Archived: Kensington Lodge

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

Kensington Lodge is a residential care home providing personal care. It is an adapted period building over four floors. The service is a large home, bigger than most domestic style properties. It was registered for the support of up to 15 people. Eleven people were using the service at the time of the inspection. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

People’s experience of using this service and what we found

The provider’s and registered manager’s lack of knowledge regarding regulation and legislation meant concerns were found at this inspection. Effective governance procedures were not in place and the registered manager was not given the time nor resources to fully perform their role. This had resulted in people being placed at risk of harm in some aspects of their lives.

Some risks to people were not effectively managed, including those associated with legionella, hot water and fire. The individual risks to people had not been consistently reviewed and assessed and there was no analysis in place for accidents and incidents. Allegations of abuse had not always been identified and managed appropriately. There was a lack of effective procedures in place for staff recruitment, which meant the provider could not fully assure themselves of staff’s suitability for their role.

Audits in place to monitor and assess the service and drive improvement had failed and where concerns had been identified, there was sometimes a delay in rectifying those issues. Where professionals had made recommendations to improve the service, these had not been consistently acted upon. Management and staff were not fully aware of their responsibilities and their knowledge in some areas was poor.

People received a person-centred service because the staff that supported them knew them well. However, care plans did not reflect the care delivered and contained little person-centred information; some aspects of people’s lives had not been planned for. Whilst people received support for planned activities, there were not enough staff to support them with unplanned events and people told us they would like to do more.

The service had not consistently applied the principles and values of Registering the Right Support. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. This was because people were limited in accessing the community when they wished due to not enough available staff to support them to do so.

There was, however, a positive and encouraging culture at the service and people were treated with respect. The staff team and those that used the service worked together to run the home and their views were sought as was those of others. People told us they liked the staff and that they were kind to them; our observations confirmed this. Independence was encouraged and supported, and people’s confidence had grown as a result of using the service. People were supported to have 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.

People received their medicines as prescribed, had access to regular and effective healthcare and were protected from the risks associated with infectious diseases. They participated in the community and had open access to an outdoor space. Whilst the home was suitable for most that lived there, at the time of the inspection, some were struggling to access the upper floors. The home was welcoming, and people had their own private spaces personalised to their choice. Décor, however, was tired in places.

All the people we spoke with were happy with the delivery of care provided at Kensington Lodge however, improvements are required in a number of other areas to meet regulations and legislation and fully protect people from the risk of harm.

We have made a recommendation about the use of accessible information.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was good (report published 5 January 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified four breaches in relation to the safe care and treatment of people, identifying and managing potential allegations of abuse, staff recruitment and the governance and management of the service.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the service to understand what they will do to improve the standards of quality and safety. We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Kensington Lodge provides residential care for up to 15 people who are living with a learning disability. At the time of this inspection there were 12 people living within the home.

The accommodation is over three floors of a period building with communal areas including a lounge and dining room. Bedrooms have washing facilities and there are communal bathrooms available.

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.

At our last inspection in January 2015, we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to the risks associated with the premises and the governance of the service. At this inspection, carried out in December 2016, we found that the provider had made sufficient progress to no longer be in breach of the regulations.

At our last inspection carried out in January 2015 we found that the service had failed to identify and rectify the risks associated with hot water, the storage of hazardous chemicals and infection. At this inspection we found that these concerns had been addressed by the service and measures were in place to manage the risks. Improvements had been made to the premises and these were ongoing.

The provider had audits in place to help monitor the quality of the service and rectify any identified issues. These had been completed on a regular basis and covered most areas of the service. The audits had been effective but required more attention to detail to become more robust in the event of any concerns.

Staff had been recruited following appropriate checks to ensure they were suitable to work in the service. There were enough suitably skilled staff to meet people’s individual needs in a person centred way.

People received support from staff who enjoyed their work, felt supported and worked well as a team. Staff had received an induction that prepared them for their role and completed relevant training. Their competency to perform their role was assessed and discussed in regular supervision sessions.

There was a warm and friendly atmosphere within the home and people were treated with respect. People were part of the running of the home and had choice in how they spent their days. Their dignity was maintained and their confidentiality respected by staff. People could come and go as they pleased and staff encouraged their independence.

Processes were in place to help reduce the risk of abuse and avoidable harm. The risks to the people who used the service and staff had been identified and managed. People received their medicines as the prescriber had intended and good practice guidance was followed.

The CQC is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. The service was working within the MCA although not all staff had a working knowledge of the legislation. We brought this to the registered manager’s attention and they contacted us shortly after our visit to confirm that training in this topic had been arranged.

People’s individual nutritional needs were met and they had choice in what meals were prepared. They received food and drink as they wished for it and the kitchen was open for people to access. Healthcare was available and the service supported people with this as required.

The service had discussed people’s care plans with them and they had been involved in this process. Care plans were developed with people’s consent and in an individual manner that met their needs. They had been reviewed on a regular basis.

The management team were spoken about positively and were available to people. They were involved in the day to day management of the service and people told us they were approachable. The provider visited the service on a regular basis and was available by other means on a daily basis as required.

We spoke with seven people who used the service, six care staff and the activities coordinator. The provider was on annual leave but we did speak with them via the telephone during our inspection. We reviewed three people's care records and six staff files. We also reviewed a selection of other records that included the provider's emergency plans and the risk assessments for the service.

We used the evidence we collected during our inspection to answer five questions.

Is the service safe?

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act (MCA), 2005, and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The MCA provides a framework to empower and protect people who may make key decisions about their care and support. The DoLS are used if extra restrictions or restraints are needed which may deprive a person of their liberty.

At the time of this inspection no person was subject to a DoLS authorisation. The provider told us over the telephone that a number of applications for this safeguard were needed and that they would address this on their return to the service.

We reviewed three people's care plans and noted that their mental capacity had been not been appropriately assessed . This meant that the management team did not fulfil their obligation to apply the principles of the MCA. We have asked the provider to tell us what they are going to do meet the requirements of the law in relation to the MCA, its main Codes of Practice and DoLS.

During our inspection we noted that people who used the service, staff and others were not always protected from the risks associated with exposure to infection. This was because the provider did not have effective systems in place designed to assess and minimise the risk of infection. This included unclean and unhygienic areas within the home. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring a clean and hygienic environment.

Effective recruitment procedures were not always in place. We have asked the provider to tell us what they are going to do to meet the requirements in law in relation to the requirements relating to workers.

There was limited evidence to show that people's views about the care and support people received were sought or acted upon. The staff did not know whether accidents and incidents were audited. We have asked the provider to tell us what they are going to do to meet the requirements in law in relation to assessing and monitoring the quality of the service.

We found that risk assessments in relation to the home's environment and the safety and welfare of people were out of date and contained incorrect information. We have asked the provider to tell us what they are going to do to met the requirements in law in relation to records.

There were procedures in place to manage and mitigate foreseeable emergencies. These included procedures in relation to fire, flood, adverse weather and power failure.

Is the service effective?

During our inspection we noted that people's needs had been assessed and that their care and support had been planned to meet their needs. However, people's risk assessments had not been dated or signed by the person who had completed them, and people's care plans had not been reviewed on a regular basis. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to people's records.

People's records included information about visits from other health and social care professionals. This helped to maintain multidisciplinary working to help ensure that all of the person's needs were being met.

Is the service caring?

We spoke and communicated with six people who used the service and they all stated that they were happy living in Kensington Lodge. One person said, 'I am happy here. I go to the centre and go horse riding and swimming. I don't have any problems.' Another person said, 'I have just come back from the day centre and have made some bracelets there. I have had fun.' A third person who could not communicate verbally gave us the 'thumbs up' when we asked them if they were happy with their care and support. Their sign meant that they were happy.

People's care and support was person-centred and it was evident that the staff knew the needs of each person well. People's likes, dislikes and preferences were documented. We observed people undertaking activities that they enjoyed. These reflected what were documented in their care plans.

We observed the interaction between staff and the people who used the service. The staff displayed kindness and courtesy to people at all times. People's privacy and dignity were maintained. Staff displayed effective communication techniques to ensure people understood what was being said or proposed. This included the use of signs, pictures and easy read formatted information for people.

Is the service responsive?

People's needs had been assessed and their planned care and support reflected their needs. This related to people's physical, psychological and social needs. Staff responded appropriately to any deterioration in a person's health.

Is the service well-led?

The service had a complaints procedure. Staff did not know whether complaints were audited and acted upon to help improve the quality of the service. We have asked the provider to tell us what they are going to do to meet the requirements in law in relation to assessing and monitoring the quality of the service.

All of the care staff we spoke with told us that the previous 12 months had been 'challenging.' They said that this was because they had been without a permanent registered manager. At the time of our inspection the provider of the service had just registered as the manager. The staff told us that they felt optimistic that the provider would bring positive changes to the service. One staff member said, 'Things have improved with the provider being the manager. It feels more like a team now, especially since there are now three senior care staff. There is much more support.'

During the April 2013 inspection the service managers had advised us that a significant induction programme was being developed which all staff would be required to undertake. This would consist of the internal induction programme and Skills for Care training. Once this was in place and staff were familiar with the standards required by the service then appraisals and supervisions would be implemented. We were told this induction programme, appraisals and supervisions would be in place by the end of December 2013.

This inspection established that improvements had been made. The internal induction programme had been implemented. Staff appraisals and supervisions were being carried out. Staff had completed the outstanding training on infection control.

The relatives we spoke with told us their family members were happy and well looked after by the staff. One relative told us that the staff were brilliant. Another said that when their family member spent the day with them they were always happy to return to Kensington Lodge.

People's care records were well ordered and clear. They reflected people's likes, dislikes and their preferences. Where people had specific requirements we found detailed records of what needed to done and how it needed to be done to enable care and support to be delivered safely and effectively.

Training programmes were in place and Skills for Care training and organisational training was about to be rolled out to all staff. However, no staff appraisals or supervisions had been carried out.

Kensington Lodge had a complaints policy that was available in a suitable format for people living at the home. We found that when necessary staff would support people by helping them to make a complaint.