CQC report explained · a nursing home
What the CQC found at Kings Lodge Care Centre
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People told inspectors they felt safe. Risks, accidents, incidents and medicines were managed effectively, although some people sometimes waited for help during busy morning periods.
- Effective?
- Good
- Staff had access to the training they needed, and people received suitable food and healthcare. Some staff had not received regular supervision, and some mental capacity assessments needed to be made specific to individual decisions.
- Caring?
- Good
- People and relatives described staff as kind, friendly and respectful. Inspectors found that people's dignity, privacy and choices were supported.
- Responsive?
- Good
- Care was based on people's preferences, and people enjoyed a range of activities. The home had identified limited activities for people staying in their rooms and had recruited a second wellbeing co-ordinator to improve this.
- Well-led?
- Good
- The new management team had improved communication, staff morale and quality monitoring. Care plans were being reviewed, but plans for people admitted under the discharge to assess scheme did not yet contain the same level of detail.
What inspectors found, December 2022
Kings Lodge Care Centre was rated Good, with inspectors finding safer and better-led care than at the previous inspection, but some improvements were still being completed.
This was an unannounced inspection on 16 November 2022. Inspectors spoke with people living at the home, relatives, staff and visiting professionals. They also checked care records, medicines, recruitment files, complaints, accidents, policies and quality checks.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found people felt safe, medicines were managed safely, staffing levels were enough, and staff treated people with kindness and respect.
The home had improved from Requires Improvement at the previous inspection in November 2021. The two previous breaches had been addressed, and the provider was no longer in breach of regulations.
Some work was still under way. This included improving communication with some overseas staff, restarting regular staff supervision, revising some mental capacity assessments, and improving care plans and activities for people who stayed in their rooms.
Safe medicines support
Inspectors found medicines were stored, given and disposed of safely. Records checked were complete, including for medicines that had to be given at particular times.
“The medicines administration records we checked were complete with no gaps.” from the report
Kind and respectful care
People and relatives described positive relationships with staff. Inspectors found staff treated people with dignity and respect.
“People told us they had developed positive relationships with the staff who supported them.” from the report
Good food and healthcare
People said they enjoyed the food and had choices. Their dietary needs were recorded, and texture-modified meals followed healthcare professionals' guidance.
“People told us they enjoyed the food at the home. They said they had a good choice of meals and could have alternatives to the menu if they wished.” from the report
Improved management
Inspectors found that the recently appointed management team had improved communication with relatives, staff morale and the home's improvement planning.
“The management team had been working to improve the culture within the staff team with the aim of ensuring staff communicated effectively with one another and worked well as a team to provide consistent care.” from the report
People's views acted on
People, relatives and staff could give feedback through meetings and surveys. The home had acted on issues raised, including concerns about the laundry service.
“People told us their feedback was listened to and acted upon.” from the report
Communication with some staff
needs fixingSome people found communication difficult with overseas staff whose English was limited. The provider had identified this and was providing English lessons and support.
“Some people told us they found it difficult to communicate with overseas staff at times due to the staff's limited command of English.” from the report
Waiting at busy times
needs fixingSome people said they sometimes waited for help after breakfast during busy mornings. The provider agreed to review how staff were deployed at these times.
“Some people told us they sometimes had to wait for staff support at busy times, such as during the morning.” from the report
Staff supervision
minorSome staff had not been receiving regular supervision before September 2022. The manager said regular supervision would take place in future.
“Records indicated some staff had not received regular supervision prior to September 2022.” from the report
Care plan detail
needs fixingCare plans for people admitted under the discharge to assess scheme did not yet have the same quality or detail as plans for permanent residents.
“Care plans for people admitted to the home under the discharge to assess scheme did not contain the same quality of information or level of detail.” from the report
Activities for people in rooms
needs fixingSome people who chose to stay in their rooms had limited opportunities for activities and social engagement. The home had recruited a second wellbeing co-ordinator and assigned staff to provide more one-to-one opportunities.
“Some people told us there were limited opportunities for activities and engagement for people who chose to stay in their rooms.” from the report
- 01How far has the review of care plans for people admitted under the discharge to assess scheme progressed?
- 02How do you check that people can communicate effectively with all staff, and what support is still being provided with English?
- 03What changes have been made to reduce waiting times for people who need help during busy morning periods?
- 04Are staff now receiving regular supervision, and how do you monitor this?
- 05What one-to-one activities are available for people who prefer to stay in their rooms?
This was an unannounced inspection covering all five CQC questions and infection prevention and control, with improvements checked against the previous inspection. This explanation was written from the published report of 8 December 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, November 2022
Requires Improvement; inspectors found risks in safe care, medicines and care records, although staff numbers and some management improvements were in place.
This was an unannounced focused inspection on 1 September 2021. Inspectors looked mainly at Safe and Well-led after receiving concerns about care and medicines. They spoke with people, relatives, staff and professionals, observed care, and checked medicines, incidents, risk assessments and care plans.
Inspectors found that people had not always received safe care. Examples included unsuitable texture-modified food, a person leaving the home unnoticed, unexplained bruising, faulty equipment and an incorrectly set pressure mattress. Medicines were also not always managed safely.
Many care plans and risk assessments were overdue for review. This meant staff may not have had accurate information about people's needs. The home had an improvement plan, extra management support and monthly monitoring visits, but inspectors still found weaknesses.
The overall rating was Requires Improvement. Safe and Well-led were both rated Requires Improvement. The other areas were not inspected during this visit, so earlier ratings for those areas were used in calculating the overall rating.
Enough staff on duty
Inspectors found enough staff on each shift, and people said staff were available when needed. Staff said they had enough time to provide care without rushing.
“There were enough staff on each shift to provide people's care.” from the report
Safeguarding awareness
Staff understood how to recognise and report possible abuse. Safeguarding incidents had been reported to the local authority when needed.
“Staff were confident in their knowledge of safeguarding and the process for reporting any concerns they had.” from the report
Action after feedback
The provider had added management support, created an improvement plan and started monthly monitoring visits. Staff had also acted on professional advice about supporting people to drink.
“The senior management team had developed a service improvement plan, which was reviewed and updated regularly to ensure actions were being completed.” from the report
People were listened to
People, relatives and staff had opportunities to give their views. The home also involved people in choosing meals and worked with local community groups.
“People who lived at the home and their relatives had opportunities to give their views at regular meetings.” from the report
Unsafe care and equipment
seriousInspectors found several examples where people were put at risk, including unsuitable food, a person leaving unnoticed, unexplained bruising, a collapsed bed and an incorrectly set pressure mattress.
“The failure to ensure people received safe care and treatment was a breach of regulation 12 Safe care and treatment of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.” from the report
Medicines were not always safe
seriousControlled drugs were not recorded in line with guidance. Inspectors also found missing care plans, out-of-date first aid equipment, weak oxygen signage and an old medicines policy.
“The failure to manage medicines safely was a further breach of regulation 12 Safe care and treatment of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.” from the report
Care records were overdue
seriousMany care plans and risk assessments were overdue for review. Some did not give staff enough detail about important needs such as diabetes, nutrition or mobility.
“The failure to maintain complete and accurate records about people's care and treatment was a breach of regulation 17 Good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.” from the report
High use of agency staff
needs fixingAround 70% of staffing hours were being filled by agency staff at the inspection. Relatives said this affected consistency and made it harder for relationships to form.
“Although there were sufficient staff on duty to support people, people's experience of care was adversely affected by the high usage of agency staff.” from the report
- 01What has been done to make sure medicines, controlled drugs and oxygen storage are now managed safely?
- 02How many people's care plans and risk assessments are currently overdue for review?
- 03How do you make sure agency staff understand people's individual needs before providing care?
- 04What changes were made after the problems with unsuitable food, faulty equipment and the incorrectly set pressure mattress?
- 05What progress has been made against the service improvement plan since this inspection?
This was a focused inspection of Safe and Well-led only; Effective, Caring and Responsive were not inspected and their previous ratings were carried forward. This explanation was written from the published report of 17 November 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Kings Lodge Care Centre
5 rated inspections over 7 years: the service has improved, from Inadequate to Good.
- December 2022Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- November 2022Requires improvementSafe: Requires improvementWell-led: Requires improvement
- November 2020Inspected but not ratedSafe: Inspected but not rated
- May 2017Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- April 2016Requires improvementup from InadequateSafe: Requires improvementEffective: GoodCaring: Requires improvementResponsive: GoodWell-led: Good
- December 2015InadequateSafe: InadequateEffective: InadequateCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- May 2019
Registered with the Care Quality Commission on 20 May 2019.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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