CQC report explained · a nursing home
What the CQC found at Kingswood House Nursing Home
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Risks were not consistently assessed, managed or followed up. Medicines management was also not always safe, although staffing, recruitment, basic building checks and cleanliness were found to be satisfactory.
- Effective?
- Good
- This key question was not inspected during this visit. The report says ratings for key questions not inspected were carried over from the previous inspection.
- Caring?
- Good
- This key question was not inspected during this visit. The report says ratings for key questions not inspected were carried over from the previous inspection.
- Responsive?
- Good
- This key question was not inspected during this visit. The report says ratings for key questions not inspected were carried over from the previous inspection.
- Well-led?
- Requires improvement
- Management systems did not identify important problems with incidents, medicines, care plans and risk assessments. A new management team was open about the problems and had begun an improvement plan.
What inspectors found, June 2022
Rated Requires Improvement; inspectors found risks, medicines management and reporting systems were not always safe or well managed.
Inspectors made unannounced visits on 24 and 26 May 2022. They spoke with people, staff and visiting professionals, observed medicines being given, and reviewed care, safety, staffing and management records.
They found enough staff, safe recruitment, trained staff giving medicines and a clean home. However, risks linked to incidents, behaviour, community visits and personal histories were not always properly assessed or followed up. Medicines were not always monitored safely, including pain relief and possible interactions.
The inspection focused on Safe and Well-led. Both were rated Requires Improvement. The provider breached regulations about safe care and treatment, good governance and reporting incidents to CQC. The new management team had started an action plan, but CQC said it would continue to monitor the home.
Enough staff
Inspectors found staffing levels were sufficient for people's needs. Staff were also recruited using the required checks described in the report.
“There were enough staff to support people safely. Staffing levels were assessed based on people's support needs.” from the report
Clean home
The home was clean, with cleaning schedules in place and monitored.
“The overall cleanliness of the home was good. Cleaning schedules were used and monitored” from the report
Trained medicines staff
Registered nurses gave medicines and had regular supervision and refresher training. Medicines records also included stock checks.
“Registered nurses were the medicine givers and all received regular supervision and medicine training refreshers.” from the report
Staff understood safeguarding
Staff knew how to recognise abuse and raise safeguarding concerns. Most people told inspectors they felt safe.
“Staff were aware of the signs of abuse and how to report safeguarding concerns.” from the report
Management willing to improve
The new management team was described as open and transparent. It started an action plan and took some immediate steps after the inspection.
“The management team though new was strong, open and transparent. They were committed to improvement and immediately started to prepare an action plan.” from the report
Risk management
seriousIncidents involving anger, aggression, substance misuse and community visits were not consistently analysed or followed up. Care plans and risk assessments did not always contain the information staff needed.
“Risks to people were not consistently managed well. There was a lack of follow up to incidents where some people's anger and frustration had escalated.” from the report
Medicines monitoring
seriousThe home did not monitor regular requests for as-needed pain relief or assess possible side effects and interactions with other medicines. Some people also lacked assessments about support with their medicines.
“There was no risk assessment or monitoring of possible side effects or interactions, which may impact on their health and well-being.” from the report
Incident reporting
seriousThe home had not reported all required incidents to CQC for about 10 months. This included deaths, police involvement, aggression incidents and a COVID-19 outbreak.
“CQC had not been informed of deaths, and coroner investigations, police involvement in the premises or incidents of aggression between people who lived in the service.” from the report
Weak oversight
needs fixingManagement checks had not identified several shortfalls in records, medicines and incident reporting. Records were not always complete enough to guide consistent care.
“Although there were systems to monitor the running of the service, they were not always effective, and they had not identified some of the shortfalls we found on inspection.” from the report
Infection outbreak planning
needs fixingThe home had no contingency plan for staff shortages during an outbreak. Managers said the home had been understaffed during its previous outbreak.
“However, there were no contingencies in place to manage staff shortfalls during an outbreak.” from the report
- 01What has been changed since the inspection to assess and review risks after incidents, including incidents involving anger, aggression or substance misuse?
- 02How are regular requests for as-needed pain relief now reviewed, and how are possible medicine side effects or interactions monitored?
- 03How do you make sure care plans and risk assessments contain up-to-date personal information and guidance for staff?
- 04How do you now ensure all deaths, safeguarding incidents, outbreaks and other reportable events are notified to CQC on time?
- 05What is the current plan for maintaining safe staffing levels during an infection outbreak?
This was a focused inspection of Safe and Well-led, including infection prevention and control under Safe; the other key-question ratings were carried over from the previous inspection. This explanation was written from the published report of 30 June 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, September 2019
Rated Good; inspectors found safe, kind and personalised care, with improvements since the previous Requires Improvement rating.
This was an unannounced inspection on 24 July 2019. One inspector spoke with people and staff, observed care, and reviewed care, medicines, recruitment, training and management records. Feedback was also sought from professionals.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found enough staff, suitable recruitment checks, safe medicines procedures, personalised support plans and good links with health professionals.
The home had improved its infection control, medicines management and quality checks since the previous inspection. People said staff knew them well, treated them with respect and supported their choices and independence.
Safe medicines
Medicines management had improved since the previous inspection. Records and audits showed that people received medicines when needed and staff had guidance for as-required medicines.
“At this inspection we found the management of medicines had been reviewed and staff followed a clear process for ordering, storing, giving out and disposing of medicines safely.” from the report
Personalised care
Care plans described individual physical and mental health needs, preferences and goals. Staff knew people well and supported independence while managing risks.
“Support plans were personalised to meet people's individual needs.” from the report
Kind and respectful staff
Inspectors saw friendly relationships between people and staff. Staff respected privacy, dignity and people's choices, including when people declined support.
“We saw that there were good relationships between people and staff.” from the report
Effective leadership
Quality checks were used to find problems and check whether improvements worked. The report says infection control, medicines management and monitoring had improved since the previous inspection.
“At this inspection we found the quality assurance process was effective and had monitored all aspects of the services provided at Kingswood House.” from the report
Inspectors raised no specific concerns in this report.
- 01What regular activities are now available, and how are they matched to my relative's interests and mental health needs?
- 02How will you make sure medicines remain safely managed, including as-required medicines and medicines taken out of the home?
- 03How often will my relative's support plan and risk assessments be reviewed when their needs change?
- 04How will you support my relative to make choices and remain independent while keeping risks under review?
- 05How will you respond if my relative's mental or physical health changes, including arranging GP or specialist support?
This was an unannounced comprehensive inspection covering all five CQC questions, with the previous overall rating of Requires Improvement reviewed. This explanation was written from the published report of 4 September 2019 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 Kingswood House Nursing Home
6 rated inspections over 7 years: the service has improved, from Inadequate to Requires improvement.
- June 2022Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
Read what inspectors found at Kingswood House Nursing Home →
- September 2019Goodup from Requires improvementSafe: GoodWell-led: Good
Read what inspectors found at Kingswood House Nursing Home →
- August 2018Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- December 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- July 2016Requires improvementup from InadequateSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- November 2015InadequateSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: InadequateWell-led: Requires improvement
- December 2013
Registered with the Care Quality Commission on 12 December 2013.
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.
Weigh the report against the rest
Fees, photos and reviews from families
How to read CQC ratings and reports
What to check when you visit
19 live-in carers within about an hour of East Sussex
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £1,000 to £1,400 a week. 13 can care for a couple. 10 years' experience on average.
“When he point blank refused to go into hospital for a life saving blood transfusion she talked him through the situation and agreed to go in the ambulance with him and stayed until he was settled.”
“Una felt safe, secure and loved in her time with Debbie which is a gift that I am eternally grateful for.”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.