Kingsland House 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. The care home can provide accommodation and nursing care for up to 71 people in one adapted building. The service is arranged into three areas, Memory Lane, which accommodates people living with dementia, Adur which accommodates people with less progressed dementia and mobility needs and Bluebell, which accommodates people with a range of health and nursing needs. There were 58 people using the service at the time of the inspection. The service provides support for people living with a range of healthcare needs, including people living with dementia and chronic conditions.

The service had an acting general manager who was in the process of applying to be the registered manager as a temporary measure, while the provider recruited to the registered manager’s post. The service had not had a registered manager for four months. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered managers, 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 last inspection on 13 August and 7 September 2017, the service was rated ‘Inadequate’. This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

At this inspection the provider was found to have met the previous breaches of regulations, having carried the actions from the action plan they provided to tell us how they would address the breaches. These breaches were in relation to shortfalls in staffing levels, medicines administration practice, the promotion of dignity, notifying the Care Quality Commission of serious events and the management and governance of the service. We undertook this inspection to check that the provider had followed their action plan and to confirm if they had met legal requirements. Many improvements had been made, however we found continued improvements were needed to sustain and embed those made. The overall rating for Kingsland House has been reviewed to Requires Improvement. This report discusses our findings in relation to this.

People and their relatives told us that staff were available to support them when required and our observations during the inspection demonstrated that staff were available to assist them with their needs, preferred choices and comfort. One person told us, “I don’t know how many staff are here but there seems to be quite a few of them. Considering it’s a home, it’s a very good home. I’ve not had problems waiting for someone to help me. I’m happy.” The service was not full to its capacity of 71 people during the inspection. However, the acting general manager and the regional director explained that it was staffed on the days of the inspection as it would be at capacity. Although, the feedback from people, relatives and staff was that there was sufficient staff. We were unable to determine whether the current service provision could be sustained over time, should the number of people living at the service increase.

People and their relatives told us, and our observations demonstrated, that the management of the service had improved. The quality assurance systems in place ensured they were meeting people’s needs. Shortfalls were recognised and the provider and management team had work

This comprehensive inspection took place on 13 August 2017 and 7 September 2017 and was unannounced. At the last comprehensive inspection on 27 September 2016, the service was rated as ‘Good’ overall. This comprehensive inspection was undertaken in response to information of concern we received, which included allegations that people were not always provided with safe care and treatment.

Kingsland House is registered to provide nursing and residential care for up to 71 people with a range of healthcare needs, including people living with dementia and chronic conditions. On the first day of our inspection, there were 66 people living at the service. On the second day of our inspection, there were 62 people living at the service, as some people were in hospital, or had sadly passed away. Kingsland House is a purpose-built care home which is divided into two units: Memory Lane, which accommodates people living with dementia and Bluebell, which accommodates people with a range of health and nursing needs.

A registered manager was in post. 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.

We were told that staffing levels had been assessed based on people’s care and support needs. However, people, relatives and staff felt that there were insufficient numbers of staff on duty at certain times of the day and night to ensure people’s safety. Our own observations supported this.

Certain aspects of the management of medicines required improvement and we saw that safe procedures for the giving people their medicines were not routinely being followed.

Several people commented they were well looked after by care staff. However, care was not always personalised to the individual. For example, people did not always get up or spend their day how they wished. It was recognised that staff had a good understanding of person centred care and knew people’s routines well. However, staffing levels at the service did not allow staff to routinely meet people’s preferences in relation to how their care was delivered.

There was a range of quality assurance systems to help ensure a good level of quality of care was maintained. However, these systems had not fully ensured that people received a consistent and good quality service that met individual need, specifically in relation to the assessment of staffing levels.

Unpleasant odours and the smell of urine were evident in Memory Lane at the time of our inspection and cleanliness was not of a high standard.

People were complimentary about the food and drink on offer. There was a varied daily choice of meals, special dietary requirements were met, and people’s weight was monitored. However, improvements were needed to the mealtime experience, and people’s food preferences being met in some parts of the service.

Care plans were accurate, however three out of the 10 we looked at lacked information to guide staff when people’s needs had changed.

Although some staff spoke positively of the culture and how they all worked together as a team, feedback from other staff was mixed and indicated that there was a lack of cohesion, support and a negative culture in the service. We received mixed feedback from people, relatives and staff in relation to the service being well led.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service. Staff had received both one-to-one and group supervision meetings, and formal personal development plans, such as annual appraisals were in place. However, some improvement was required in relation to the induction provided for agency staff.

When staff were recruited, their employment history was checked and references obt

We inspected Kingsland House on the 27 September 2016. We previously carried out a comprehensive inspection at Kingsland House on 2 March 2016, in order to look at specific areas of concern. We found the provider was no longer in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. However, we did identify areas of practice that needed improvement in relation to the Mental Capacity Act 2005, the sustainability of staffing levels and care delivery, and requirements relating to a registered manager. The service received an overall rating of ‘requires improvement’ from the comprehensive inspection on 2 March 2016.

Kingsland House is a purpose built home that provides nursing care and accommodation for up to 71 older people with a physical disability, dementia and/or related mental health conditions. The service includes ‘Memory Lane Community’, a dedicated part of the home that accommodates people living with a dementia and ‘Bluebell Community’, part of the home where people with complex and general nursing needs reside. Services offered at the home include nursing care, end of life care, respite care and short breaks. At the time of this inspection, there were 45 people living at the home. Kingsland House belongs to a large corporate organisation called Barchester Healthcare Homes Limited. Barchester Healthcare Homes Limited provides residential and nursing care in a large number of services across the United Kingdom.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the improvements identified at the previous inspection had been met. We found that they had. The overall rating for Kingsland House has been revised to good.

There was a registered manager in post. 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 improvements that we identified in relation to staffing levels and the planning and delivery of personalised care had been fully embedded and sustained. Robust pre-assessment protocols and criteria had been implemented, to ensure that care could be delivered safely and appropriately when the numbers of people living at the service increased.

Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and the provider was meeting the requirements of the Deprivation of Liberty Safeguards. People were being supported to make decisions in their best interests. The manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement. The service had an ongoing action plan for improvement and the registered manager was required to feedback progress weekly to senior management. This information was then fed into a central action plan to monitor progress. Significant improvements had been made, and it was identified that improvements had been fully implemented and sustained.

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. One person told us, “They answer my bell quickly. I don’t know where I’d be without it”. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place.

Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited

We inspected Kingsland House on the 2 March 2016. We previously carried out a focussed inspected at Kingsland House on 12 and 13 August 2015, in order to look at specific areas of concern. We found the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because we identified concerns in respect to people not receiving person centred care, people not being treated with dignity and respect, people’s consent to care and treatment not being sought , people not receiving adequate amounts of food and drink, quality monitoring and inadequate staffing levels. The service received and overall rating of ‘Inadequate’ from the focussed inspection on 12 and 13 August 2015. After this inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to these breaches.

Kingsland House is a purpose built home that provides nursing care and accommodation for up to 71 older people with a physical disability, dementia and/or related mental health conditions. The home includes ‘Memory Lane Community’, a dedicated part of the home that accommodates people living with a dementia and ‘Bluebell Community’, part of the home where people with complex and general nursing needs reside. Services offered at the home include nursing care, end of life care, respite care and short breaks. At the time of this inspection, there were 41 people living at the home. Kingsland House belongs to a large corporate organisation called Barchester Healthcare Homes Limited. Barchester Healthcare Homes Limited provides residential and nursing care in a large number of services across the United Kingdom.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had followed their action plan, and confirm that the service now met legal requirements. We found improvements had been made in many areas. However, further areas were identified in order to improve some practices in relation to the need embed and sustain improvements in relation to staffing levels and increased occupancy, the need to obtain consent and there being no registered manager in post.

The overall rating for Kingsland House has been revised to requires improvement. We will review the overall rating of requires improvement at the next comprehensive inspection, where we will look at all aspects of the service and to ensure the improvements have been sustained.

There was a manager in post, however they had not currently registered with the CQC. The service had been without a registered manager for approximately ten months. 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.

Despite the improvements that we identified in relation to staffing levels and the planning and delivery of personalised care, we were unable at this inspection to determine whether the current service provision had been fully embedded and could be sustained over time, should the number of people living at the service increase.

Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and the provider was meeting the requirements of the Deprivation of Liberty Safeguards. However, several MCA assessments did not record the steps taken to reach a decision about a person’s capacity. Capacity enables people to make their own decisions about their care and support. Assessing capacity in the right way at the right time is vital in care planning. A senior manager told us, “It is a work in progress with the MCA assessments, it is not consistent across the home”.

The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement. The s

During our inspection we spoke with seven people who used the service and two of their relatives. We also spoke with the registered manager, four nurses, five care workers, an activities co-ordinator and a visiting health care professional. We looked at care documentation, staff files, records of audits and minutes of meetings.

People who used the service told us that they liked living at the home, they were happy with the care they received and the service met their needs. They told us that staff were “Very kind and caring” and there was usually someone around to provide help and support. However they also told us “We do have to wait sometimes, when they are busy but I don’t mind too much.” One relative we spoke with told us “It’s a bit quieter here at weekends and there are not so many staff around.”

We saw that individual care plans provided guidance for care workers, to ensure that the assessed current and on-going support needs of people using the service could be met consistently and safely.

People were protected against the risks associated with medication because the provider had appropriate arrangements in place to manage medicines.

There were enough qualified, skilled and experienced staff to meet people’s needs.

Staff told us that they had received regular training and supervision. They said they felt valued and were supported to carry out their roles and meet the needs of people who used the service.

We visited Kingsland in August 2013 and noted some improvements needed to be made in order to achieve full compliance with the management of medicines. We requested an action plan from the provider and this action plan was submitted promptly, indicating the issues identified, the actions required, and completion dates. We have contacted the provider, and we spoke with the registered manager, the head of clinical care, and consulted documentation that was provided. We found that action had been taken to achieve compliance.

We spoke with the registered manager, the training manager, the clinical nurse manager, two nurses, four care workers and the chef. We spoke with four people who lived in Memory lane, six people who lived in Bluebell and six relatives. We observed the care being delivered and consulted relevant records and documentation. We found the home was under the management of a newly appointed registered manager. We saw that internal plans to check the overall quality of service and make improvements when needed were in progress. We found that people's needs were assessed and care was delivered in line with their individual care plan. One person told us, "I like living here, the staff are so kind".

We reviewed how the service managed medication and found that improvements were made since our last visit. However, additional improvements were identified to achieve compliance.

We found staffing levels were satisfactory and that recruitment was in progress. One member of staff told us, "We are coping although at times it gets so busy we could do with extra staff".

We found that the food provided was of a good standard and in sufficient quantities. A relative told us, "My mother loves the food here, it is always good".

We found that staff were appropriately supported, trained and encouraged to gain qualifications. One nurse told us, "Our training programme is ongoing and we are encouraged to progress within the organisation".

We spoke to 13 people who used the service, four relatives and six staff. We also reviewed six care plans. The service had two units called Bluebell and Memory Lane. Memory Lane is a specialist unit for people with dementia. We observed care in Bluebell and in the Memory Lane Units.

People told us that “It feels like home” and “I’m as happy as I can be when not in my own home”. People said they felt “Well cared for” and we saw many people being visited by relatives. People described staff as “Friendly and helpful and always smiling” and “Have a caring nature”.

In the last year, the home has had two managers, and the most recently appointed manager left suddenly without giving notice. The Manager’s post is being fulfilled by an Operations Manager and the Deputy Manager.

Throughout the inspection we saw that people were spoken to with dignity and respect and that the atmosphere in the home was friendly and relaxed. The home was well presented, clean and all the people we spoke with seemed well looked after.

We saw that the medications policy was not being followed and that there were gaps and inconsistencies in recording and dispensing medicines.

Staff told us that sometimes they were short staffed and people told us that they sometimes had to wait longer than they wanted for call bells to be answered.

The provider had a comprehensive audit system in place, but where improvement actions have been noted they had not always been put in place.

People were very positive about the standard of care they were receiving, and said they were treated with respect by staff. One person said there was a “happy atmosphere, better than it was”.

People said the meals were very good and that there was a good choice. They told us that there were now more staff on duty which was helping better meet their needs.

People told us that there were insufficient staff on duty and that they had to wait a long time for care to be given. They commented that staff were kind and patient but were always rushed and that medications were sometimes late.

We carried out an unannounced comprehensive inspection at Kingsland House on 8 and 9 January 2015. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the care and welfare of service users, assessing and monitoring the quality of service, the management of medicines, respecting and involving service users, consent to care and treatment, staffing and supporting workers.

We undertook this focused inspection on 12 and 13 August 2015 to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Kingsland House on our website at www.cqc.org.uk

Since the previous inspection on 8 & 9 January 2015 there has been a change in the regulations that we use to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008. For this inspection, we have transferred the regulations used at the previous inspection to the current regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Kingsland House is a purpose built home that provides nursing care and accommodation for up to 71 older people with a physical disability, dementia and/or related mental health conditions. The home includes ‘Memory Lane Community’, a dedicated part of the home that accommodates people living with a dementia and ‘Bluebell Community’, part of the home where people with complex and general nursing needs reside. Services offered at the home include nursing care, end of life care, respite care and short breaks. At the time of this inspection, there were 61 people living at the home.

There is no registered manager at the home. 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.

You can read a summary of our findings below.

There were 61 people living at the service during our inspection. We found improvements had been made in respect to the management of medicines and supporting workers. However, we continue to have significant concerns in respect to staffing, dignity of service users, consent to care and treatment, quality assurance, and the planning and recording of care. We also identified further significant concerns in respect to people receiving adequate nutrition and hydration. Concerns were also identified around the culture of the service and lack of consistent management.

People’s safety was being compromised in a number of areas. People and staff spoke negatively of the service and commented they felt there were not enough staff to provide safe care. Our own observations supported this. Staffing levels were stretched and staff were under pressure to deliver care in a timely fashion. One person told us, “You never get anyone [staff] around here, it’s disgusting. You pay all this money, I just can’t get anyone and I’m just stuck here. I’ve been asking for a bath for two weeks and my hair needs washing, it’s dirty and it itches. There should be more staff. If I want the toilet they keep saying to me ‘I’m not the only one here’, they need more people to look after us. I can be sitting on the toilet and pull the cord and I’m just waiting and waiting. You can call out, but they just take no bloody notice. They need more help, there are not enough girls [staff]”.

People were at risk of malnutrition and dehydration. We found lunchtimes to be chaotic and unpleasant, with some people not receiving their lunch until 2:00pm. A member of staff told us, “I’m really hot on nutrition, but the staff don’t have enough time to feed everyone properly”. Assessed dietary plans were not being followed and people were not being supported adequately to eat and drink enough to meet their needs. The recording of food and fluids was inaccurate and incomplete and discrepancies were not followed up or acted upon.

Assessed plans of care for people who were at risk of pressure damage were not being followed. The recording of pressure care was not accurate and did not always reflect the care people needed.

People’s dignity, privacy and choices were not respected especially around continence support. We observed people having their requests for assistance around continence being ignored. The delivery of care suited staff routine rather than individual choice. A member of staff told us, “If you have 28 residents to look after, how can you take someone to the toilet four times in an hour? I know it should be their choice, but we can’t”.

The provider was not meeting the requirements of the Mental Capacity Act (MCA) 2005. Mental capacity assessments were not completed in line with legal requirements. Staff were not following the principles of the MCA. We found there were restrictions imposed on people that did not consider their ability to make individual decisions for themselves as required under the MCA Code of Practice.

Staff did not feel well supported or listened to, and the culture and morale at the service was poor. This negative culture had an effect on the wellbeing of people and staff, the ability to deliver care and the professional integrity of staff.

A manager was in post, but they were not the registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider. The home has been without a registered manager since February 2015.

Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that where required, DoLS applications had been made and the manager understood when an application should be made and how to submit one.

Staff had received both one to one and group supervision meetings with their manager, and formal personal development plans, such as annual appraisals were in place.

Overall, we found significant shortfalls in the care provided to people. We identified six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The Care Quality Commission is considering the appropriate regulatory response to resolve the problems we found. We will publish what action we have taken at a later date.

We have raised our concerns with the Local Safeguarding Authority.