The inspection took place on 29 August 2018 and was unannounced.

Kingsclear is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Kingsclear provides facilities and services for up to 97 people who require personal or nursing care. The service is purpose-built and provides accommodation and facilities over three floors. An area on the first floor provides care and support to people who are living with dementia, this area is called Windsor. Since our last inspection there has been a reduction in the number of people living at Kingsclear. On the day of the inspection there were 15 people living at the service.

At our inspection on 7 March 2018 we identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following receiving concerns relating to people’s care people were receiving we completed a further focussed inspection of Kingsclear on 1 May 2018 looking at the areas of Safe and Well-Led. During this inspection five breaches of legal requirements were identified. Concerns identified during these inspections related to a lack of managerial oversight, risks to people’s safety not always being identified and acted upon, staff not being appropriately deployed and accidents and incidents not being adequately monitored. We found that people’s legal rights were not always protected as the principles of the Mental Capacity Act 2005 not being followed, training for nursing staff not being comprehensively updated, care not always being provided in a person centred manner and safeguarding concerns not always being reported to the local authority or to CQC.

Following our inspection on 1 May 2018 we issued warning notices in relation to safe care and treatment and good governance. As a result of our concerns Kingsclear was placed into Special Measures. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe, Effective, Caring, Responsive and Well-led to at least good. At this inspection we found improvements had been made in all areas of the service. However, continued work was required to ensure that Kingsclear was meeting all regulations. During our inspection we identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and made one recommendation.

Since our last inspection a new registered manager had been appointed who had registered with CQC. 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 registered manager had started their employment at Kingsclear seven weeks prior to our inspection.

During our inspection we found inconsistencies in the way the principles of the Mental Capacity Act 2005 were applied. Following the inspection, the registered manager forwarded evidence that these concerns had been fully addressed. We have made a recommendation that systems used to assess people’s capacity and ensure best interest decisions are recorded and embedded into practice.

There were sufficient staff who were appropriately deployed to meet people’s needs safely. People’s needs were responded to in a timely manner and staff had time to spend with people. Staff had received the training they required to meet people’s needs. Staff were provided with an induction, regular training and supervision to ensure they had the skills they required for their role. Safe recruitment processes were in place to ensure people received support from suitable staff.

Risks to people’s safety and well-being were assesse

We undertook an unannounced focused inspection of Kingsclear on 1 May 2018. This inspection was done following receiving concerns from the local authority safeguarding team. These included, safeguarding concerns which had not been appropriately investigated or reported, continued staffing issues and the management oversight of the service. The team inspected the service against two of the five questions we ask about services: is the service Safe and is the service Well-Led.

We completed a comprehensive inspection of Kingsclear on 7 March 2018 where we identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Concerns including insufficient staff being deployed to meet people’s needs, risks to people’s safety not being identified and met, a lack of person centred care and the overall governance of the service. The ratings from the previous comprehensive inspection for the Key Questions of Effective, Caring and Responsive were included in calculating the overall rating in this inspection. Due to the short timescales between the inspections the provider has not had the opportunity to submit an action plan regarding how they intend to address the breaches identified during the inspection on 7 March 2018.

Kingsclear 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. Kingsclear accommodates up to 97 people in a new adapted building. Part of the service specialises in providing care to people living with dementia. At the time of our inspection there were 33 people living at Kingsclear.

There was no registered manager in post. Prior to the inspection we were informed by the provider and local authority safeguarding team that the registered manager had left the service without serving notice. A peripatetic manager had been allocated to the service and supported us during the inspection. They told us they intended to apply to register with the CQC as the manager of Kingsclear. 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.

Risks associated with people’s behaviours had not been comprehensively assessed and staff were not provided with guidance on how to keep people safe. Triggers to people’s behaviours had not always been identified and acted upon. People’s health needs were not always monitored effectively and there was a lack of understanding from staff regarding how pain and discomfort may affect people’s behaviour.

There was a lack of management oversight of the service which meant the provider was unable to assure themselves that people were safe and were receiving the care they required. The management team in place did not have a comprehensive overview of the risks within the service. Records regarding accidents, incidents and safeguarding were not accurately maintained so the provider could not take an overall view of the needs of the service. Although the provider had systems in place to enable them to monitor and action emerging risks, these were not been used effectively. There was a lack of leadership regarding how staff were deployed. This had led to people not always receiving their care in a timely manner and some staff feeling under pressure.

The peripatetic manager was unable to access records relating to people’s needs or the care they had received. Care staff employed by the provider did not have full access to risk assessments and care plans in order to ensure they were providing the care people required and were aware of any risks to their safety. Agency staff were unable to access any r

The inspection took place on 7 March 2018 and was unannounced. This was our first inspection of the service since its registration in October 2017.

Kingsclear 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. Kingsclear accommodates up to 97 people in a new adapted building. Part of the service specialises in providing care to people living with dementia. At the time of our inspection there were 27 people living at Kingsclear.

There was a registered manager in post who supported us to access information during the inspection. 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.

Prior to the inspection we received concerns regarding the clinical competency of nursing staff and staffing levels within the service. We found sufficient staff were not consistently deployed to meet people’s needs. Staff told us they struggled with the workload and did not have time to spend with people socially. Following the inspection senior managers told us they had reviewed the allocation of duties to support staff in their roles. We found that clinical training had not always been provided in line with the needs of people living at Kingsclear. This meant that pressure was being put on community nursing services and that people were at risk of not receiving healthcare in a timely manner. The provider assured us that training was booked for clinical staff and this would be completed within six weeks. We have made a recommendation regarding this. In other areas we found that staff had received the training they required for their roles and that a full induction into the service and organisation had been provided.

Risks to people’s safety were not always managed consistently and there was a lack of guidance for staff on how to support people when they became anxious. Care records available to staff lacked detail and guidance regarding people’s individual needs and preferences. Staff were unable to tell us about people’s personal histories, their likes and dislikes in detail. There was a lack of person centred activities available to people. This meant staff were unable to provide person centred, responsive care to people. People told us they were regularly bored and staff told us they felt people needed more stimulation. People’s legal right were not always respected as the principles of the Mental Capacity Act 2005 were not consistently followed. Assessments to determine people’s capacity to make decisions were not decision specific and best interest decisions were not recorded.

Staff did always feel valued and listened to. There was a lack of consistency in approach and ethos within the service and staff did not work together as a team. Although quality assurance systems were in place these did not always identify shortfalls in the service provided. Where concerns were identified these were not always acted upon effectively.

Staff supported people in a kind and friendly manner. However, although interactions were pleasant they were not always focussed on the individual as staff did not know people as well as they could. On occasions staff did not use terminology which was respectful to the people they supported and were heard to discuss people’s care in communal areas. We have made a recommendation regarding this. With the above exceptions we observed staff respected people’s privacy and supported them in a dignified way. People were offered choices and supported to maintain their independence. People told us that they generally enjoyed the food and choices were avai