At the previous inspection in June and July of 2018 we rated the service ‘Inadequate’ in the areas of Safe and Well Led. We found the provider had breaches in the regulations under 12, 9, 20A and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This meant the service was awarded a rating of ‘Inadequate’ overall. This was the first time the service had been rated ‘Inadequate’ overall.

As the service was rated ‘Inadequate’ we placed the service in special measures. We asked the provider to send us an action plan each month of how they were meeting the regulations. We placed two conditions on the provider’s registration, telling the provider that they must send us documentary evidence to show that immediate action had been taken to cover all radiators and all exposed hot water pipes at Kingsley Cottage. In addition, we said the provider must send us documentary evidence to show that immediate action had been taken to prevent service users, visitors or unauthorized staff from accessing the first-floor boiler room.

Services in special measures are kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvements are made within this timeframe, so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This may lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements and is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.

We inspected this service again on the 5 and 7 November 2018. The inspection was unannounced on the first day. On the second day of the inspection the provider and manager were informed we would return to the home. The inspection was to check on whether the provider had made the necessary improvements.

Kingsley Cottage 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. Kingsley Cottage is registered to provide care and accommodation to a maximum of 17 older people including people with a diagnosis of dementia. At the time of the inspection there were 17 people living at the home.

There was an experienced registered manager in post at the time of our 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.

We found some improvements had been made at the home since our previous inspection. At this inspection we found the provider was meeting the Regulations, and was no longer in breach. However, we continue to rate ‘Safe’ and ‘Well-Led’ as Requires Improvement.

The conditions we placed on the provider’s registration at our inspection in June/July 2018 had been met. All radiators and hot water pipes at the home had been covered, and procedures were in place to prevent people and unauthorised staff from accessing the first-floor boiler room.

At our previous inspection we found the provider and registered manager did not always manage risks to people's safety, and people were placed at unnece

Kingsley Cottage 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.

Kingsley Cottage accommodates up to 17 people with bedrooms on the ground floor and first floor, which is accessible by a lift and stairway. At this inspection 17 people were living there.

Kingsley Cottage had a registered manager in post who was present during day one of this inspection’s site visit but was not available on day two due to pre-planned annual leave. The registered provider was available and present during day two. 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.

Following our last inspection we published our report in November 2017. At that inspection we identified areas of improvement that needed to be made. These were in relation to the key questions, Effective, it was not evident how decisions were made with people, Responsive, people had differing experiences regarding social activities, and Well Led, the provider needed to embed their quality monitoring processes to ensure people received a “Good” service.

At this inspection we identified that improvements had been made regarding people’s activities and social interactions. However, we found serious concerns regarding people’s safety, care planning and medicines and improvements relating to decision making and quality monitoring were still needed.

In total, during this inspection, we identified four breaches of regulations. These were in relation to, unsafe care and treatment of people, people not having personalised care, ineffective quality assurance systems to identify improvements and the requirement to display the rating of the latest inspection.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The provider and management team did not fully understand their requirements of registration with the Care Quality Commission in meeting the associated regulations. The provider and management team had been unable to achieve an overall “good” sinc

Kingsley Cottage provides accommodation for up to 17 people who require support. On the day of our inspection visit, there were 17 people living at the home, some of whom were living with dementia.

We carried out an unannounced inspection visit on 18 September 2017. Our inspection team consisted of two inspectors and an expert by experience. An expert by experience is a person who has personal experience of providing care or support for people.

We had previously inspected the home on 7 February 2017 and rated the home as ‘Requires improvement’ overall and inadequate within our question ‘Is this service well led?’ Our rating reflected our concerns with the safety of the home’s environment; how the staff supported people who needed help with decision making and the effectiveness of the systems used to monitor and improve the quality and safety of the service. We received an action plan from the provider which said the improvements would be made by July 2017. At this inspection we found the provider had made the improvements they told us they would make, although further improvements were needed.

People had mixed views about how they were supported to be involved with activities related to their hobbies and interests and people spent time unoccupied. When people lacked capacity to make decisions for themselves, capacity assessments had been completed however, these were not always specific to the decision being made. Further work was needed when decisions were made in people’s best interests.

Staff were available at the times people needed them and had received training so that people’s care and support needs were met. Staff understood their responsibility to safeguard people from harm. Where risks associated with people’s health and wellbeing had been identified, there were plans to manage those risks. Risk assessments ensured people could continue to enjoy activities as safely as possible.

People were involved in decisions about their care and told us that they received support in the ways they preferred. People were supported to maintain relationships with people important to them and visitors were welcomed at the home.

People were dressed in their own style and if they needed support, staff helped people to take a pride in their appearance. The staff understood how people wanted to be supported and ensured people’s privacy and dignity.

People had a choice of food, and were encouraged to have enough to drink. People were referred to external healthcare professionals to ensure their health and wellbeing was maintained. Medicines were managed so that people received their medication as prescribed.

There were processes to monitor the quality and safety of the service provided and to understand the experiences of people who lived at the home. People knew who to speak to if they wanted to raise a concern and there were processes in place for responding to complaints. People were happy with the service provided and how staff provided their support.

This inspection took place on 7 February 2017 and was unannounced.

Kingsley Cottage provides accommodation for up to 17 people who require accommodation and or personal care. On the day of our inspection visit, there were 17 people living at the home, some of who were living with dementia.

We had previously inspected the home on 24 March 2016 and rated the home as requires improvement overall with specific concerns about the safety of the home’s environment, how the staff supported people who needed help with decision making and the effectiveness of the systems used to assess, monitor and improve the quality and safety of the service. We received an action plan from the provider which said the improvements would be made by July 2016. At this inspection we found the provider had not made all of the improvements they told us they would make. We also found improvements were needed in other areas including the administration and management of people’s medicines and the risks associated with people’s care.

We saw that some improvements had been made to the home’s environment but we identified ongoing concerns regarding the management of the service. There was a lack of effective governance and managerial oversight of the service. Steps to ensure the health and safety of people and others were not always considered and risk assessments had not been developed for all areas of identified risk. The registered manager had introduced audits for medicines, but these had not been effective in identifying the concerns we found with the storage and administration of medicines.

Risks associated with people’s care had been assessed but management plans were not always followed to ensure any identified risks were minimised. People felt safe at the home and sufficient numbers of suitably recruited staff were available to meet people's needs. Staff understood their responsibilities to keep people safe from the risk of abuse. Staff received training and support to meet people’s needs and felt supported by the registered manager.

Further improvements were required to ensure the provider and registered manager consistently followed the requirements of the Mental Capacity Act 2005 where people were unable to make certain decisions for themselves. Staff sought people’s consent and encouraged people to make choices about their daily routine to promote their independence. People accessed the support of other health professionals when needed.

Staff treated people in a kind and compassionate manner but at times, they did not always treat people with dignity and respect. People were not always supported to have an enjoyable mealtime experience and some people’s individual needs were not met.

People were not always offered opportunities to join in social activities and follow their hobbies and interests. People were encouraged to maintain important relationships and visitors were made welcome.

People knew how to raise any concerns and complaints and were kept informed about things that were happening in the service. However, the provider did not routinely seek people’s views on how the service could be improved.

The provider was not meeting some of the requirements of their registration with us. They had not displayed their performance rating as required and had failed to notify us about a safeguarding concern referred to the local safeguarding team.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

This inspection took place on 24 March 2016 and was unannounced. At our last inspection on 29 May 2013, we found the provider was meeting the legal requirements we inspected.

Kingsley Cottage is registered to provide accommodation and or personal care for up to 17 people, some of whom were living with dementia. On the day of our inspection, the home was full.

There was a registered manager in post who had registered in 2002. 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 provider worked alongside the registered manager at the service. There were no clear arrangements in place to determine who had overall responsibility for ensuring effective systems to assess, monitor and drive improvement in the quality and safety of the service. The home’s environment was not well maintained and potential risks to people’s safety were not being identified and managed. People received their medicines when they needed them but improvements were required to ensure medicines were stored, recorded and managed safely.

The registered manager and staff were not working within the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. Staff sought people’s consent before providing care but people’s capacity to make their own decisions was not assessed when needed. Some people were being deprived of their liberty to keep them safe but applications had not been made to ensure this was formally and legally agreed to be in their best interests.

People felt safe living at the home and their relatives were confident they were well cared for. If they had any concerns, they felt able to raise them with the staff and management team. Risks to people’s health and wellbeing were assessed and managed. There were sufficient suitably recruited staff to keep people safe and promote their wellbeing. Staff received training so they had the skills and knowledge to provide the support people needed.

Staff knew people well and encouraged them to have choice over how they spent their day. Staff were kind and caring, promoted people’s privacy and dignity and encouraged them to maintain their independence. People were supported and encouraged to eat and drink enough to maintain a healthy diet. People were able to access the support of other health professionals to maintain their day to day health needs.

People received personalised care and were offered opportunities to join in social and leisure activities. People were supported to maintain important relationships with friends and family and staff kept them informed of any changes. People’s care was reviewed to ensure it remained relevant and relatives were invited to be involved.

There was a positive atmosphere at the home. People and their relatives were asked for their views on the service and this was acted on where possible. Staff felt supported by the registered manager and provider and were encouraged to give their views on the service to improve people’s experience of care.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We visited Kingsley Cottage on a planned unannounced inspection which meant the service did not know we were coming.

At our previous inspection in November 2012 we had concerns that the staffing levels were not sufficient to meet the needs of the people who used the service, staff did not feel supported and did not have adequate knowledge in safeguarding procedures. We were supported throughout the inspection by the manager and the provider. At this inspection we found that improvements had been made in all these areas.

We looked to see if people who used the service consented to their care, treatment and support. We found that people were consulted with as much as they were able to be and were involved in their care planning.

We found that Kingsley Cottage had a complaints procedure and people who used the service and their relatives knew how to make a complaint and who to complain to.

We saw that peoples' care and welfare needs were being met; people who used the service and their relatives told us that they were happy with the care they received. One person told us: “It’s like a five star hotel here”.

We visited Kingsley Cottage on a planned unannouced inspection which meant the service did not know we were coming.

People who used the service told us they liked living at Kingsley Cottage and the staff were all kind. We saw that staff treated people with dignity and respect throughout the day.

Staff we spoke with told us they were happy at Kingsley Cottage but they felt they needed more support in areas of their personal development.

Although staff had received training in safeguarding all the staff we spoke with were unable to tell us the safeguarding procedure and when it might be implemented.

We had concerns over the staffing levels at Kingsley Cottage and we asked the provider on the day of the inspection to increase the levels to meet the needs of the people that used the service.

The service had implemented limited quality monitoring systems to ensure good quality care was being delivered.

Throughout our visit to the home we found that most people were positive in their views regarding issues of person centred care and involvement, respect and preserving dignity. A visitor told us: "It was difficult to accept that mum would be going into a home, but we haven’t regretted it one bit, Kingsley Cottage is a great place, with fine people and good standards".

Some comments we received during the course of inspection from people using the service, visitors and professionals stated: "In respect of communications this was excellent, as all the issues decided by B and her family, along with professional discussions, were all imparted to each member of staff. B’s wishes were more than met during this period", and "This home is the best, the carers are very kind with everyone, able to give good care and provide the one to one love so appreciated".

We met with several people who told us that the quality of the food was generally very good, and one lady said: "I have found the food to be well prepared and tasty, and the staff always present the food nicely”. People also remarked that they find the environment to be clean and tidy, indicating their approval of a good standard of cleanliness throughout Kingsley Cottage. Several people spoken to expressed a sense of security and satisfaction in the quality and presentation of the care environment, and identified a confident and open relationship, based on mutual trust and respect: "They have very good managers and a lot of very good staff, who are always looking after my needs".

Our discussions with the staff indicated a strong morale, and satisfaction with the employers and standards of care offered. One member of staff commented: "It's good working at Kingsley Cottage, the senior carers are very diligent and helpful, and the provider and manager very approachable. We are all proud of the standards of care here".

Overall we found that people using the service and visitors, demonstrated a readiness to express their views as to the quality of their care. The majority of comments were positive, mainly concerning the friendliness of the staff and the high standards of care.