Kent House

We found the following examples of good practice.

The service followed current government visiting guidance. They ensured that safe visiting arrangements were in place. Visiting procedures included ensuring visitors had a confirmed negative lateral flow test and wore appropriate personal protective equipment (PPE). Staff also took a lateral flow test every day before commencing work.

There were procedures to manage visits in the event of an outbreak. The registered manager told us visits in exceptional circumstances such as end of life care were always supported and facilitated. People who had relatives and friends that were unable to visit were supported by other means including telephone and video calls.

Managers felt empowered to manage the risks associated with COVID-19. They had put in place practical arrangements to manage infection risks. There was an up to date infection control policy in place and there were standard operating procedures that were regularly updated in line with changes in government policy.

All staff had received training about COVID-19, and in the use of PPE. Regular audits of infection prevention and control (IPC) practice were carried out to assure the provider that people were protected and safe.

The service had ensured there were sufficient supplies of PPE. During the COVID-19 pandemic, the service was able to reliably get hold of enough of the right PPE to meet people’s needs. The service had also worked effectively with local agencies in ensuring there were sufficient supplies.

During the pandemic the provider ensured they kept up to date with all relevant guidance to do with the pandemic. They ensured that updates were promptly communicated to staff, people and relatives. This and regular communication with the host local authority, public health teams, community healthcare professionals and managers from other care homes helped to ensure the home carried out good IPC practice that kept people safe.

Any staff or person who had tested positive, were isolated in line with government guidance. This minimised the risk of spread of infection in the home and people and staff becoming unwell.

Kent House is a residential care home providing personal care and accommodation to people aged 65 and over, most of whom are living dementia. The service can support up to 40 people. At the time of the inspection the service was providing support to 33 people.

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

People were able to take positive risks. They were involved in monitoring safety in the service and in the recruitment of staff. People's relatives felt the service was a safe place for their family members to live. People’s medicines were administered and managed safely. The service had appropriate infection control and prevention systems in operation to provide a COVID-19 safe environment for people, staff and visitors.

People were offered a nutritious, balanced and culturally appropriate diet.

The service was well run and benefitted from an experienced registered manager and provider, who had good oversight of the service. The staff team were positive about the support they received from the registered manager, who was keen to develop the service further for the benefit of people in the home.

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

Rating at last inspection

The last rating for this service was Good (published 28 September 2019).

Why we inspected

We received concerns in relation to medicines, staffing, pressure care, eating and drinking and the overall management of the service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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 coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has not changed from Good. This is based on the findings at this inspection.

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

Kent House is a residential care home providing personal care and accommodation to 36 people aged 65 and over. At the time of the inspection the service supported 36 people.

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

We have made a recommendation about the management of some medicines. We judged that improvements were required to the medicines audit system used at the home. This is because, in as much as audits were being undertaken, they had not identified some of the gaps we found during this inspection. Apart from this, we found people were protected from the risk of harm and abuse. There were safeguarding policies and procedures in place and staff were aware of this. Staff had been recruited safely. They underwent appropriate recruitment checks before they commenced working at the service. This same scrutiny was subjected to volunteers who worked at the home.

There was a system for managing accidents and incidents to reduce the risk of them reoccurring. There were adequate systems for reviewing and investigating when things went wrong. Staff understood their duty to raise concerns and report incidents and near misses.

There was evidence of on-going and relevant staff training. People told us staff had the right skills to support them safely. There was an infection control policy and measures were in place for infection prevention and control. The environment was clean. Staff wore personal protective equipment (PPE) such as gloves and aprons.

People received individualised care that met their needs, preferences and interests. People were supported, if needed, to express their views and preferences in relation to their care and support. The service identified and recorded how people wished to communicate and their communication needs. Assessments of people’s needs were in place. There was evidence of improved safety of people, including reduction of falls and pressure ulcers. This showed risks were being managed properly.

The environment had been adapted to meet their specific needs of people with dementia. People received co-ordinated input from a range of specialist services, such as psychiatrists, health professionals and community pharmacists.

People’s nutritional needs were met. They had been involved in drawing up the menu plans, and choices were regularly adapted in line with their preferences. Specific needs in relation to equality and diversity issues were recorded in people’s care plans and addressed. The menu plans fully catered for different cultures and cuisines.

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. When people were unable to make decisions about their care and support, the principles of the Mental Capacity Act (2005) were followed.

People were supported and treated with dignity and respect. People’s relatives confirmed that staff were kind and caring. People’s care records contained information about their choices and independence. The service recognised people’s rights to privacy and confidentiality. Confidentiality policies had been updated to comply with the new General Data Protection Regulation (GDPR) law.

There was a complaints procedure, which people and their relatives were aware of. The procedure explained the process for reporting a complaint

There were methods of monitoring the quality of the service in place. Regular checks and audits had been carried out in areas related to maintenance of the premises, health and safety, medicines management, infection control and management of accidents and incidents. Although we found shortfalls in medicines management, the home rectified the concerns raised during and soon after our inspection. We judged, the likelihood of this happening again in the future was low. Therefore, we judged the service to be ‘Good’, overall.

Rating at last inspection:

At our last inspection, the service was rated "Requires Improvement". Our last report was published on 30 January 2019.

Why we inspected:

This was a scheduled inspection based on the previous rating.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

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

The last inspection was carried out in December 2017. The overall rating for the service was Inadequate. We found the provider was in breach of Regulations 12 (safe care and treatment), 9 (Person Centred Care) and 17 (good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider was placed in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During our comprehensive inspection in September 2018, the home demonstrated to us that improvements had been made. The home is no longer rated as Inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Kent 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 both were looked at during this inspection. Kent House is registered to accommodate a maximum of 40 people with dementia. At the time of our inspection 28 people were living at the home.

A registered manager was in post. 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.

Overall there was a system to ensure that people were safe and protected from abuse. Staff knew how to recognise abuse and how to report allegations and incidents of abuse. There was evidence risks to people had been identified and assessed. However, we found the content and quality on some of the risk assessments to be variable. In some examples, risk assessments had understated risk. Although there had not been any immediate effects, this potentially posed a risk. Safe recruitment procedures were in place. We saw that pre-employment checks had been completed before staff could commence work. There were sufficient numbers of staff to support people to stay safe. We also saw there were systems in place to protect people and staff from infection. There were suitable arrangements for the recording, administration and disposal of medicines.

Staff had not received regular supervision and appraisal. Furthermore, although staff had received relevant training, we found that their capabilities were not assessed to ensure that they could effectively use relevant tools to identify adults at risk of malnutrition. Since the previous inspection, improvements had been made to ensure people were supported to have choice and control of their lives. Their care records showed relevant health and social care professionals were involved in their care. The home was working within the principles of the Mental Capacity Act 2005 (MCA). Care records held best interest decisions including details of people's relatives who were involved in the decision-making process. The home also followed the requirements of Deprivation of Liberty (DoLS), which meant that people were not deprived of their liberty unlawfully. There were arrangements to ensure that people’s nutritional needs were met.

People’s privacy and dignity were respected. Staff understood the need to protect and respect people's human rights. We saw they had received training in equality and diversity. People’s spiritual or cultural wishes were respected. Representatives of local churches visited the care home regularly for prayers with people. People received compassionate and supportive care when they were nearing the end of their lives. Selected staff had attended ‘End of Life Care Champion’ and a ‘Palliative Care’ training provided by a local hospice.

Improvements had also been made to ensure people received personalised care. Most people told us they were listened to and that staff responded to their needs and concerns. The service undertook a pre-assessment of people’s needs prior to them moving to the home. This assessment informed people’s care plans. The service ensured that the communication needs of people were assessed and met. However, information for people with dementia was not provided in an accessible way. There were appropriate arrangements in place to meet people's social and recreational needs.

We found that the registered provider had made improvements in their quality monitoring systems. However, these improvements were not sufficient to address the breaches in legal requirements identified at the previous inspection. Although the service monitored the quality of the service, this had failed to identify the shortfalls we found. We also found that the service had failed to act on information gathered to improve the quality of the service provided. Therefore, the provider remained in breach of relevant regulations.

During this inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Kent 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 both were looked at during this inspection. Kent House is registered to accommodate a maximum of 40 people with dementia. At the time of our inspection 28 people were living at the home.

There was no registered manager in post at the time of our inspection. The current manager was in the process of applying to become the registered manager. 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.

This was the first comprehensive inspection of Kent House since it was re-registered under the provider, GCH (South) Ltd in May 2017. Prior to this the service had been inspected in May 2017 under the previous provider, GCH (Kent) Ltd, at which time it was rated 'Requires Improvement’'..

At our last inspection in May 2017, we found two breaches of regulations. We found medicines were not managed safely and that the provider did not effectively assess, monitor and improve the quality and safety of the service provided. At this recent inspection we found improvements had not been made and we identified further areas of concern.

Prior to this inspection CQC had received intelligence from external sources, including professionals, raising concerns for the safety of the people residing at Kent House. We looked into these concerns as part of our inspection.

We found the leadership of the home to be weak and inconsistent. Kent House has had four managers since 2016. People’s relatives expressed concerns about the constant changes of managers. They told us there was a general lack of continuity. We also found there was a general low level of staff satisfaction because the absence of a stable management team meant that staff did not always receive consistent support.

There was no evidence of learning, reflective practice and service improvement. Although there was an internal audit system in place, we found this to be unreliable and irrelevant because shortfalls were either not addressed or identified. This meant we could not be assured that the audit process was effective.

Risks to people had not always been identified and managed appropriately. There was limited action to assess, monitor or improve the safety of the service. Where risks had been assessed plans were not clear or coordinated. In other examples, there were no plans in place to instruct staff on how to safely manage those risks. At times information about risks to people was not passed on to the staff and others who needed it. A few staff members were not aware of specific risks to people.

The service did not regularly review its staffing levels to make sure that it was able to respond to people’s changing needs. Although the levels of staffing described by the provider were mostly maintained during the week, this was less so during the weekends. We saw records of people who now had higher needs since moving to the home, but this had not been taken into account in staffing decisions.

People were at risk because staff did not administer medicines safely. In some examples we found people did not receive medicines as prescribed. This was a repeated breach, as we saw no improvements since our last inspection in May 2017.

Accidents and incidents were not competently managed. We found the approach to reviewing and investigating causes to be insufficient and slow. We found people with documented history of falls but no effective action had been taken to improve their safety. There was little evidence of learning from these occurrences.

The provider did not always make referrals for appropriate care and treatment at the right time. In some examples we found that recommendations for care and treatment by other professionals were not always carried out as directed.

Whilst we saw that staff asked for people’s permission before carrying out care, people’s care records did not always reflect how decisions had been reached in their best interests. We also found some staff were unclear about the requirements relating to consent.

People’s relatives told us people were treated with kindness. We observed that generally people were treated with dignity, respect and kindness during all interactions with staff. However, we noted that some did not always respond to the needs of people in distress or discomfort in a timely way.

People’s care needs were not regularly reviewed. We found some care plans did not sufficiently inform staff on people’s current care, treatment and support needs. We also found that the care needs of people who had recently moved to the home were not always fully assessed and planned for.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review. If we have not taken immediate action to propose to cancel the provider's registration of the service, they will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe and a rating of inadequate remains for any key question or overall, we will take action in line with our enforcement procedures. This could be to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

During this inspection we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report. We are currently considering what action to take. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.