Kent House provides care, support and accommodation for up to 22 people with acquired brain injury. Not everybody who used the service was able to express their views verbally. In those cases we observed the interaction between them, staff and other people who lived in Kent House to help us make judgements. We talked to five people who received support and to nine members of staff and one family visitor. We looked at care records, staff training and supervision records and records of staff and service user meetings which had been heldWe considered the evidence we had gathered under the outcomes we inspected. We used this information to answer the questions we always ask:
' Is the service safe?
' Is the service effective?
' Is the service caring?
' Is the service responsive?
' Is the service well led?
This is a summary of what we found-
Is the service safe?
People were cared for safely. Staff had the knowledge and skills they needed to help them provide safe and appropriate care. There were risk assessments in place, together with appropriate behavioural plans to address specific patterns of behaviour, where applicable. These included details of how risks were to be eliminated or managed and how behaviour could be safely, effectively and appropriately managed.
CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). The home had policies and procedures in relation to the Mental Capacity Act 2005 and DoLS. Relevant staff had been trained to understand when an application should be made, and how to submit one. There was one DoLS in place which had been subject to a formal review. This confirmed there were proper safeguards in place.
The provider had an emergency contingency plan in place. This showed how staff should respond in an event which may have presented a risk to the home, for example flooding or power failure. This demonstrated the provider had arrangements in place to deal with foreseeable emergencies.
Is the service effective?
People who received care and support were positive about their experiences. We observed good interaction between staff and people who received support. Staff had a very clear understanding of the individual care needs of people and how they wanted their support provided.
People's care needs were assessed with their involvement. We saw care plans were subject to review so they remained appropriate and up to date.
People were provided with the specialist equipment they needed to meet their mobility or other care needs. People had ready access to community health services, for example GPs, dieticians and specialist nursing teams. This ensured their care and support was appropriate and effective.
The staff team included qualified psychologists and occupational therapists who advised and worked with other care and support staff to promote effective, high quality care. Staff training and supervision had now been delivered and/or was planned to ensure it was received regularly and consistently to help staff maintain effective support to people.
Is the service caring?
The relative we spoke with told us how supportive and caring staff were. People who received care were positive about the standard of care and support they received.
We observed respectful and sensitive care being provided. Care staff supported people without hurrying them and gave them encouragement whilst doing so.
Although the most recent survey of satisfaction had not been well supported, those who did respond were positive. The previous survey had a significant majority of positive responses about the standard of care and how it was provided.
Is the service responsive?
We saw care plans included details about people's preferences, interests, likes and dislikes. These were in formats which were accessible to them and had been used to determine how their needs were to be met. Where people's needs changed, the care planning and review system in place enabled this to be identified and action taken to respond effectively. This meant care planning and delivery was sufficiently flexible to respond to changes in a person's assessed needs.
We saw people were able to access the local community and to retain contact with people who were significant to them.
Is the service well led?
Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.
We found systems were in place to measure the quality of the service provided. There were regular audits of key areas of the home's operation to monitor quality. Views of people who used the service and those responsible for their care were sought on a regular basis. Where response levels had been disappointing, the provider had actively taken steps to improve this by considering changes to the way feed-back was obtained and by looking at alternative additional systems and processes.
We spoke with staff at all levels and with different roles. They confirmed prompt action had been taken to address concerns reflected in the previous report by the Commission of December 2013. These were about support for staff and the frequency and consistency of staff supervision and training. Additional forums for staff had been proposed and staff training and support through meetings and supervision had become more regular and consistent. We were told the service continued to go through a significant period of change. This remained a challenge for the service and their were differing views as to the outcome.