We carried out a review of the data available to us about Kingshill on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Kingshill, you can give feedback on this service.
Kingshill is a residential care home that provides short term accommodation and 24 hour care, support and enablement services for a maximum of 15 people who live with a mental illness. The accommodation is provided in 1 building with bedrooms across 2 floors and communal areas on the ground floor. At the time of the inspection 14 people lived at the service.
People’s experience of using this service and what we found
Recruitment checks were robust to ensure staff were suitable to work with vulnerable adults. Staff had received training relevant to their roles when they first started working at the service, and thereafter they received regular training refreshers. Staff training compliance was maintained. The service had enough staff.
People were protected from the risks of abuse and staff were trusted to keep them safe. Staff had received training in how to safeguard people. Staff were confident to report concerns and were satisfied action would be taken to investigate them.
People's care needs were risk assessed and care plans provided staff with the information they needed to manage the identified risk. Accidents and incidents were recorded and monitored. The provider had appropriate infection prevention and control systems.
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.
Medicines were managed safely. Staff supported people to be independent with taking their medicines. Staff were trained to administer medicines.
Auditing systems had vastly improved and were robust. Governance systems had been revamped.
The provider was passionate about creating a culture of greater understanding and support. People were at the heart of the service. The management team's primary focus was to develop people's skills and confidence and provide them with the tools needed to live more independently. People's quality of life was enhanced by the service's culture of improvement and inclusivity.
The culture of the service was led by a respected registered manager. Staff felt empowered and valued in their roles. They were encouraged to share their ideas and make suggestions. The registered manager sincerely promoted staff well-being.
The service worked closely in partnership with other health and social care organisations and the community to achieve good outcomes for people using the service. Professionals who worked with the service spoke highly about the registered manager, the staff and the care and support delivered.
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 5 August 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
At our last inspection we recommended the provider reviews their food provision systems. At this inspection we found the provider had worked with the people who lived at the service and implemented better systems.
Why we inspected
We undertook this 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 Safe and Well-led which contain those requirements.
For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to 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 Kingshill on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Kingshill Rehabilitation and Outreach Service is a residential care home that provides short term accommodation and 24 hour care, support and enablement services for a maximum of 15 people who live with a mental illness. The service also provides outreach support for people living in the community. The accommodation is provided in one building with bedrooms across two floors and communal areas on the ground floor. At the time of the inspection 15 people lived at the service and two people received support with their personal care in the community.
People’s experience of using this service and what we found
Staff were not always suitably trained to meet the needs of the people living at the service. Staff skill mix was not appropriately implemented or reviewed. The provider did not have a systematic approach to determine and regularly review the number of staff needed to meet the needs of people using the service. Robust safeguarding systems were not always in place.
The provider’s care planning processes involved monthly reviews of people’s care. However, these monthly reviews did not always happen consistently. Auditing systems were not always robust. Governance systems did not identify some of the issues we found during the inspection.
People were unable to access any other snack type food besides fruit after 8pm, due to the service trying to promote healthy eating. We have made a recommendation about the provider reviewing their food provision systems.
People told us they trusted staff to keep them safe. People's care needs were risk assessed and care plans provided staff with the information they needed to manage the identified risk. Medicines were managed safely.
Staff felt supported and praised the acting manager and provider. The service worked in partnership with other health and social care organisations to achieve better outcomes for people.
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 October 2017).
Why we inspected
We received concerns in relation to the management of medicines and the management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
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.
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 COVID-19 and other infection outbreaks effectively.
The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.
We have found evidence that the provider needs to make improvement. 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.
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 monitor the service.
We have identified breaches in relation to the governance of the service, staffing systems and training.
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 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.
At the last inspection in August 2015, the service was rated good. This inspection took place on the 6 July 2017 and was unannounced. At this inspection we found the service remained good overall. For the last five years the service had consistently met the standards we inspected against.
The management team promoted a culture of inclusion, and people living at the home were encouraged to achieve their goals and improve their skills of daily living. People’s goals and plans were reviewed regularly with input from an occupational therapist. Support was provided to people in a way that helped them achieve the best results they could.
Staff we spoke with were aware of how to recognise signs of abuse, and systems were in place to guide them in reporting these. They were knowledgeable about how to manage people’s individual risks, and were able to respond to people’s needs. People told us they were supported in a safe way and worked with staff to have their medicines when they needed them.
People told us staff knew how to support them and understood how to meet their needs. Staff had up to date knowledge and training to support people. 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 place supported this practice. People had food and drink they enjoyed and had choices available to them. Staff actively encouraged and supported people to maintain a healthy lifestyle. People said they had access to health professionals when they needed to. Relatives were confident their family member was supported to maintain their well-being and had access to the health professionals as they needed.
People said they were happy living at the home and supported by patient and kind staff. Relatives told us they were happy with the service their family member received. They told us staff were patient and knew people’s preferences and respected them. People living at the home were able to see their friends and relatives as they wanted. We saw staff treated people with dignity and respect and had a good knowledge of people’s rights.
The management team sought people’s views and acted upon them. People and their relatives knew how to raise complaints and felt confident that they would be listened to and action taken when needed.
The registered manager promoted an inclusive approach to providing care for people living at the home. For example, people and their relatives were encouraged to attend regular meetings, and to complete questionnaires to share their views about the quality of the service. The management team had actioned suggestions made by people, their families and staff where possible, and took a proactive approach to making improvements. The provider had systems in place to monitor the quality of care and treatment people living at the home received. The registered manager had identified where improvements were needed and had a plan in place to ensure these were made in a timely way.
Kingshill is a residential care home that provides accommodation in the form of 24 hour care for people who suffer, or have suffered from a mental illness. Some people live at the home permanently, whilst others are supported to move into their own accommodation after an approximate two year period of receiving support from the service. The home is situated in the Standish area of Wigan.
We carried out our inspection of Kingshill on 05 August 2015. At the previous inspection on 30 December 2013, we found the service was meeting each of the standards assessed.
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 about how the service is run.
We spoke with four people who lived at the home who all told us they felt safe as a result of the support they received. One person said; “I do feel safe living here. I like all the staff. I would feel confident speaking with them if I didn’t feel safe”.
People’s medicines were looked after properly by staff that had been given training to help them with this. Regular checks were done to make sure they were competent.
We looked at how the service managed risk. We found individual risks had been completed for each person and recorded in their support plan. There were detailed management strategies to provide staff with guidance on how to safely manage risks and also ensure people’s independence, rights and lifestyle choices were respected.
People were protected against the risks of abuse because the home had a robust recruitment procedure in place. Appropriate checks were carried out before staff began work at the home to ensure they were fit to work with vulnerable adults. During the inspection we looked at six staff personnel files. Each file contained job application forms, a minimum of two references and evidence of either a CRB or DBS (Criminal Records Bureau or Disclosure Barring Service) check being undertaken. Several people living in the home had been actively involved in the recruitment of new staff.
We looked at how the service ensured there were sufficient numbers of staff to meet people’s needs and keep them safe. We looked at the staff rotas. We found the home had sufficient skilled staff to meet people's needs. Staff spoken with told us any shortfalls, due to sickness or leave, were covered by existing staff which ensured people were looked after by staff who knew them. They also said staffing numbers were kept under review and adjusted to respond to people’s choices, routines and needs.
All staff were given training and support they needed to help them look after people properly. We observed staff being kind, friendly and respectful of people's choices and opinions. The atmosphere in the home was relaxed and the staff spoken with had a good knowledge of the people they supported. People were able to ‘come and go’ when they wanted and had good access to the local community.
People living at the home were supported with all aspects of daily living, in order for them to develop the living skills to become independent in their own accommodation. This included support with budgeting, food preparation, laundry and cleaning their bedroom.
The Mental Capacity Act 2005 (MCA 2005) sets out what must be done to make sure the human rights of people who may lack mental capacity to make decisions are protected. The Deprivation of Liberty Safeguards (DoLS) provides a legal framework to protect people who need to be deprived of their liberty to ensure they receive the care and treatment they need, where there is no less restrictive way of achieving this. From our discussions with managers and staff and from looking at records we found all staff had received training about the MCA and DoLS. The manager and staff spoken with expressed a good understanding of the processes relating to DoLS.
People living in the home were involved in the planning of the menus and went shopping with staff to local shops and supermarkets. People, who were able to, were given support by staff to prepare their own meals. There was no set meal for lunch time and people living in the home were able to choose either to dine in or out of the house at a time convenient to them.
From looking at records, and from discussions with people who used the service, it was clear there were opportunities for involvement in many interesting activities both inside and outside the home. People were involved in discussions and decisions about the activities they would prefer which would help make sure activities were tailored to each individual. Activities were arranged for groups of people or on a one to one basis. Each person’s support contained a ‘weekly planner’ and set out the different types of things they liked to do during the weeks and at weekends.
The staff we spoke with spoke positively about the management and leadership of the home. One member of staff said; “I feel that the service is extremely well managed. The manager has achieved a lot in a short period of time”.
The complaints procedure in place. The procedure was available in an easy read format that could be understood by everyone who lived at the home. We looked at the complaints log and saw complaints had been responded to appropriately, with a response given to the individual complainant.
There were effective systems in place to regularly assess and monitor the quality of the service. They included audits of the medication systems, supports plans, money, fire safety, infection control and environment. There was evidence these systems identified any shortfalls and that improvements had been made.
Care and support plans were clear and staff told us they worked with people to make sure they enjoyed a valued and inclusive life. They said they were committed to an individual, person centred philosophy of service delivery with the main aim being to support people to manage their own condition and gain or regain the skills and confidence to achieve their own goals.
Staff were well trained and supported and demonstrated, through discussions and observations, their total commitment to maximise the daily lives of the people who lived at Kinsghill.
The home held regular residents meetings and used various quality assurance systems to make sure it was run in the best interests of the people who lived there.
People said that they liked the home very much and felt settled. Comments included 'I love it here, I don't ever want to leave', "I feel very happy here, staff are lovely'. 'Staff are very kind and caring', 'I can do what I want and staff are here to help me', 'The manager is kind and listens to me, so do all the staff. It is my home and I love it'. 'The staff are great, they help me to achieve the things I want in life and help me to be creative. They empower me to show my brilliance',' They make us feel good about ourselves,' They really care' and 'I trust the staff to care for the people living here. Staff are very professional in all that they do.'
We were told:
'I love this place I think it's the best place I've ever been in.'
'I like the building and it's handy for the bus stop.'
'I've never had a complaint I'm happy just as it is.'
'They treat me with respect it's awfully nice here.'
When asked about improvements needed we were told:
'There's nothing really, they have socials and we get invited, there's good family contact and low turn over of staff.'
And:
'The 'Star' is great. (Recovery Star support package) It's rewarding to think about and find things you want to achieve. I write poetry and Making Space has published them. I'm encouraged by staff to improve myself.'
We found the service at Kingshill compliant with the essential standards of quality and safety assessed. We found the manager to be well organised, diligent, and competent and so the service was well run.
It was clear that through his leadership skills the changes in emphasis towards enabling and promoting independence had been fully embraced by people living at Kingshill and implemented by those working in the service.
We found the people living at Kingshill were supported to be successful and to have a good standard of life.