Background to this inspection
Updated
25 September 2019
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection team consisted of two inspectors 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.
Service and service type
Kingly House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
At the time of our visit the service was without a manager registered with the Care Quality Commission. A registered manager and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. The providers operations manager was acting as the manager.
Notice of inspection
This inspection was unannounced.
Inspection activity started on 26 July 2019 and ended on 27 July 2019.
What we did before the inspection
We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections.
We reviewed information we held about the service such as notifications. These are events which happened in the service the provider is required to tell us about. We sought feedback from the local authority and clinical commissioning group who monitor the care and support people received.
We took this into account when we inspected the service and made the judgements in this report.
During the inspection
We spoke with five people who used the service and one relative about their experience of the care provided. We spoke with seven members of staff including the manager, senior care workers, care workers and the chef.
We reviewed a range of records. This included two people’s care records and multiple medication records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
Updated
25 September 2019
About the service:
Kingly House provides accommodation for up to 17 adults with acquired brain injuries and neurological conditions. The staff team includes occupational therapists, a speech and language therapist and a physiotherapist to assist people with their support and rehabilitation. There were 16 people using the service at the time of our visit.
People’s experience of using this service and what we found:
People’s care and support needs may not always be met in a timely manner due to the high use of agency staff. This was because they didn’t know people well and were unable to provide them with the same care regular staff could. A number of people commented on how the inconsistent use of regular staff affected the quality of the service.
People felt well cared for and staff had a caring and compassionate approach to those they were supporting and people felt confident in raising their concerns and that they would be investigated.
People felt safe at Kingly House and staff protected them from avoidable harm. People received their medicines safely and were protected from the risk of infection.
Regular staff had the skills and experience to support people and staff were recruited safely and had good training to support their role.
People had comprehensive care plans in place however, documentation within them didn’t always correspond, providing inaccurate information to the reader. This compromised the support provided by agency staff. Risks to some people’s health were compromised by the lack of monitoring of their assessed risks.
Regular staff knew people’s health needs and ensured they received treatment from the necessary health professionals to keep them well.
People’s nutritional needs were met with food plentiful and well balanced. The environment was homely and plans to improve the décor and presentation of the service had begun.
Staff gained consent from people prior to delivering care. 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.
People were provided with a comfortable and homely place to live. A refurbishment plan was in place to improve the environment for people.
The service was without a registered manager therefore the providers operations manager was acting as manager. The overall monitoring of the service was not robust, and some monitoring had not yet been put in place.
Staff meetings and meetings for the people using the service had been held, though records of these were not always available. The management team worked in partnership with others for the benefit of the people using the service.
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 outstanding (report published 2 August 2017).
Since this rating was awarded the provider has changed its legal entity. We have used the previous rating to inform our planning and decisions about the rating at this inspection.
Why we inspected:
The inspection was prompted in part due to concerns received around staffing levels and the overall management of the service. A decision was made for us to inspect and examine those risks.
We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive and well led section of this full report.
The overall rating for the service has changed from outstanding to requires improvement. This is based on the findings at this inspection.
Enforcement:
We identified a breach of the Health and Social Care Act (Regulated Activities) Regulations 2014 relating to Staffing. Details of the action we have asked the provider to take can be found at the end of this report
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.