Kings Hill

Kings Hill is a domiciliary care service providing personal care to people in their own homes. It is registered to provide care for babies, children, younger adults, older people, people living with dementia, a learning disability or autistic spectrum, a mental health problem, substance misuse, eating disorder or physical or sensory disability. At the time of the inspection, there was just one person receiving personal care.

CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service

People had a positive experience from using the service. One person told us, “I am happy with it. I would not change anything”.

There continued to be no registered manager and the appointed nominated individual was not involved in the management of the service. We made a recommendation about the provider's understanding of the role of the Nominated Individual.

Quality monitoring systems continued to be insufficient to identify shortfalls and drive continuous improvement in the service. The service was not proactive. Improvements and changes were only made when we brought them to the attention of the provider.

Steps had not been taken to reduce the potential fire risk for people who used emollient creams. This was despite this risk being highlighted to the provider at our last inspection.

There continued not to be effective staff recruitment. Staff files were not available at the inspection visit.

We made a recommendation about communicating with people about their end of life wishes and preferences.

There were systems to support staff and check their skills and knowledge. However, these were only available to one of the two care staff employed at the service.

Improvements had been made to ensuring people received personalised care. Care plans contained individual information about people’s likes and dislikes and things that were important to them. The views of people who used the service had been sought.

Staff were up to date with all mandatory training with the exception of practical moving and handling. The provider booked this training for staff after the inspection.

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

Rating at last inspection (and update)

The last rating for this service was Inadequate (published 23 April 2021) and it was placed in special measures. During this inspection, the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified continuing breaches in relation to the management of medicines, staff recruitment and quality assurance.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Kings Hill is a domiciliary care service providing personal care to people in their own homes. At the time of the inspection there were four people receiving personal care. This included older people and people with a learning disability. Care and support hours varied from a few hours a week to 24 hours a day. Care and support were provided in West Kent and Medway.

CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

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 guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. Staff did not always have access to information about people’s past history which helps to provide person-centred care. It was not clear who was managing the service as there was no registered manager in post. There were no checks on the care and treatment provided to one person who was not always able to express themselves clearly.

People’s experience of using this service

There continued to be widespread shortfalls in the way the service was led as the provider did not have full oversight of the service. There continued to be no registered manager, the nominated individual was absent, and it was unclear who was managing the service in their absence. A positive culture was not consistently promoted throughout the service.

We raised a safeguarding with the local authority before the inspection visit as we were unable to contact the provider or anyone else at the agency for four days.

Quality monitoring systems continued to be insufficient to identify shortfalls and drive continuous improvement in the service. Shortfalls in risk management, records, medicines and providing person-centred care continued at this inspection. In addition, we found shortfalls in staffing and staff recruitment.

Staff who worked alone were not regularly checked to make sure they had the skills necessary for their role to provide a satisfactory standard of care. Records about people’s care were not audited to ensure staff responded appropriately to people’s changing needs. People’s records were not always available to staff.

People were at potential risk of harm as there continued to be a limited approach to assessing and acting on risks to people’s safety. This included not identifying potential hazards at people’s homes, and not acting to minimise risks when they had been identified.

Staff training records showed staff were up to date with all mandatory training. However, it was not possible to concur all staff had been trained as there was not a definitive list of staff who supported people. The provider had not regularly checked medicines records or staff’s competency in administrating medicines.

Some staff had started to support people unsupervised, before their suitability to work with vulnerable people had been checked.

The views of people, relatives, staff and health and social care professionals had not been actively sought to make improvements to the service.

Feedback from a relative was that they would recommend the service and the provider responded when they contacted them.

Staff knew people well and said that the staff team worked well together. They said other team members and the provider was easily contactable for advice and support.

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

Rating at last inspection (and update)

The last rating for this service was Requires Improvement (published 11 May 2020). The provider had sent us an action plan after the last inspection to show what they would do, and by when, to improve. At this inspection not enough improvement had not been made and the provider was still in breach of multiple regulations.

Why we inspected

We carried out an announced inspection of this service on 1 February 2021. This was a focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions of Safe, Responsive and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Inadequate. 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 Kings Hill on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to quality monitoring, assessing risk, medicines, providing personalised care, records, staffing levels, staff recruitment, protecting people from harm and changes to the provider’s registration.

We will check on actions taken by the provider to improve the service.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 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.

Kings Hill is a domiciliary care service providing personal care to people in their own homes. At the time of the inspection there were 4 people receiving personal care. This included older people and people with a learning disability. Care and support hours varied from a few hours a week to 24 hours a day. Care and support was provided in West Kent and Medway.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

The service 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.

People’s experience of using this service

People were supported by a consistent staff team or staff member. Feedback was that staff were kind and caring and knew people well including their routines. However, there was limited information on people’s personal histories. One live-in carer was not able to describe a person’s individual care needs.

There were widespread shortfalls in the way the service was led as the provider did not have full oversight of the service. The provider was managing the service in the absence of a registered manager. They had not promoted a positive culture as they divided their time between other services they managed. Feedback was that the provider was not easily contactable for advice and support

Quality monitoring systems continued to be insufficient to identify shortfalls and drive continuous improvement in the service. Areas highlighted as needing improvement did not contain sufficient detail so action could be taken to address them.

Staff who worked alone were not regularly checked to make sure they had the skills necessary for their role to provide a satisfactory standard of care. Records about people’s care were not audited to ensure staff responded appropriately to people’s changing needs. People’s records were not always available to staff.

The views of people, relatives, staff and health and social care professionals were not sought so they could be acted on to make improvements to the service.

The provider had not notified us about changes in their registration. They had not told us the service had moved to a new location, or that the nominated individual had left the service.

People were at potential risk of harm as there continued to be a limited approach to assessing and acting on risks to people’s safety. Risk assessment did not include people’s health needs and there were hazards in the home environment that had not been minimised.

Staff did not always receive the necessary training, support, supervision or appraisal necessary to enable them to carry out their duties.

People could not be confident they would receive the right medicines at the right time. This was because the provider had not regularly checked medicines records or staff’s competency in administrating medicines.

Guidance for staff about how to manage people’s health and medical conditions was not always available. People were not always supported to access the dentist to maintain their oral health.

People were not treated with dignity as some people’s personal information was not always kept confidentially.

The provider told us they had consulted people about their end of life wishes and choices, but they had not been recorded. This is an area identified for further improvement.

Shortfalls in staff recruitment and the assessment process identified at the last inspection had been addressed.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

Support for people enabled them to be as independent as possible so they could remain in their own home. They had 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.

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

Rating at last inspection (and update)

The last rating for this service was Requires Improvement (published 29 January 2019). The provider had not sent us an action plan after the last inspection to show what they would do, and by when, to improve. At this inspection not enough improvement had not been made and the provider was still in breach of regulations. This is the second time the service has been rated Requires Improvement.

Why we inspected

This was a planned inspection based on the rating at the last inspection.

Enforcement

We have identified breaches in relation to quality monitoring, assessing risk, medicines, providing personalised care, treating people’s records confidently, staff skills and knowledge and changes to the provider’s registration.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service did not have a registered manager 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. The service was being managed by the registered provider, who was an individual, and a newly recruited service manager.

Staff were not always being recruited in a safe way. The registered provider had not checked the accuracy of references provided by candidates during the recruitment process. The registered provider had not kept accurate records of staff ability to work in the United Kingdom. Risks to people and the environment were being assessed. However, guidance was not being provided to staff in order to reduce the risks and to keep people and staff safe. The registered provider was not considering all people’s needs when assessing them before they started to receive a service. This included their mental health needs, or any needs associated with their protected characteristics under the Equality Act 2010. Overarching quality assurance audits of the service were not taking place, so the registered provider was unaware of all the concerns we identified during our inspection.

People were protected from the risk of abuse. Staff were knowledgeable about the different types of abuse, and knew what action to take if they had any concerns. There were enough staff to meet the needs of those using the service. People told us they were supported by a small number of regular care staff. People were supported to manage their medicines themselves wherever possible, but if support was needed people received their medicines safely. People were protected by the prevention and control of infection. Staff had access to protective equipment such as gloves and aprons.

All staff had been transferred from a different service managed by the registered provider. Records showed they had received an induction and ongoing training which equipped them with the skills to meet people’s needs. The registered provider had a training plan to ensure mandatory subjects like safeguarding and manual handling were kept up-to-date. When required, staff supported people to maintain a balanced and healthy diet. Staff kept a record of people’s allergies and preferences. People were supported to have access to health care services, and staff worked with people, their families and professionals to help deliver effective care.

People said care staff treated them in a compassionate manner, and were mindful of their dignity. Staff supported people to be involved in making decisions about their care and support. People’s personal and confidential information was kept secure. People received support that was delivered in a person-centred manner. People and their relatives knew how to complain and were confident to do so.

People, their relatives and staff told us they felt engaged in the development of the service, and thought the registered provider was responsive to any changes. There were procedures in place to formally gather people’s views, although these had yet to take place. The registered provider worked in partnership with local agencies in the community when needed.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Health and Social Care Act 2008 (Registration) Regulations 2009. Full information about CQC's regulatory response to any concerns found during inspections is added to the back of the full version of the reports after any representations and appeals have been concluded.

This is the first time the service has been rated Requires Improvement.