Kensington Hall

Kensington Hall is a residential care home providing personal care to 10 people at the time of the inspection. The service can support up to 13 people.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it. Based on our review of key questions of safe and well-led, the service was not able to demonstrate how they were consistently meeting some of the underpinning principles of Right support, right care, right culture.

Right Support:

Medicines were managed safely. However, improvements were needed in the records and guidance for topical and when required medicines. Care records were not always complete or accurate. Care plans and risk assessments had not always been completed with specific details required about people’s care and some included out of date information. Audits did not always identify the issues we found.

There were effective staff recruitment and selection processes. There were enough skilled and experienced staff who knew people well to safely meet people's health and physical needs. We received some mixed feedback about how the level of staff consistently supported independence and choice.

Infection control measures were in place, people were supported by staff to keep their home safe and clean. 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.

Right Care:

People received safe care in relation to their physical and health needs. Staff and people cooperated to assess risks people might face. People were kept safe from avoidable harm because staff knew them well and understood how to protect them from abuse. The service worked well with other agencies to do so.

Right Culture:

Governance systems were in place but the oversight of these was not always effective. There was a registered manager in post who is registered across 2 services. There had recently been additional support for the registered manager so they could spend dedicated time in the home making improvements. Longer-term a senior support worker was being upskilled to provide more management support. Both told us they felt supported by the wider organisation.

People did not always receive care that supported their needs and aspirations, was focused on their quality of life, and followed best practice. People's care plans did not always reflect clear goals and outcomes to support people’s independent living skills. There was limited evidence that activities were structured or planned to be as person centred as possible. Some people were active in the local community, but other people had limited access. The registered manager was already aware this was an area needing development and had started work to address this. We have made a recommendation about person centred support.

Most people and relatives told us there was a positive atmosphere in the home and staff were kind and caring. People and staff told us the registered manager was helpful, approachable and dealt with concerns if raised. Staff had close links with health professionals and met with them regularly to review people’s needs. Management and staff were working proactively on improvement plans from partner agencies. There were systems in place to gather feedback on the service. Most people, relatives and staff told us their feedback was valued and acted on.

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 14 January 2019).

Why we inspected

This was a planned focused inspection based on the length of time since the last inspection.

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 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 and well-led sections of this full report.

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

Enforcement and Recommendations

We have identified breaches in relation to good governance at this inspection. We have made a recommendation about person-centred support.

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

Follow up

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

We found the following examples of good practice.

¿ Systems were in place to prevent people, staff and visitors from catching and spreading infections. The home was proud to have had no known cases of Covid-19. The home supported people and staff as far as possible with social distancing. The home had a cleaning schedule in place and had implemented additional cleaning of frequently touched areas.

¿ Staff had undertaken training in infection prevention and control (IPC), personal protective equipment (PPE), hand hygiene and other Covid-19 related training. Staff were seen wearing appropriate PPE. The home had sufficient supplies of PPE including a PPE station in each person’s room.

¿ Staff supported people’s social and emotional wellbeing. Activities such as themed nights, Halloween and birthday celebrations were taking place to engage people. People took part in person-centred individual activities such as sewing and cross stitch.

¿ People had Covid-19 specific risk assessments and individual care plans were updated. People were supported to have telephone contact with friends and relatives. Relatives were kept up to date with weekly telephone calls, letters and cards.

¿ Only essential health and compliance visits could take place at the time of the inspection. Visitors were screened for Covid-19. When visits were allowed, in line with the easing of local lockdown restrictions, these were managed safely in accordance with national guidance. Visits took place outside and were by appointment only. Infection prevention and control measures were in place to avoid potential transmission with others.

¿ The home had robust IPC policies and risk assessments in place. Infection control audits and checks were carried out. The registered manager had regular meetings with the provider and passed on important information about Covid-19 to staff.

¿ The home reported it had a good relationship with the GP. The home accessed support regularly and whenever needed to help keep people safe.

Further information is in the detailed findings below.

At this inspection we found the evidence continued to support the rating of 'Good' and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risk or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Kensington Hall is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Kensington Hall provides accommodation and personal care for up to 13 older people living with a learning disability and/or autistic spectrum disorder.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. On the day of our inspection there were 13 people using the service.

The home had a registered manager in place. A registered manager is a person who has registered with 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 provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff. There were sufficient numbers of staff on duty to meet the needs of people who used the service.

The provider had effective procedures in place for managing the maintenance of the premises and appropriate health and safety checks were carried out. The home was clean, spacious and suitable for the people who used the service.

Accidents and incidents were appropriately recorded and risk assessments were in place. The registered manager understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vulnerable adults.

Appropriate arrangements were in place for the safe management and administration of medicines.

Staff were supported to provide care to people who used the service through a range of training, supervision and appraisal.

People who used the service and their relatives were complimentary about the standard of care at Kensington Hall. Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves, where possible.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

Care records showed people’s needs were assessed before they started using the service and care plans were written in a person-centred way and were reviewed regularly. Person-centred is about ensuring the person is at the centre of any care or support and their individual wishes, needs and choices are taken into account.

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. People had access to healthcare services and received ongoing healthcare support. Care plans were in place that recorded people’s plans and wishes for their end of life care.

Activities were arranged for people who used the service based on their likes and interests and to help meet their social needs, in the home and within the local community.

The provider had an effective complaints procedure in place and people who used the service and their relatives were aware of how to make a complaint.

The provider had an effective quality assurance process in place. People who used the service, relatives and staff were regularly consulted about the quality of the service through meetings and surveys.

We previously inspected Kensington Hall on 30 September 2014, at which time the service was compliant with all regulatory standards.

Kensington Hall is a residential home in South Hetton, County Durham, providing accommodation and personal care for up to 13 people living with a range of learning disabilities. There were 11 people using the service at the time of our inspection.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like directors, 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.

We found that there were sufficient numbers of staff on duty in order to meet the needs of people using the service, as well as to ensure premises were clean and well maintained.

People who used the service, their relatives and a range of external professionals all expressed confidence in the ability of staff to protect people from harm.

Staff we spoke with displayed a good knowledge of safeguarding principles and how to look out for signs of abuse. They were clear about their responsibilities should they have any concerns.

We saw there were effective pre-employment checks of staff in place, including Disclosure and Barring Service checks, references and identity checks, to reduce the risk of unsuitable people working with people who may be vulnerable.

The storage, administration and disposal of medicines was safe and in line with guidance issued by the National Institute for Health and Clinical Excellence (NICE).

All areas of the building including people’s rooms, bathrooms and communal areas were clean, with infection control risks well managed and appropriately resourced.

Individualised risk assessments were in place to manage the risks people faced. These assessments and associated care plans were reviewed regularly and included advice from healthcare professionals to keep people safe.

Visiting professionals had confidence in the experience and knowledge of staff, citing a range of examples where they ensured people’s healthcare needs were met. There was prompt and regular liaison with GPs, nurses and specialists to ensure people received the treatment they needed.

Staff were trained in areas specific to meeting people’s changing needs, for example dementia awareness and communication training, and were also trained in areas the provider considered mandatory, such as safeguarding, health and safety, moving and handling and dignity.

Staff were supported through well-planned regular supervision and appraisal processes as well as ‘hands-on’ from management when required.

We saw people had choices at each meal and were involved in planning the menu. We saw people who required help to eat were supported patiently and people with specialised diets had their needs met.

Each room had an en suite shower room, whilst the rest of the building was well maintained, with bright spacious corridors and ample communal and outdoor space.

Group activities were varied and well planned, coordinated by a new member of staff with relevant experience. Improvements were planned to ensure people who could not choose to engage in group activities had alternative, meaningful options.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS).

We checked whether the service was working within the principles of the MCA. The registered manager displayed a good understanding of capacity and we found related assessments and decisions had been properly taken and the provider had followed the requirements in the DoLS.

The atmosphere at the home was welcoming and relaxed. People who used the service, relatives and external stakeholders told us staff were caring and compassionate and we saw numerous instances of compassionate and fun interactions.

Person-centred care plans were in place and contained comprehensive information about people’s likes, dislikes and life histories. We saw regular reviews took place, ensuring people who used the service, relatives and healthcare professionals were involved.

A range of group activities took place along with individualised activities for people, based on their own goals and aspirations.

The service had built and maintained good community links.

Staff, people who used the service, relatives and external professionals we spoke with knew the registered manager and spoke positively about their approachability, flexibility and knowledge of people who used the service.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

Is the service safe?

People told us that they felt their rights and dignity were respected.

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduces the risks to people and helps the service to continually improve.

Staff knew about risk management plans and showed us examples where they had followed them. People were not put at unnecessary risk but also had access to choice and remained in control of decisions about their care and lives.

Is the service effective?

People's health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary needs had been identified where required. People said that their care plans were up to date and reflected their current needs.

One person had a part time out reach support worker and told us that the service had helped them to find them. Other people we spoke with were also supported by outreach worker's.

Is the service caring?

We spoke with ten people being supported by the service. We asked them for their opinions about the staff that supported them. Feedback from people was positive, for example; 'the staff are brilliant they should all be given a pay rise', 'Sometimes I help to write my care plan', 'I feel safe here."

When speaking with staff it was clear that they genuinely cared for the people they supported.

People using the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were taken on board and dealt with.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People knew how to make a complaint if they were unhappy. One person said that they had made a complaint and were satisfied with the outcome.

The service worked well with other agencies and services to make sure people received care in a coherent way.

Is the service well-led?

The service has a quality assurance system, and records showed that identified problems and opportunities to change things for the better were addressed promptly. As a result the quality of the service was continuously improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the service and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

We spoke with several people who lived at the home and some of their relatives. People were very happy with the care provided. Comments included 'I like the staff very much, everything's fine and I'm doing very well' and 'They are like my best friends.'

We spoke with some staff, people who lived at the home and their relatives about staffing levels. They all said they thought there was enough staff on duty to meet everyone's needs.

People said they knew they could speak to a member of staff if they had any concerns. One person said "I would speak to them or the manager: they would sort it out for me.' Another said 'I haven't had to complain but I know what to do.'

We reviewed three care records and saw that people's preferences and care needs had been well documented. We spoke with four members of staff. Staff were knowledgeable about the people's care needs and what they should do to support them.

People told us they enjoyed the food. One person said, "Lunch was very nice, it always is."

Staff training was kept up to date so that staff could care for people safely and to an appropriate standard.

We found that the provider had made suitable arrangements to protect vulnerable people from the risk of abuse.

There was an effective system in place to monitor and assess the quality of the service.