Archived: Kingston Farmhouse Care Home

About the service

Kingston Farmhouse Care Home is a care home and is registered to provide accommodation and personal care for up to nine people and predominantly supports people living with a learning disability. At the time of the inspection there were nine people living at the service.

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

People told us they enjoyed living at Kingston Farmhouse and they felt supported by staff who knew them well.

Staff had received training in safeguarding and understood their responsibilities. People were protected from abuse and there was an open culture, where staff supported people to express any concerns. People received their medicines safely and as prescribed. Appropriate arrangements were in place for obtaining, recording, administering and disposing of prescribed medicines.

Staff had received appropriate training and support to enable them to carry out their role safely. There were enough staff available to provide person centred care to people. Safe recruitment processes were followed, and people were involved in the process, to ensure they had a say in who worked in their home.

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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. The outcomes for people using the service promoted choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to be involved in decisions about their own lives and gain new skills.

The provider had systems and processes to monitor quality within the home. The registered manager understood their regulatory responsibilities and shared information with stakeholders in a timely way.

There was a complaints procedure and people and their relatives knew how to complain and were confident that if they raised concerns, these would be acted on.

People, their families, staff and external professionals all told us that the registered manager was very supportive, and the home was well led.

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 requires improvement (published 30 April 2019) and there were three breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led, which contain those requirements.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Kingston Farmhouse Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Kingston Farmhouse Care Home 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. Kingston Farmhouse is registered to provide accommodation and personal care for up to nine people and predominantly supports people living with a learning disability. At the time of the inspection there were nine people living at the service.

Best practice guidelines recommend supporting people living with a learning disability in settings that accommodate less than six people. Kingston Farmhouse supports up to nine people, therefore the service model was not fully aligned to the principles set out in Registering the Right Support. However, the outcomes for people using the service reflected the principles and values of Registering the Right Support including; choice, promotion of independence and inclusion. People's support was focused on them having as many opportunities as possible, to have new experiences and to maintain their skills and independence.

People’s experience of using this service:

• People told us they enjoyed living at Kingston Farmhouse Care Home. They said they felt safe and cared for by kind and compassionate staff.

• People’s family members could not praise the service enough and all spoke highly of the care their relatives received and the choice and control they had over their lives.

• Although we found some area of improvements since the last inspection, we found some areas of practice had not improved and had the potential to place people at risk.

• People were not always protected from the risk of abuse. Where incidents had occurred that placed people at risk of harm, actions had not been taken to mitigate risks. Appropriate risk assessments had not always been implemented where required and incidents had not always been monitored to help identify patterns of behaviour. Incidents of abuse had not been reported by the registered manager or staff to relevant parties, such as the local safeguarding team or CQC.

• Governance systems used to assess the quality and safety of the service did not always identify concerns and drive improvement. Information to keep people safe in an emergency or identify their needs was not easily accessible due to the extensive information held within people’s care files.

• People received their medicines safely and as prescribed, while being looked after in a clean and well-maintained environment aimed to promote independence and meet people’s needs.

• People received compassionate support which met their needs from kind and caring staff. People had developed meaningful relationships with the staff. Staff knew what was important to people and ensured people had support that met their needs and choices.

• People’s dignity and privacy were respected and their independence was promoted.

• People's rights to make their own decisions were respected. Staff supported people to make choices in line with legislation.

• People were supported to participate in a range of activities of their choice.

• People and family members knew how to complain and were confident that if they raised concerns, the registered manager would act promptly to address these.

• People and staff were fully engaged in the running of the service.

Rating at last inspection:

The service was last inspected in December 2017 where we undertook a full comprehensive inspection (report published February 2018). It was awarded a rating of Requires Improvement.

Why we inspected:

This was a planned inspection based on the previous inspection rating.

Follow up:

We found one repeated breach of regulation and two new breaches of regulation. The service also remained rated as requires improvement. We will request an action plan from the registered provider about how they plan to improve the rating to good and meet the requirements of the regulations. In addition, we will meet with the provider to discuss their plans to make improvements. We will also continue to monitor all information received about the service to monitor any risks that may arise and to ensure the next planned inspection is scheduled accordingly.

At the last inspection on the 15 October 2016 the service was rated Good. At this inspection we found the service Requires Improvement.

The home is registered to provide accommodation for nine people. At the time of our inspection there were nine people living at the home. The home is arranged over two floors with most of the bedroom accommodation on the first floor. Bedrooms had facilities where people could wash and there were toilets and bathrooms available to people on each floor. There were 3 communal areas in the home, which included a kitchen, dining room and lounge.

The inspection was conducted on 15 December 2017 and was unannounced. 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.

There were quality assurance systems in place to help ensure the safety and quality of the service; these had not been fully effective in ensuring that shortfalls were addressed.

People and their families told us they felt safe living at the home. Staff knew how to identify, prevent and report abuse. They assessed and managed risks to people and risks posed by the environment effectively.

When risks around people were identified, the registered manager acted quickly and sought support from external health and social care professionals. Collaborative working had enabled risks to be managed promptly with positive outcomes for people.

People received their medicines as prescribed. However, we identified some areas where improvements could be made to ensure the safety of medicines management and these were acted on promptly by the registered manager.

There were enough staff to meet people's needs in a timely way. Recruitment procedures were in place and pre-employment checks were completed before staff started working with people. Staff were appropriately trained to meet the needs of the people using the service. Staff were supervised in their role and received an annual appraisal to aid their personal development.

The home was clean and hygienic and staff followed best practice guidance to control the risk and spread of infection.

Staff sought verbal consent from people before providing support and followed Mental Capacity Act legislation which is designed to protect people's rights when making decisions on their behalf. The registered manager understood their responsibilities under Deprivation of Liberty Safeguards (DoLS). DoLS applications had been made to the relevant supervisory body in line with guidance.

People had enough to eat and drink and received appropriate support where needed. Meals were balanced and nutritious and support was given to promote healthy options.

People were supported to access health care services when needed. Staff worked with healthcare providers to help ensure continuity of care.

People were cared for with kindness and compassion. Staff knew people well and supported people to maintain relationships that were important to them.

People’s dignity and privacy was respected and they were supported to remain as independent as possible. People were supported to develop skills and to take positive risks so that they could become more independent.

Staff worked well as a team and were motivated and organised. They enjoyed working at the home and told us they felt valued.

The registered manager had sought feedback from people, their relatives and other stakeholders about the service provided. Their opinions had been used to make changes and to promote and drive improvements. People and their relatives felt the service was well run. Family and visitors were welcomed to visit at any time.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. The staff worked in line with current legislation.

Services are required to prominently display their CQC performance rating. The provider had displayed the rating.

We found one regulatory breach at this inspection. There is further information about this at the end of the report.