Kingsway Clayton House Residential Care Home

About the service

Kingsway Clayton House Residential Care home is a care home providing personal and nursing care. At the time of the inspection ten people with learning difficulties and autism were being supported at the service. The service can support up to 16 people.

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

Based on our review of key questions Safe and Well Led the service was able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture.

Right Support

People had support to pursue their interests in a meaningful way. Although this was a larger than recommended service under the right care, right support, right culture principles, people were supported to undertake activities in an individualised and meaningful way. They were able to personalise their rooms and spend time in different areas of the service as they wished to.

Staff supported people with their medicines to achieve the best possible health outcome. Medicines were managed safely.

Staff enabled people to access healthcare in the community and were supported to maintain their own health and wellbeing.

Safeguarding processes at the service had been improved and had resulted in better management of people’s finances, and people’s positive behavioural plans were used effectively to provide good outcomes for them. Risks to people’s safety were reviewed and measures were in place to safely support people.

People at the service were all able to verbally communicate with staff and make their needs know.

Right Care

People’s support plans were individualised and contained personalised details of the support people required.

Staff were trained so they understood how to protect people from poor care and abuse, and support people’s differing needs .

There was information on display at the service in formats accessible for people living there about safeguarding and whistleblowing.

The service had enough appropriately skilled staff to meet people’s needs and keep them safe.

Right Culture

There had been improvements to the governance arrangement at the service, resulting in better oversight of people’s care since our last inspection. However, the arrangements were a temporary measure and further arrangements were required to ensure the long-term oversight of the service was maintained. The service was being run by the deputy manager and office manager. They had the support of a family member of the provider, and a consultant employed by them. The provider’s family member recognised the arrangements needed to be formalised and was working to address this.

Feedback on their care was obtained from people and there was evidence on how the service promoted improvement or acted on people's views.

People were supported by staff who knew them well and the staff turnover was low which had a positive effect on the people living at 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 and update.

The last rating for this service was requires improvement (published 15 December 2021) The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support right care right culture. We carried out an unannounced focused inspection of this service on 3 November 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, safeguarding people and governance of the service.

We undertook this focused inspection to check they 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 Safe and Well-led which contain those requirements.

Enforcement

We have identified a breach in relation to Regulation 4 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider was not meeting the requirements of their registration as due to ill health they were not able to fulfil their duties as registered provider at this inspection.

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 monitor the service and will take further action if needed.

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

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

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained Requires improvement. 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 Kingsway Clayton House Residential Care home on our website at www.cqc.org.uk.

Kingsway Clayton House Residential Care home is a residential care home providing personal and nursing care. At the time of the inspection ten people with learning difficulties and autism were being supported at the service. The service can support up to 16 people.

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

The systems and processes in place did not always protect people from the risk of abuse. Risks to people’s safety were not always well managed.

Lessons from incidents and events had not been learnt to mitigate ongoing risk. Staff recruitment processes were not robust.

There was a lack of formal oversight from the provider and quality monitoring processes were either not in place or were not effective in identifying risks or improving care.

There was a lack of reporting events and this had resulted in poor practices developing among staff leading to punitive approaches to people’s behaviours.

There were enough staff to support people, medicines were managed safely, and infection and prevention practices were in place.

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 statutory guidance which supports CQC 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 the underpinning principles of right support, right care, right culture.

Due to the lack of oversight and learning from events there had been a development of a closed culture at the service. Following our inspection, the registered manager took steps to address the areas of concern we raised to them.

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 Good (published 20 December 2019).

Why we inspected

The inspection was prompted in part due to concerns received about safeguarding concerns. 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 and well led sections of this full report.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Kingsway Clayton 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 safeguarding, management of risk, staffing and governance of the service at this inspection.

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.

Kingsway Clayton House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. It provides accommodation for people living with a learning disability.

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.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 16 people. Eleven people were using the service. This is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

There was a process in place to carry out quality checks. These were carried out on a regular basis. The home was clean, and staff understood how to prevent and manage infections.

There was enough staff to support people. Appropriate employment checks had been carried out to ensure staff were suitable to work with vulnerable people. Arrangements were in place to safeguard people against harm. People said they felt safe.

People enjoyed the meals and their dietary needs were catered for. This information was detailed in people’s care plans. Staff followed guidance provided to manage people's nutrition and pressure care. People were supported by staff who had received training to ensure their needs could be met. Staff received regular supervision to support their role.

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 had good health care support from external professionals. When people were unwell, staff had raised the concern and acted with health professionals to address their health care needs. People did had access to a range of activities and leisure pursuits.

We saw evidence of caring relationships between staff and people who lived at the home. Staff were aware of people's life history and preferences and used this information to develop relationships. People felt well cared for by staff. Care records were personalised and were regularly reviewed.

The provider had displayed the latest CQC rating at the home and on their website. When required notifications had been completed to inform us of events and incidents.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

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.

More information is in the detailed findings below.

Rating at last inspection

The last rating for this service was Good (published 19 May 2017). At this inspection the service remains rated Good.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

There was 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.

On the day of our inspection staff interacted well with people. People and their relatives told us that they felt safe and well cared for. Staff knew how to keep people safe. The provider had systems and processes in place to keep people safe.

Medicines were administered and managed safely.

We found that people’s health care needs were assessed and care planned and delivered to meet those needs. People had access to healthcare professionals such as the district nurse and GP and also specialist professionals. People had their nutritional needs assessed and were supported with their meals to keep them healthy.

There were sufficient staff to meet people’s needs and staff responded in a timely and appropriate manner to people. Staff were provided with training on a variety of subjects to ensure that they had the skills to meet people’s needs. The provider had a training plan in place and staff had received supervision.

People were encouraged to enjoy a range of leisure and social activities. They were supported to maintain relationships that were important to them.

Staff felt able to raise concerns and issues with management. Relatives were aware of the process for raising concerns and were confident that they would be listened to. Regular audits were carried out and action plans put in place to address any issues which were identified. Arrangements were in place to use best practice guidance to improve the care to people.

Accidents and incidents were recorded and investigated. The provider had informed us of notifications. Notifications are events which have happened in the service that the provider is required to tell us about.

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 support this practice.

Further information is in the detailed findings below

We found the people were provided with a choice of suitable and nutritious food and drink in sufficient quantities to meet their individual needs and preferences. Comments included, 'The food is very nice,' and, 'I like the food especially the Sunday roasts.'

People told us they thought the support staff had the right skills and knowledge to provide care in a safe and competent manner. One person told us, 'I feel safe here the staff are very nice to me.'

We found that people were provided with the opportunity to comment on the quality of service provision and make suggestions for improvements. People also told us they felt confident that any concerns or complaints would be addressed by the management team to their satisfaction.

We looked at records. These included care records and information about how the service operated. We also spent some time in communal areas of the home. We spoke with people and observed how staff interacted with, and supported them to do what they wanted to.

We observed staff provided positive support and engaged with people who lived at the home. People appeared relaxed and comfortable in the presence of their support staff. In discussion with staff, it was evident staff understood the needs of people they supported. One person said, 'I like the staff, they look after me well.' Another person said, "They always help us to do the things we like and make sure we are healthy."

A visiting relative told us, "As long as xxx is happy we are happy. We are here for a review, the staff are easy to talk to and as a family we are very happy with the care that xxx receives."

We found staff had time to support people to undertake a range of activities, trips and holidays. One person told us, "We go on holiday at least once a year.' Other comments we received ranged from, 'I work in a shop every Wednesday and Friday and I love it' and 'We are going on a health walk today" to 'I am a member of the local theatre club in Gainsborough, I really feel I enjoy going.'