Kingswood Manor

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We found breaches in respect of safe care and treatment. People’s clinical needs were not always monitored and responded to in a person centred way. For example, bowel management, pain, skin conditions and other health conditions were not treated in a person centred way as the medicines prescribed to treat these conditions had not been given appropriately. Nursing staff did not demonstrate they understood the impact of failing to provide person centred care in respect of medicines in support of people’s health. Information about people’s communication needs was not always clear or appropriately supported. No-one in the home who lived with communication difficulties or advanced dementia had communication aids and systems in place to help them communicate with staff. Referrals to other health and social care professional in support of people’s needs were made appropriately and equitably. Relatives told us they were kept informed about any changes in people’s wellbeing or any accident and incidents involving their loved ones by staff. They felt well-informed about their loved one’s care. The people we spoke with were aware of and were and comfortable with relative’s receiving updates with regard to their wellbeing. Their comments included, “They let my daughter know if there’s anything happening with me” and “They keep in touch with my family”. Resident and relative meetings took place to enable relatives and people living in the home to feedback any views, suggestions or concerns about the service, where they were able.

This service scored 64 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Most people experienced person centred support from care staff in respect of their daily lives activities and risks. Some people’s needs were not fully outlined so it was difficult to assess whether care was person centred in these areas. For example, end of life care and dementia care. People did not always receive person centred care from nursing staff in respect of their clinical needs such as bowel management, pain relief, skin conditions and other health conditions as the medicines prescribed to treat these conditions had not been given appropriately. There was also a lack of guidance on how to administer ‘as and when required’ medicines for people who had communication difficulties and who when unable to tell staff when they were uncomfortable or in pain.

Care staff demonstrated they understood the importance of delivering person centred support. Nursing staff did not demonstrate they understood the impact of failing to provide person centred care in respect of medicines in support of people’s medical conditions.

We observed that people’s day to day needs, for example support to mobilise and eat and drink were supported in a person centred way by care staff. We saw however nursing care was not always planned or delivered in a person centred way. For example, some people did not receive the medicines they needed to keep them well or to mitigate the risk of pain or discomfort. People wounds, bowels and skin conditions were also not always managed adequately by the nursing team. Improvements in the provision of support for people's nursing and medicinal needs was required.

People received appropriate health care support from external professionals, including medical professionals, occupational therapy, Speech and Language Therapy, District Nurses, Opticians and Podiatry. The support and advice given from other professionals was documented and followed with the exception of medicines. Nursing staff had not always maintained sufficient wound assessment and management records to share with District Nurse Team or Tissue Viability Nurses should a person’s wound decline. End of life care planning required further discussion and development with people and their families to ensure people’s end of life wishes and choices were properly documented.

Staff told us they prioritised and co-ordinated people’s day to day care. Records showed that people’s day to day care was organised efficiently.

Partner agencies raised no concerns in this area.

There were processes in place to ensure referrals to other health and social care professionals were made in a timely manner. Staff had access to Telemeds and GP advice when people became unwell. There was also a process in place to discuss any changes in people’s continuity of care at a weekly multidisciplinary meeting.

Information about people’s communication needs was not always clear or appropriately supported. Care plans contained limited information about hand gestures or facial expressions people may use to express consent or pain. No-one in the home who lived with communication difficulties or advanced dementia had communication aids and systems in place to help them communicate with staff. Information was provided mainly in written format for example the complaints policy, menus and service user/relative meeting minutes. Relatives told us they were kept informed about any changes in people’s wellbeing or any accident and incidents involving their loved ones by staff. Relatives felt the manager and staff in the home communicated with them well. One relative told us, “They keep us informed of what’s happening with her”. Another said, “They keep us informed about everything, they permed mum’s hair, we are invited for Xmas lunches and events that happen, there are relatives meetings” The people we spoke with were aware of and were and comfortable with relative’s receiving updates with regard to their wellbeing. Their comments included, “They let my daughter know if there’s anything happening with me” and “They keep in touch with my family”.

Staff told us they had access to policies and procedures in respect of their role. Staff had access to electronic care planning information about people’s needs, risks and wishes on handheld devices.

People's personal information was collected and stored in line with data protection legislation. There was however a lack of formal consent provisions around the sharing of people’s personal information with other people, including family and other health and social care professionals. This required review.

People and their relatives we spoke with told us they felt able to make suggestions and raise any care related concerns. Due to a lack of suitable communication aids and alternative communication formats, the experience of some people in respect of being actively listened to, encouraged, and involved in their own care may not have been robust as other people. For example, for example those with communication difficulties or those living with dementia.

Regular staff meetings took place to enable staff to be involved in discussions about the delivery of people’s care.

There was a lack of clear involvement of people with regards to discussions about their care during the provider’s monthly care review process. Records were very brief. A resident/relatives meeting took place to enable the manager to share information about the service and for people to share their own ideas, suggestions about how it could be improved or developed. Feedback from relatives and professionals had also been obtained via a survey. There was no evidence an accessible survey with people living in the home had been completed, to assess their satisfaction with the service and the care they received.

People’s experience of referrals to other health and social care professional was an equitable process based on their individual needs.

Care staff told us they reported any health concerns such as weight loss, ill-health and falls to the nursing team to act upon. Records confirmed this.

Partners provided no feedback in this area.

There was a process in place to ensure referrals were made in accordance with guidance. There was a process in place to ensure changes in people’s needs were identified and discussed at multi-disciplinary meeting to ensure equity of access to other services.

People we spoke with felt they were treated fairly and with respect. Records showed people had equal access to support from staff and their GP.

Staff had completed training in topics important to ensuring equity in experiences and outcomes. For example, equality and diversity, person centred care and privacy and dignity.

Policies and procedures were in place to outline how equity in experiences and outcomes for both staff and people living in the home would be achieved. People’s access to a range of social and recreational activities was equitable and people told us there was lots of choice. This promoted people’s emotional wellbeing and inclusivity. People’s care plans included information on their personal characteristics, wishes and preferences to ensure people’s equality and diversity was respected. We saw that some staff meetings included discussions around the importance of equality and diversity and how to promote it. The ability of people living with communication difficulties or dementia to be able to share their feelings, concerns or needs with staff was not equitable at all times. This was because there were no communication aids or tools in the home to support them to do so. Communication with staff relied on staff interpreting people’s needs from facial expressions or gestures. We recommend the provider reviews alternative formats for communication to support people equity in experience. People’s experience of medicines was not always equitable with some people not receiving the medicines they needed to promote outcome.

No-one at the time of inspection was receiving end-of-life care. Care plans did not indicate that discussions around people’s end-of-life wishes and preferences had been discussed. It is important these discussions take place whilst people are well enough and have the capacity to make decisions about their future care.

Staff had received training in end-of-life care. Managers and leaders had not implemented or directed staff how to use this training by providing robust end of life care plans and guidance on how to support people’s needs appropriately at the end of their life.

There was process in place to assess people’s end of life needs as part of the provider’s normal assessment and care planning processes. However, most of the end-of-life care plans in place were generic, meaning that people’s individual wishes and preferences were not documented. This compromised the ability of staff to provide person centred care at the end of people’s lives. There was a process in place to ensure that ‘Do not resuscitate orders’ (DNARs) were agreed appropriately. Some people had ‘do not resuscitate orders’ (DNARs) in place to advise staff that they did not wish for CPR (Cardiopulmonary Resuscitation) to be undertaken if they stopped breathing, or their heart stopped. There was a process in place to ensure that ‘Do not resuscitate orders’ (DNARs) were agreed appropriately. Where people did not have the capacity to consent to a DNAR, the Mental Capacity Act had been followed in their best interests.