Kings Den

Updated 10 August 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by one inspector.

Service and service type

Kings Den is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Kings Den is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was not a registered manager in post . A new manager started their employment the week of our inspection and were being inducted into the service. Plans were in place for the manager to register with CQC.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We reviewed information we had received about the service. This included notifications about important events at the service and feedback shared directly with CQC. We used all this information to plan our inspection.

During the inspection

We observed staff interacting with people and looked at the premises. We spoke with four members of staff including the provider, the manager and two care staff. We observed the four people who use the service. We also spoke to three people living at the service and three professionals. We reviewed three people's care records and records related to medicines. We looked at two staff files in relation to recruitment. We also looked at records relating to the management of the service, including audits and safety checks were reviewed.

After the inspection

We reviewed the evidence sent by the provider electronically. This included the service's staff training data, policies and procedures, records related to people’s risk management and the services improvement plan.

Updated 10 August 2022

About the service

Kings Den is a residential care home providing accommodation for persons who require nursing or personal care for up to four people. The service provides support to adults with learning disabilities or autistic spectrum disorder. At the time of our inspection there were four people using the service supported in one adapted building. People had access to all communal areas including shared bathrooms, lounge, dining area, kitchen and an enclosed rear garden.

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

People, their representatives and staff consistently spoke positively about the leadership in the home and the quality of care people received.

We found some improvements were needed to ensure safe recruitment practices were followed and to ensure audits were fully effective in identifying and addressing quality and safety concerns in the area of staff recruitment.

We found some improvements were needed to ensure medicines were managed safely, people’s risk were assessed and mitigated in areas such as epilepsy management and management of anxious behaviours and that the service stored care records for people which were up to date and relevant to current people’s needs and that care records were available for staff which reflected people’s current support needs.

The service did not always have infection control processes and systems in place to reduce the risk of people contracting COVID-19 and audits were not fully effective in identifying and addressing quality and safety concerns in the area of infection prevention control.

We found improvements were needed to ensure that effective systems were in place to monitor the quality of the service in order to pick up areas of improvements such as the ones which we have identified.

We did not find that these shortfalls had impacted on people's care and the provider and manager had started taking action during our inspection to ensure improvements were being made.

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.

The service was able to demonstrate how they were the underpinning principles of Right support, right care, right culture.

Right support: The provider had developed a model of care and an environment that maximised people's choice, control and independence.

Right care: People's care was planned and delivered with their individualised needs in mind. People were involved in planning their care. We saw examples of how people's care promoted their dignity, privacy and human rights.

Right culture: We saw how the vision, values, attitudes and behaviours of the management and care staff supported people to be confident and empowered in living in the community.

People received care and support from a consistent staffing team who knew them well. Staff spoke positively about the support they received and how this promoted person centred care.

Staff understood people's needs and how to assist them to protect them from avoidable harm.

People were supported by staff who had been trained and supported to meet their needs. People and their representatives spoke positively about the caring nature of staff.

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

Rating at last inspection

This service was registered with us on 16 April 2021 and this is the first inspection.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 29 and 30 June 2022. This was a planned inspection based on the service being newly registered.

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.

Enforcement

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 breach in relation to regulation 19 (Fit and proper persons employed) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. 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 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.