked the capacity to consent to decisions about their care, the provider had not ensured consent was obtained in accordance with the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguard (DoLS) legislation. At this inspection, sufficient improvements had been made. People’s capacity to make specific decisions had been assessed to ensure legal consent was obtained. Appropriate applications to the Local Authority had been made to ensure any restrictions on people’s liberty were appropriate and approved, to keep them safe. Although improvements had been made, it was not clear how people with communication difficulties participated in these decision-making processes without access to appropriate communication aids enable them to express their thoughts and wishes.