Kingston House

Updated 14 December 2023

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 2 inspectors.

Service and service type

Kingston House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and we looked at both during this inspection.

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.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.

We used all of this information to plan our inspection.

During the inspection

Inspection activity started on 13 October 2023 and ended on 24 October 2023. We met with the 2 people who used the service. People were unable to speak to us due to their health conditions. We therefore spent time in the communal lounges observing care practices, so that we could gain an understanding of people's experience in how they received support.

We also spoke with 4 care staff, the manager and regional manager. We reviewed a range of records including 2 people's care records, medication records, staffing information, the services training matrix and records relating to the running of the service.

We spoke via telephone with a person’s relative about the service's performance. We attended a safeguarding meeting where 7 health and social care professionals attended and shared their views on the service.

We also reviewed the various documents we had requested during the site visit.

Updated 14 December 2023

Kingston House is a registered care home providing personal care for up to 3 people with a learning disability. At the time of the inspection there were 2 people living at the service. The service is based in a detached house over 2 floors with passenger lifts for people to access the upper floor. The service was equipped with facilities to support the needs of people living at Kingston House.

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.

Based on our review of safe, caring and well led. The service was not able to demonstrate how they were meeting some of underpinning principles of 'Right Support, Right Care, Right Culture.'

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

Right Support:

People’s medicines were not always managed safely.

The recruitment checks for new staff were not robust.

People were supported to make decisions by staff who used best practice in decision-making and communicated with people in ways that met their needs.

People’s care and support was provided in a safe, clean environment which met their physical needs. People had a choice about their living environment and were able to personalise their rooms.

People could access health and social care support in the community.

Right care

Staff had not been provided with sufficient guidance on how to protect people from identified risks.

People received¿kind and compassionate care from staff who protected¿and respected¿their privacy and dignity and understood and responded to their individual needs.

The service had enough staff working each day to meet people’s needs and keep them safe.

Staff understood people’s individual communication needs.

People received care and support from staff who knew and understood people well and were responsive to their needs.

Right culture

The provider had not taken the opportunity, since the last inspection, to implement effective change to ensure the service met the regulations, reflected best practice expected by Right Support, Right Care, Right Culture, and offered improved outcomes to people.

There were no effective processes in place for assessing and monitoring the quality of the services provided and to ensure records were accurate and complete. Systems had failed to identify that people were not always protected from avoidable harm.

Systems in the service did not ensure that all the utilities were monitored to ensure safety.

The service involved appropriate professionals in planning people’s care.

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 information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection and update

At our last inspection we found breaches of the regulations in relation to the management oversight of the service and made a recommendation in respect of the records required when recruiting staff. We have identified 1 continued breach in respect of good governance. We have also identified 2 new breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment and staffing.

The last rating for this service was Requires Improvement (published 19 October 2022)

Why we inspected

We were prompted to carry out this inspection due to concerns we received about the service. These included concerns that people were not receiving personal care, medicine administration, the culture of the staff and the impact on people they support, unsafe moving and handling, and a lack of support from the management team.

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

Since the last inspection we recognised that the provider had failed to have oversight of the service, had not ensured appropriate recruitment checks had been made, failed to ensure medicines systems were safe and the provider had not assessed or acted on risks to the health and safety of people receiving care. These are breaches of regulations. Full information about CQC’s regulatory response has been added to the end section of the full version of this report as enforcement action has concluded.

Follow up

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