Kings Manor Care Home

Some people said getting help and support at key times was more difficult and they sometimes had to wait. One person said, for example, "It can be difficult getting them at times as we are all wanting then at the same time, but they come as quick as they can. They are very good at understanding me though, like yesterday, I didn't want to get dressed as I didn't feel well, and they looked after me". Staffing levels were sufficient, but like all care providers there had been key times during the pandemic and lockdown when staffing levels had fallen slightly below the providers preferred numbers. This had not compromised anyone's safety but did mean that care and support may be delayed slightly for some people at peak busy times.

During the inspection visit we observed staff being observant to people's needs and wishes. Even during a medical emergency, staff remained calm and dealt with this in a professional and compassionate manner. Staff understood people's needs and responded to them patiently and were warm and friendly at all times.

Relatives said the care and support was good but three mentioned that there were occasions when their relatives personal care was not as good as they had expected such as dirty or long fingernails. We fed this back to the registered manager and operations manager who said they had not been made aware of these issues from family members. They planned to hold some additional evening meetings for families and said this would be an opportunity to gain peoples' views and ask for direct feedback for ongoing improvement.

There was sufficient staff with the right skills and competencies to provide safe and effective care to people at the time of the inspection. The registered manager said this was kept under review using a dependency tool to help them assess the right numbers and right deployment of staff for each floor. She explained that the top floor was mainly complex nursing, middle floor for people living with dementia and bottom floor for those who were more able. The whole service is registered as a care home with nursing so although nurses were based mainly on the top floor, their support was used across all floors for people assessed as needing nursing support.

Staff training and support was seen as key to providing high quality care and support. In discussion with the

registered manager, we identified that staff had not yet received training in working with people with complex dementia care where diffusion and breakaway techniques may be needed. By the second day of inspection activity, the registered manager confirmed this training had now been sourced and booked for staff.

Staff were positive about the support and training they received. One staff member said they were being supported to complete a nursing qualification. Another said, "This is the best training I have ever had since working in care." The training matrix showed staff had a wide range of training in all aspects of their work.

People were kept safe because risks for individuals and the environment were completed and reviewed when needed. Staff understood about abuse and who to report any concerns to. Staff recruitment was robust and ensured new staff only started employment once all their checks were in place to show they were suitable to work with vulnerable people.

People were supported to have a varied diet and snacks and drinks were offered throughout the day and evening. One person said they were not offered anything after teatime. We fed this back to the registered manager who said she would ensure people were made aware they could access food and drink 24/7 if they wished, and that there was a later supper trolley available with hot drinks, cakes and sandwiches. People said the meals and choices were good. Comments included "The food is very good, I enjoy everything they give me, especially the puddings."

Where people were at risk of poor hydration or nutrition, staff supported them to encourage additional drinks and snacks and their daily intake was monitored.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Systems and audits were effectively used to ensure the quality of care and support as well as the environment was being monitored and to help drive up improvement. An action plan was used to review areas identified for improvement.

Some relatives said that communication was not always consistent and three said they would like more regular contact from the service about their loved one. This had been fed back to the provider who agreed to look into how they could make improvements to this.

The service employed a liaison person whose role included forging links with the local community. Prior to the pandemic this was working really well with local groups coming to use the facilities, such as the ground floor, coffee bar area for things such as will writing sessions. People using the service were also able to join in these groups.