Kingdom House

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

People’s health, care, and communication needs were not consistently assessed. People’s relatives and representatives were not always involved in decisions when appropriate and people’s consent to their care was not consistently sought for all decisions.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People’s needs were assessed, and plans were in place. Some people’s representatives told us they had not been involved in discussions around their relatives needs to be involved in care planning. One relative said, “There aren’t any discussions about the care plan.”

Staff with long-term experience at the service were well-versed in the care needs of individuals. In contrast, new staff members depended more on care plans, which were often inconsistent and required thorough reviews.

People's needs were assessed and plans included details on peoples communication needs and included information on how best to support them at times of distress. Some information relating to people needs were missing and care plans had been reviewed and reviews had not identified all people's needs. Records were not always completed as required and files were difficult to navigate. Health Action Plans needed to be reviewed to ensure they were sufficiently detailed and up to date.

People told us they had enough to eat, and they were able to choose their meals which they enjoyed. People’s relatives and representatives told us they were not always included or involved in their relative’s care and treatment. One relative said, “No, family are not really involved.”

Staff were knowledgeable of people’s needs with regards to nutrition and knew who required modified foods and what the level was. Staff were able to raise issues where they felt people’s needs had changed or had observed changes.

Care plans identified where people required support with maintaining their health and wellbeing, however they were not always sufficiently detailed. Records to monitor food and fluid intake for people who were at risk of malnutrition and dehydration, were not always fully completed or detailed enough to give assurance that daily targets were being met.

We received mixed feedback from people’s relatives and representatives. Some said the service was supporting their relatives well whilst others felt they should be better informed and involved in needs relating to health and wellbeing outcomes.

Staff provided varied feedback regarding the operation of the service. While some employees were content, others expressed difficulties due to numerous changes in management. They reported that despite raising issues with managers and being heard, it frequently did not lead to any changes or enhancements.

Partner agencies had been closely monitoring the service. Improvements were taking place however there needed to be further improvements and consistent management support.

The provider and new management team had implemented more robust processes to ensure information was shared appropriately with internal teams and external professionals, where necessary. Staff team meetings were held more regularly to ensure updates could be provided consistently to all members of the team.

People told us they felt they received the right care and treatment, and additional medical input was sought as needed. A relative said, “There was a health review about May time, and a doctor comes to see my relative.”

Staff were well-informed about individuals' health needs, with some having supported people for an extended period. Referrals for professional input were made as necessary. A range of health professionals provided input, ensuring that people's health requirements were addressed.

A range of documents supported individuals' health, including health action plans and hospital passports. People's health was regularly reviewed through annual check-ups and consistent appointments with specialists.

People told us they were engaging in various enjoyable activities in the community, and relatives and representatives noted a range of daytime activities available where people went out with staff. However, observations showed there were limited opportunities and a lack of planned activities within the home both during the day and into the evenings.

Staff reported that they assist individuals in accessing local amenities such as cafes and walks. They acknowledged past issues with some staff members' lack of engagement. One staff member expressed, "I take pleasure in witnessing the service users grow more independent, learning new skills and knowledge. I value the time spent with them, offering support within the community." Another added, "Each person has the opportunity to go out at least once daily to engage in an activity of their choice, such as shopping, bowling, or visiting Starbucks."

People's care plans included a section dedicated to the activities and outcomes deemed important for individuals to achieve. Although some outcomes were documented, they were not consistently monitored or evaluated to ensure that targets were being met, which is essential for leading a meaningful life. The provider's quality monitoring failed to address this issue to facilitate improvements.

Relatives and representatives confirmed that they were not consistently included in the decision-making process regarding individuals' care. We found while decisions regarding care and treatment were made for most areas, they did not always involve the relevant parties or document how the decisions were reached in a manner that centred on the individual.

Staff understood the importance of seeking consent from the people they cared for. However, staff said they had received limited training on mental capacity to support their understanding.

Deprivation of Liberty Safeguards (DoLS) were in place, and the provider had applied for their renewal when required. However, while mental capacity assessments and best interest decisions were made, they were not consistently conducted with the involvement of the individual or their representatives. Although the provider had monitoring systems, they did not detect that some decisions had not been fully considered. For instance, bed rails were used for one individual without a corresponding best interest decision documented.