This was an unannounced inspection that took place on 17 and 18 April 2018. We previously inspected this service in December 2016 and found the following breaches of the Health and Social Care Act; Regulation 10 Dignity and respect; Regulation 12 Safe care and treatment; Regulation 14 Meeting nutritional and hydration needs; Regulation 17 Good governance and Regulation 18 Staffing. In December 2016 we rated the service as 'Requires Improvement'. Following the last inspection we met with the provider and asked them to complete an action plan to show what they would do, and by when, to improve the service.

Kingston Court Care Home is situated in the grounds of the Cumberland Infirmary in Carlisle.

Kingston Court 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.

The home accommodates up to 74 people in a purpose built building with three floors. At the time of our visit there were 63 people living there.

The home had a suitably qualified and experienced registered manager. 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 staff team were aware of their responsibilities under the Mental Capacity Act 2005. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service to support this practice required further development; we made a recommendation about this.

The service provided structured activities for people who lived at Kingston Court. People told us they welcomed these activities and enjoyed them. The service intended to develop in this area and create a broader range of activities.

Risk assessments and care plans provided guidance for staff in the home. People in the service were involved in the creating of support plans and were able to influence the content. The management team had ensured the plans reflected the person centred care that was being delivered.

The staff team understood how to protect vulnerable adults from harm and abuse. Staff had received suitable training and talked to us about how they would identify any issues and how they would report them appropriately. Risk assessments and risk management plans supported people well. Arrangements were in place to ensure that new members of staff had been suitably checked before commencing employment. Any accidents or incidents had been reported to the Care Quality Commission as necessary and suitable action taken to lessen the risk of further issues.

The registered manager ensured that there were sufficient staff to meet people's needs in a timely manner. Our findings corroborated this. Staff were suitably inducted, trained and developed to give the best care possible. We met experienced and kind team members who understood people's needs as well as new staff who were keen to learn.

Medicines were appropriately managed in the service with people having reviews of their medicines on a regular basis. People in the home saw their GP and health specialists whenever necessary. They accessed hospital appointments as a matter of routine.

We saw that an assessment of needs was in place and that the staff team analysed the outcomes of care for effectiveness. People were very happy with the food provided and we saw well prepared healthy meals that staff supported and encouraged people to eat.

The home itself was clean and comfortable on the day we visited. Suitable equipment was in place to support people with their mobility.

We observed kind, patient and suitable

This was an unannounced inspection carried out on the 6 & 7 December 2016. We last inspected Kingston Court Care Home on 20 January 2014. At that inspection we found the service was not meeting one of the regulations that were in force at that time. We found that the service had not ensured that care plans contained all the detail needed and were updated when people’s needs changed. This related to Regulation 9: Care and Welfare of people who use services of the Health and Social Care Act 2008 (Regulated activities) Regulations 2010. These regulations have now been replaced with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Kingston Court Care Home is a care home that provides accommodation, nursing and residential care. The home is registered to provide care for up to 80 people who may be living with dementia, physical disability or require nursing care. The home is a three storey purpose built home situated in Carlisle. It is near to all the city amenities and is served by good public transport. All accommodation is in single en-suite rooms. The home cares for people with dementia in a specialist unit situated on the top floor of the building called the Memory Care Centre. The ground and first floors have people who need personal and nursing care, and some may also have dementia.

At the time of our inspection 70 people were living at Kingston Court Care Home. The provider and owner of the home is Executive Care Group. The registered manager informed us that the running of the home had been recently transferred by Executive Care Group from one operating company to another called Careport.

The service had a registered manager in place. A registered manager is a person who has registered with the CQC 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 the home had met the breach found at the last inspection and now had good systems to ensure that care plans were up to date and reviewed when people’s health care needs changed.

People told us contradictory things about the service. While some people were happy, others were not. We also received mixed views from relatives about the care. People told us that at times there were not enough staff available to answer their call bells and provide support when they needed it. We observed that staff were very busy and were at times under pressure. Care and support was mainly based around completing tasks and did not always take account of people’s preferences or meet their social and recreational needs. People living in the home and several relatives reported issues with fluctuating staffing levels. One person said, “There aren’t many staff sometimes, mostly less at night.” Another told us, “If you push your buzzer you have to wait.” They also told us that staff were often rushed. We found that this was the case with staffing levels on the middle floor of the home particularly being insufficient. Staff reported being “very over stretched” on this floor.

Overall we found that there were insufficient staff available, and deployed in such a way to in order to meet people’s needs. The management team agreed to undertake a full review of the dependency levels of people to check how many staff was required to meet people’s needs and to adjust staffing levels accordingly. Considerations of roles and task was also to be undertaken to see that staff were clear on their role and where deployed in the most effective way possible.

The majority of people living in the home told us that staff were caring and treated them well. One person told us, “There's a lot of good staff, they are good at their job, it’s clean and there’s no odours. The cleaners and laundry staff work hard too.”

People told us that their family could visit whenever they liked and were

This was an unannounced inspection that took place on 20th January 2015.

Kingston Court is a three storey purpose built home situated near to the Cumberland Infirmary in Carlisle. It is near to all the city amenities and is served by good public transport. All accommodation is in single en-suite rooms.

The home cares for people with dementia in a specialist unit situated on the top floor of the building. The ground and first floors have people who need personal and nursing care.

Executive Care own a number of other nursing and residential care homes around the UK.

The home has a registered manager. 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 and associated Regulations about how the service is run.

We found the service to be safe because the staff team were trained and competent in protecting vulnerable adults from harm and abuse. Staff recruitment was managed correctly and there were sufficient staff on duty to give good levels of care. The home had suitable disciplinary procedures in place.

The building was safe and good infection control was in place. Accidents and incidents were monitored appropriately.

Medicines management was of a good standard.

Staff were suitably trained and experienced to give people effective care and support.

The registered manager understood her responsibilities under the Mental Capacity Act 2005.

People were, where possible asked for their consent for any interventions.

The catering in the home was of a high standard and staff were aware of nutritional planning to keep people as well as possible.

The company were aware that the shared areas needed to be improved on and were planning some structural changes to the environment.

We judged that the staff had a caring approach. We saw patient, kind and attentive responses to people in the home. We heard from visiting relatives, friends and professionals that the staff team were caring. People were encouraged to be as independent as possible.

People told us they were satisfied with the activities, outings and entertainments on offer. Complaints were handled correctly in the service.

The service was not responsive to need. The manager was aware of the gaps in care planning. We judged that assessment and review of care were of an acceptable standard but some of the written plans of care needed more detail and some needed to be updated. This is a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

The home had a suitably trained and experienced registered manager. She was supported by the operations manager and other senior officers of the company. The company’s values and vision were known to people in the home and to relatives. The staff team understood their roles and responsibilities in the home. The service had a suitable quality assurance system that was being used appropriately.

When we spoke to people who made Kingston Court their home they told us that they were happy, settled and satisfied with the care and services they received.

"It is marvellous here, the staff are very good."

"Everything is fine. The place is clean and my bed is comfortable, all my meals are made and I do get out and about."

People were generally happy with the food provided, the delivery of care and the activities on offer.

We saw sensitive and compassionate care being delivered to people with dementia. We also had evidence to show that for people with complex health needs the delivery of nursing care helped them to be as well as possible.

We walked around the home and we saw that all areas were clean, fresh and tidy. We also checked on the availability of equipment and found that equipment to help with moving and handling people and with nursing care was readily available.

On the day of our visit the staffing levels were good, staff were attending training and there were enough nurses on duty to give people good levels of care.

We checked on recruitment, induction and deployment of staff and this too was suitable for the assessed needs of the people in the home.

We checked on a wide variety of records kept in the home and we had evidence to show that these reflected what was happening in the home and that they were up to date, easily accessible and suitably detailed.

People in this service were asked before any care or treatment was provided. The management team understood their responsibilities when asking people about consent.

People received good levels of personal and nursing care.

"I am happy with the care I get...the staff are very good and I trust the nurses to help me with my needs".

We looked at medicines in the service and these were stored, administered and disposed of correctly.

Staff in the service get good levels of support and ongoing training.

Complaints are dealt with appropriately by the manager and by the company. No one we met on the day had any complaints.

"I have nothing to complain about. I have a nice room and good food. I am cared for properly and feel safe here."

The people we met were generally very positive about the care and services they received in the home.

"Very nice ...I have no complaints...I am quite settled."

"It is OK...they try their best...I spend a lot of time in my room and they are fine with that...I haven't been well and someone always stays with me when I go for treatment."

"I love the classes...there is something on every day...I have done a lot of the collages that are around the home...I like being busy."

"The food is really excellent... we have dinner at night and I like that...I like my breakfast and a snack lunch then a proper dinner at night."

"The staff are very very nice...there are a lot of them but most of the time you see the same faces and they know us quite well."

"It would be nice if we had our own kitchenette and we could help with the chores and have a cup of tea when we wanted to make one."

"The manager is always around and people from the company ...including the managing director...come to see me and make sure things are all right."