Kenton House

About the service

Kenton House is a residential care home providing personal and nursing care to 17 people with learning disabilities or autistic spectrum disorder at the time of the inspection. Kenton House can support up to 17 people in one adapted building.

Kenton House has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 17 people. 17 people were using the service. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size.

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

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.

Safe recruitment practices were not always followed. However, the registered manager was taking action to address this.

Most of the care plans and risk assessments were up-to-date, person centred, and goal orientated with a focus on achieving outcomes. However, care plans and risk assessments relating specifically to health did not always contain sufficient clarity of detail to enable staff to carry out the support safely. However, the risk was mitigated by staff demonstrating clear knowledge and understanding of how to support people safely.

Regular checks were undertaken in relation to the maintenance and safety of equipment and concerns identified. However, actions and outcomes were not always recorded for concerns identified from these checks. We have made a recommendation about evidencing response to safety checks.

The environment was accessible and met the needs of the people living at Kenton House. There was some required maintenance that once completed would enhance the environment.

Staff were caring. Everyone we spoke with was very complimentary about the service and said they would recommend the home.

Activities were available to keep people occupied both on a group and individual basis. Activities were organised in line with people's preferences.

A system was in place to ensure medicines were managed in a safe way for people. Staff were trained and supported to ensure they were competent to administer medicines.

People received support with meals and drinks and there was an emphasis on identifying and monitoring likes and dislikes for people using their preferred communication methods.

Staff knew how to access relevant healthcare professionals if their input was required. The service worked in partnership with other organisations and healthcare professionals to improve people's outcomes.

There were sufficient numbers of staff deployed to keep people safe and to meet their care needs. Staff were received appropriate training which was relevant to their role. Staff were supported by the registered manager and were receiving formal supervision where they could discuss their on-going development needs.

Individual needs were assessed and met through the development of detailed personalised care plans, which considered people's equality and diversity needs and preferences. Care plans were up to date and most detailed the care and support people wanted and needed. Risk assessments were in place and showed what action had been taken to mitigate most risks which had been identified. Appropriate referrals were being made to healthcare professionals when necessary.

There was a complaints procedure available which enabled people to raise any concerns or complaints about the care or support they received. Systems were in place to ensure complaints were encouraged, explored and responded to.

The service had links with other resources and organisations in the community to support people's preferences and meet their needs.

Kenton House met the characteristics of Good in some areas and of Requires Improvement in others. Overall, we have rated the service as Required Improvement.

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 3 February 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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

We identified one breach of regulations. You can see what action we have told the provider to take at the back of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Kenton House 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.

Kenton Road, is a care home which provides residential and nursing care for up to 23 older adults. People receiving the service lived with profound learning and physical disabilities. Some people living at the service also had additional health conditions such as epilepsy and conditions which meant they were unable to move independently. The home comprises of two floors with its own secure rear garden and is situated in Headley Down. At the time of the inspection seventeen people were using the service.

Kenton House has a registered manager in post. 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.

Relatives of those using the service told us their family members were kept safe. Staff understood and followed the provider’s guidance to enable them to recognise and address any safeguarding concerns about people.

People’s safety was promoted because risks that may cause them harm had been identified and guidance provided to manage these appropriately. People were assisted by staff who encouraged them to remain independent. Appropriate risk assessments were in place to keep people safe.

The provider used robust recruitment processes to ensure people were protected from the employment of unsuitable staff. Recruitment checks were in place to ensure people were of suitable character and experience to enable them to complete their role.

People were kept safe as the provider ensured sufficient numbers of staff were deployed in order to meet people’s needs in a timely fashion. In the event of unplanned staff sickness the provider sought to use existing staff including the registered manager to deliver care to ensure familiarity to those receiving the service.

Contingency plans were in place to ensure the safe delivery of people’s care in the event of adverse situations such as large scale staff sickness or accommodation loss due to fire or floods.

People were protected from the unsafe administration of medicines. Nurses were responsible for administering medicines and had received additional training to ensure people’s medicines were administered, stored and disposed of correctly. Nurse skills in medicines management were regularly reviewed by managerial staff to ensure they remained competent to administer people’s medicines safely.

New staff induction training was followed by a period of time working with experienced colleagues to ensure they had the skills and confidence required to support people safely.

People were supported by staff who had up the most relevant up to date training available which was regularly reviewed to ensure staff had the skills to proactively meet people’s individual needs.

Documentation was not always available to show people had been appropriately assessed to ensure they were able to make decisions regarding where they lived and all aspects of the care they received. However best interest meetings were used with family, health and social care professionals involved with people to ensure consent was provided prior to the delivery of all aspects of people’s care. People where possible, were supported by staff to make their own decisions. Staff were able to demonstrate that they complied with the requirements of the Mental Capacity Act 2005 when supporting people during their daily interactions.

This involved making decisions on behalf of people who lacked the capacity to make a specific decision for themselves. The home promoted the use of advocates where people were unable to make key decisions in their life. This is a legal right for people who lack mental capacity and who do not have an appropriate family member of friend to represent their views about health issues and where people wished to live.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager showed an understanding of what constituted a deprivation of person’s liberty. Appropriate authorisations had been granted by the relevant supervisory body to ensure people were not being unlawfully restricted.

People were supported to eat and drink enough to maintain their nutrition and hydration needs. People were able to choose their meal preferences. We saw that people enjoyed what was provided. People’s food and drink preferences and eating support required were understood and appropriately provided by staff.

People’s health needs were met as the staff and the registered manager had detailed knowledge of the people they were supporting. Staff promptly engaged with healthcare agencies and professionals when required. This was to ensure people’s identified health care needs were met and to maintain people’s safety and welfare.

Staff had taken time to develop close relationships with the people they were assisting. Staff understood people’s communication needs and used non-verbal communication methods where required to interact with people. These were practically demonstrated by the registered manager and staff.

People received personalised and respectful care from staff who understood their care needs. People had care and support which was delivered by staff using the guidance provided in individualised support plans. Support plans contained detailed information to assist staff to provide care in a manner that respected each person’s individual requirements. People were encouraged and supported by staff to make choices about their care including how they spent their day within the home or in the community.

Relatives knew how to complain and told us they would do so if required. Procedures were in place for the registered manager to monitor, investigate and respond to complaints in an effective way. Relatives and staff were encouraged to provide feedback on the quality of the service during regular meetings with staff and the registered manager.

People were supported to participate in activities to enable them to live meaningful lives and prevent them experiencing social isolation. A range of activities were available to people to enrich their daily lives. Staff were motivated to ensure that people were able to participate in a wide range of external activities and encouraged them to participate in external day trips they knew people would enjoy.

The registered manager was new to their position however had fulfilled their legal requirements by informing the Care Quality Commission (CQC) of notifiable incidents which occurred at the service. Notifiable incidents are those where significant events happened. This allowed the CQC to monitor that appropriate action was taken to keep people safe.

Relatives and staff told us the home was well led and staff told us they felt supported by the registered manager. The registered manager provided strong positive leadership and promoted a culture which focused on providing person-centred care to people within a homely environment. These values were supported by staff and evidenced in practice.

Quality assurance processes were in place to ensure that people, staff, relatives and external health and social care professionals could provide feedback on the quality of the service provided. The provider routinely and regularly monitored the quality of the service being provided in order to drive continuous improvement.

The 17 people using the service on the day of the inspection were unable to communicate their views to us. Therefore we observed staff interactions with people and spoke with four people's relatives. The registered manager was unavailable on the day of the inspection so we spoke with the deputy manager, the operations manager and three staff. We also reviewed records relating to the management of the home which included, three care plans and daily care records.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

We found the service to be safe because staff had received training in safeguarding people and had access to relevant guidance.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. One application had been submitted to date. We found that there were proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made, and how to submit one.

There was evidence that staff had undergone appropriate checks on their suitability as part of the recruitment process. The professional registration of nurses had been checked. The service employed nurses, care staff, an activities co-ordinator and an assistant physiotherapist to meet people's needs.

Is the service effective?

The service was effective because people had been supported to give their consent to decisions about their care where they were able to do so. Guidance had been provided for staff about people's individual communication methods and how best to facilitate their decision making. People's relatives confirmed to us that staff supported people to make their own decisions where they were could do so. One person's relative told us 'X can make basic decisions. Staff support X to make decisions.' We observed that staff sought people's consent through sound, facial expression and eye contact during our inspection.

Where people could not give their consent to an aspect of their care, there was evidence that people's capacity to make the specific decision had been assessed and best interests decisions had been made with the involvement of others relevant to the decision or person, such as family or health professionals. One person's relative told us 'Yes, I am always consulted about every aspect of X's care when X cannot consent.'

People had care plans in place to meet their individual care needs and to manage risks to them. This demonstrated that the service effectively promoted people's health and welfare

The service had provided opportunities for people to live active lives both at the service and in the wider community. There were two minibuses and these were used regularly to enable people to access the local community.

Is the service caring?

We spoke with people's relatives who told us that the staff were caring. One person's relative told us 'Staff are totally caring.' Staff were observed to be interact warmly with people. They spoke with people constantly about what was going on.

Is the service responsive?

The service was responsive to changes in people's needs. We saw evidence that people had been referred to a range of health services to meet their needs. These included speech and language therapy (SALT), incontinence services, epilepsy and wheelchair services. The provider had a physiotherapy assistant on site. This enabled them to respond promptly to any changes in people's needs in relation to physiotherapy.

Although the service had not received any written complaints, people's relatives told us that they felt able to speak freely with the staff if they wanted to raise any issues. One relative told us 'If I want to speak with the manager I just knock on the door.' The service had sent out a quality survey in 2013 and arrangements were in hand to send out the 2014 survey. This ensured that the provider had sought people's views of the service provided.

Is the service well-led?

The service had a permanent registered manager in place. People's relatives whom we spoke with told us that they found the manager to be effective and approachable.

There were systems in place to enable the provider to have oversight of the quality of the service provided and to assess the quality of the service provided.