Archived: Kenton House

Kenton House is a residential care home providing accommodation and personal care to up to 11 people. The service provides care and support to older people some of whom live with dementia. At the time of our inspection there were 7 people using the service.

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

Since the last inspection we found that improvements had been made.

The service ensured people’s safety was fully assessed and managed. Risks to people were identified at their initial assessment and the provider had systems in place to ensure risk assessments were regularly reviewed and updated where required. Staff were provided with the guidance they required to ensure potential risks to people were minimised as far as possible.

The provider had ensured a sufficient number of staff were in post to meet people’s care and support needs. Staff had received an induction at the commencement of their employment to ensure they had the knowledge they required to meet people’s needs. The provider had a system in place to ensure training was refreshed annually or as required. Staff received regular supervision from the manager.

People's care was planned and delivered in a person-centred way. People’s care needs, wishes and preferences were assessed and their care plans contained guidance for staff on how they should ensure people’s needs were respectfully and effectively met.

There was a process in place to report, monitor and learn from accidents and incidents. The provider had procedures in place to ensure incidents and accidents and concerns were managed and reported effectively, and lessons learned from these where required.

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.

People’s relatives gave positive feedback about the support their family members received from staff. The provider had systems in place to monitor and assess the quality of the care and support provided to people. Policies and procedures which reflected current best practice were in place to underpin this. People’s views about their care were sought on a regular basis.

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 31 October 2022) and there were 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.

At our last inspection we recommended that the provider considers appropriate guidance to ensure people are protected from discrimination and their differences are recognised, respected and valued. At this inspection we found the provider had acted on the recommendation and they had made improvements.

Why we inspected

This inspection was prompted by a review of the information we held about this service. 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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Kenton House is a residential care home providing accommodation and personal care to up to 11 people. The service provides care and support to older people some of whom live with dementia. At the time of our inspection there were 10 people using the service.

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

The provider did not ensure that the systems they had in place to assess, monitor and improve the quality and safety of the service for people were always effective. The provider had not identified the issues we found on this inspection.

The service management and leadership, and the culture they created did not always support the delivery of high-quality, person-centred care. There was no registered manager at Kenton House. The home was being managed and run by a senior care team leader with support from a regional manager. However, due to staffing issues the senior care team leader was often working long shifts carrying out care and other tasks ,including management administration and medicines tasks. Therefore, it was not clear how they had the time to complete the many managerial responsibilities despite receiving some support from the regional manager.

Due to staff shortages some staff had worked a significant number of hours above their contracted weekly hours. Staff were at risk of extreme tiredness, which could affect their capability to effectively and safely carry out their duties, which could put people at risk of harm.

Care plans were not always personalised and in place for people's specific health conditions. So, we could not be assured that peoples' needs were fully understood and met by the service.

Suitable infection control practices helped to prevent and control the spread of infections including COVID-19.

Arrangements were in place to protect people from abuse. Staff had received training on how to safeguard people from abuse and were aware of the procedure to follow if they suspected that people were subject to abuse.

People were supported to access the health services they needed.

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.

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

Rating at last inspection

The last rating for this service was good (published 10 January 2018).

Why we inspected

We received concerns in relation to the management of medicines, staffing, quality monitoring and people’s care. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. We have found evidence that the provider needs to make improvements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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 overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to staffing, person centred care and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

We have made two recommendations, one about equality and diversity and the other about the Mental Capacity Act.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

At the last inspection of the service on the 4 and 6 January 2017 we rated the service as ‘Requires Improvement’. The provider was in breach of three regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because we found deficiencies in the training and supervision that staff received, and a person was being deprived of their liberty for the purpose of receiving care without lawful authority. Also systems and processes were not established and operated effectively to assess, monitor and improve the quality and safety of the service.

Following the inspection, we asked the provider to complete an action plan to show what they would do to improve the key questions Effective and Well-led to at least good. The provider sent us an action plan setting out the actions that they would take to meet the regulations. During this inspection we found appropriate systems were in place to ensure that staff received the training and support that they needed to carry out their role and responsibilities. Legal authorisations were in place where people needed to be deprived of their liberty for the purpose of receiving care or treatment, and systems to effectively monitor and improve the service provided to people were in place.

Kenton House is registered to provide accommodation and personal care for eleven people. The home provides care and support for older people some of whom may have dementia. At the time of the inspection there were eleven people using the service.

There was a registered manager in post. The registered manager had managed the service from early 2017. A registered manager is a person who has registered with the Care Quality Commission [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.

The registered manager was aware of their role and responsibilities, and since being in post had worked hard to develop and improve the service. They had promoted a positive culture in the service, which staff understood and supported. People’s preferences and choices were supported and they were encouraged to be involved as much as they wanted to be in decisions to do with the running and development of the service.

There were systems in place to keep people safe. Staff had an understanding of abuse and the safeguarding procedures that should be followed to report abuse .People had risk assessments in place to enable them to be as independent as possible and minimise the risk of them being harmed.

The staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service.

Fire safety checks and appropriate service tests had been carried out to make sure that the premises were safe.

Arrangements were in place to make sure people received the service they required from sufficient numbers of suitably trained staff.

People told us that staff were kind to them. We saw staff engaged with people in a friendly and considerate way.

People’s care plans included details about their individual needs and preferences. They contained important information about each person's background and interests which helped staff to get to know them. Where people had capacity to do so they had signed their own care plans. Where people lacked the capacity to make a specific decision, legal requirements had been met to ensure any decisions were made in the person’s best interests.

Staff had the skills and knowledge to meet people’s needs. When required, staff assisted people to receive the advices, treatment and care that they needed from healthcare and social care professionals. Staff had a good understanding of each person’s needs and abilities.

Arrangements were in place to manage people's medicines safely. People's dietary needs and preferences were supported.

Staff respected people's privacy and dignity and understood the importance of maintaining and supporting confidentiality. People were provided with the support they needed to maintain links with their family and friends.

People knew how to make a complaint and told us they felt comfortable providing feedback about the service. Where people had made complaints or had raised an issue to do with the service these had been appropriately responded to.

There was a management structure in the service which provided clear lines of responsibility and accountability. Checks were carried out to monitor and improve the quality and safety of the service.

Further information is in the detailed findings below.

At our previous inspection on 14 October 2014 the service was rated good and met regulations.

Kenton House is a care home registered to provide personal care and accommodation for 11 older people who may also be living with dementia. There were eight people using the service including one person who was in hospital at the time of our inspection. The home is located in Kenton on the outskirts of Harrow and has access to public transport and there are a range of shops within walking distance of the service.

The care home had a registered manager at the time we inspected the service, however they had recently left the service and applied to deregister with us. This process was completed by us on 9th January 2017. 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. A registered manager from another of the provider’s services and the business manager were providing management support to the service at the time of our inspection.

People using the service and their relatives informed us they were happy with the service but raised some concerns about the home not having a permanent manager. A person using the service told us they missed having a manager and would like a manager to be in place as soon as possible.

Staff were appropriately recruited. Staff received some training to enable them to be skilled and competent to carry out their roles and responsibilities. However, records showed not all staff had completed or were up to date with the provider’s mandatory and refresher training. Staff told us they were well supported by senior staff but records did not show care staff had received regular one-to-one supervision to support them to carry out their roles and responsibilities.

Staff had some understanding of the Mental Capacity Act 2005 (MCA). They were aware of the importance of gaining consent for the support they offered people. People were encouraged and supported to make decisions for themselves whenever possible. Staff knew about the systems in place for making decisions in people’s best interest when they were unable to make one or more decisions about their care, treatment and/or other aspects of their lives.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensure that an individual being deprived of their liberty is monitored and the reasons why they are being restricted is regularly reviewed to make sure it is still in the person's best interests. The documentation of one person’s DoLS was not available and the provider did not show they had followed the requirements under the act to ensure an application to deprive another person of their liberty had been authorised by a local authority.

Although checks were carried out in some areas of the service there was a lack of effective systems in place to comprehensively regularly assess, monitor and improve the quality of the services provided for people. There was no indication that feedback from people was sought to assist in the evaluation and improvement of the service.

There were procedures for safeguarding people. Staff knew how to safeguard the people they supported and cared for. They knew how to recognise abuse and that it needed to be reported to management staff but some care workers needed prompting before telling us they could inform the local authority safeguarding team if senior staff took no action.

People were cared for by staff who treated them with respect and engaged with people in a pleasant and courteous manner. Throughout our visit we observed caring and supportive interaction between staff and people using the service. Staff respected people’s privacy and dignity and understood the importance of confidentiality. People were supported to choose and take part in a range of activities and had the opportunity to choose what they wanted to eat and drink.

People had their medicines stored and managed safely. They received the medicines they were prescribed.

People’s individual needs and risks were identified and managed as part of their plan of care and support to minimise the likelihood of harm. Accidents and incidents were addressed appropriately.

Staff were aware of people’s individual needs which were documented within each person’s care plan. People were provided with the support they needed to maintain and develop links with their family and others important to them.

People were supported to maintain good health. They had access to a wide range of appropriate healthcare services that monitored their health and provided people with appropriate support, treatment and specialist advice when needed. When people were unwell staff were responsive in making sure people received the medical treatment and care they needed.

The environment was accessible for people who used wheelchairs and/or walking frames. A passenger lift provided people with mobility needs access to the first floor facilities.

During this inspection we found three breaches of Regulations relating to staff training, supervision, DoLS and good governance. You can see what action we told the provider to take at the back of the full version of the report.

People were supported to make choices. These included decisions about what they wanted to do and when they wanted to get up and go to bed. Staff interacted with people who used the service in a respectful and very sensitive manner. Comments from people who used the service included 'I can choose what to do,' 'I couldn't be better looked after,' 'I have help when I need it,' 'the staff are always very busy,' and 'I am happy living here.'

Each person who used the service had a plan of care that included up to date information about the individual support and care they needed. People's health, safety and welfare were protected as they received the advice and treatment that they needed from a range of health and social care professionals. Staff had the skills to meet people's needs and they received appropriate support and advice from the manager.

People had been involved in the assessment of their needs and their recorded plan of care. We saw care provided to people had been monitored and the health care needs of people had been met. People's likes, dislikes, preferences and goals were considered in relation to the care and support that they received.

People spoke about the activities they participated in and enjoyed. We saw people took part in a range of leisure activities.

People told us they made decisions about their lives. We saw people make a number of choices. These included deciding what they wanted to eat and what they wanted to do. These choices were respected by staff.

People told us they felt safe and knew who to talk to if they had any worries or concerns. Policies and staff safeguarding training protected people from abuse.

There were systems in place to monitor and make improvements to the service provided to people.