Archived: Kensington

Updated 6 July 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident had been brought to the attention of the police and local authority. This incident is subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident.

However, the information shared with CQC about the incident indicated potential concerns about the management of risk of how people were safeguarded from abuse. This inspection examined that concern.

This unannounced comprehensive inspection took place on 19, 24 and 25 January 2018. This meant that neither the provider nor the staff knew we would be visiting the home on the first day of our visit.

Following these visits we attended a meeting at the home with other health and social care organisations and relatives on 5 March 2018 and contacted relatives by telephone.

The inspection team consisted of an inspection manager, an inspector and an expert-by-experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. The expert-by-experience who supported this inspection had experience of nursing homes.

Prior to our inspection we reviewed the information we held about the service including statutory notifications. Statutory notifications are submitted to the Commission by registered persons in line with their obligations under the Care Quality Commission (Registration) Regulations 2009. They are reports of deaths and other incidents that have occurred within the service. We used this information to inform the planning of this inspection. We contacted the local Healthwatch service, and spoke with the local authority commissioning and safeguarding teams to gather views of professionals who come into regular contact with the service. Healthwatch are an independent organisation who listen to people’s views about local service to help them to improve. We also spoke with the police.

Not everyone who used the service was able to communicate verbally with us. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We spoke with six people who used the service and chatted with them about their views on the service. During the course of the inspection we spoke with 10 relatives, including four relatives who were visiting Kensington during our visits, and a further six relatives who we spoke with over the telephone.

We spoke with the provider’s managing director, the provider’s regional manager, the registered manager, a registered nurse, six care workers and an activities coordinator. We reviewed a range of documents and records including; eight people's care records in detail, four records of staff employed at the home, complaints records, accidents and incident records, minutes of staff meetings, minutes of meetings with people who used the service and a range of other quality audits and management records.

Updated 6 July 2018

Kensington 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 both were looked at during this inspection.

Kensington accommodates 41 people in one adapted building, across two floors. There were 29 people using the service at the time of our inspection, including some people living with dementia.

This unannounced comprehensive inspection took place on 19, 24 and 25 January 2018. This meant that neither the provider nor the staff knew we would be visiting the home on the first day of our visit.

Following these visits we attended a meeting at the home with other health and social care organisations and relatives on 5 March 2018 and contacted relatives by telephone.

We last inspected this service in February 2017 and at that time found the service was in breach of Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, entitled Dignity and Respect. We rated the service as 'requires improvement'. After that inspection the provider wrote to us, setting out the steps they were taking to address the breach. During this inspection we could see the provider had completed their action plan to improve the service; however we found further shortfalls in the delivery of care. The breach had not been met, and the service continues to be rated as 'requires improvement'.

A registered manager was in place. A registered manager is a person who has registered with the Care Quality Commission 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.

Whilst the majority of people and relatives we spoke with told us the service was caring, and that staff were kind and patient, some people and relatives described times when staff had not treated people with dignity and respect. We observed that staff were generally friendly and polite, however we saw that one member of staff expressed frustration when speaking with two people who used the service, and that other staff discussed people’s personal needs in public. Signage around the building and storage in people’s bedrooms did not promote their dignity. We shared this feedback with the provider, and the local authority safeguarding team.

People were supported to be independent and maintain their skills. People were included in decisions about their care, and care records incorporated information about people’s choices, preferences and life histories.

People told us the service was safe and described feeling comfortable and well looked after. Two relatives described observing care which could potentially put people at risk of harm. We immediately fed this back to the provider’s regional manager who assured us additional observations had been put in place to monitor the delivery of care.

Processes were in place to reduce the risk of abuse or harm. The registered manager had made referrals to the local authority safeguarding team when required, and any complaints or concerns had been investigated. We found that some identified future actions, such as increased staff supervision, in response to concerns about staff conduct had not been followed up.

People and relative’s feedback about staffing was mixed. Some thought the home was well staffed, whilst others told us more staff were required. We saw the home was a relaxed environment, busier times of the day were well managed and people’s requests were quickly met. Staff told us they thought staffing was appropriate to the needs of people in the home. Safe recruitment procedures had been followed.

The home was clean, and well maintained. Infection control procedures were well followed. Risks had been well managed, and accidents and incidents monitored for trends.

Medicines had been administered as prescribed, but policies in relation to self-administration and the use of medicines dispensed through patches had not been followed.

People’s needs had been assessed, and care plans devised to enable staff to meet those needs. Records were generally thorough, although we saw some examples where important information was missing.

Staff received training designed to equip them for their roles. Refresher training was scheduled so staff skills remained up to date. The provider did not have a policy to ensure staff were competent in modules delivered via E Learning. Staff undertook knowledge checks, but there was no pass mark, and some scores were low. We have set a recommendation about this. Staff told us they were well supported and had regular opportunities for personal development.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Applications had been made for Deprivation of Liberty Safeguards (DoLS), where it was considered that people would be unable to keep themselves safe if they were to leave the home unaccompanied.

Mealtimes were well organised and an enjoyable experience. Tables were well set, and people were made aware of the choices available to them. Choices were not offered in a way which met the needs of people with dementia, but the regional manager advised us this would be something they would look into providing. People’s food and fluid intake were well monitored. Where needed referrals were made to health and social care professionals, such as speech and language teams, dietitians, specialist nurses and GPs.

There were a range of activities on offer within the home. Activity staff spent time with people on a one-to-one basis as well as planning group activities. The home had access to a minibus and arranged visits to local landmarks. The provider had introduced a ‘Three Wishes’ programme, and people had been supported to identify ideas which would they would enjoy. Activity staff worked with care staff to help people achieve these wishes.

Complaints had been well recorded and responded to in line with the provider's policy. The registered manager identified lessons learned from complaints and had introduced changes to reduce the likelihood of future complaints.

The quality assurance system included a range of audits carried out regularly by the manager, regional manager and the provider's quality assurance team. These quality assessments were in-depth, but had not highlighted the shortfalls in care delivery which we found during the inspection.

Feedback about the management team was very positive. People, relatives and staff fed back that the registered manager was approachable and a visible presence in the home.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to Regulation 10: Dignity and Respect and Regulation 17: Good Governance. You can see what action we told the provider to take at the back of the full version of the report.