Archived: Kensington Lodge

Updated 26 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 was carried out by 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

Kensington Lodge 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.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority. 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 used all of this information to plan our inspection.

During the inspection

We spoke with six people who used the service and three relatives about their experience of the care provided. We spoke with three members of staff including one of the two registered managers and two support staff.

We reviewed a range of records. This included four people’s care records and the medication records for three people. A variety of records relating to the management of the service, including quality monitoring audits and staff recruitment files, were reviewed.

After the inspection

We continued to seek clarification from one of the registered managers to validate evidence found. We had email correspondence with the second registered manager who represents the provider. A relative also contacted us after the inspection to provide us with feedback.

Updated 26 September 2019

About the service

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.

Kensington Lodge is a residential care home providing personal care. It is an adapted period building over four floors. The service is a large home, bigger than most domestic style properties. It was registered for the support of up to 15 people. Eleven people were using the service at the time of the inspection. 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

The provider’s and registered manager’s lack of knowledge regarding regulation and legislation meant concerns were found at this inspection. Effective governance procedures were not in place and the registered manager was not given the time nor resources to fully perform their role. This had resulted in people being placed at risk of harm in some aspects of their lives.

Some risks to people were not effectively managed, including those associated with legionella, hot water and fire. The individual risks to people had not been consistently reviewed and assessed and there was no analysis in place for accidents and incidents. Allegations of abuse had not always been identified and managed appropriately. There was a lack of effective procedures in place for staff recruitment, which meant the provider could not fully assure themselves of staff’s suitability for their role.

Audits in place to monitor and assess the service and drive improvement had failed and where concerns had been identified, there was sometimes a delay in rectifying those issues. Where professionals had made recommendations to improve the service, these had not been consistently acted upon. Management and staff were not fully aware of their responsibilities and their knowledge in some areas was poor.

People received a person-centred service because the staff that supported them knew them well. However, care plans did not reflect the care delivered and contained little person-centred information; some aspects of people’s lives had not been planned for. Whilst people received support for planned activities, there were not enough staff to support them with unplanned events and people told us they would like to do more.

The service had not consistently applied the principles and values of Registering the Right Support. 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. This was because people were limited in accessing the community when they wished due to not enough available staff to support them to do so.

There was, however, a positive and encouraging culture at the service and people were treated with respect. The staff team and those that used the service worked together to run the home and their views were sought as was those of others. People told us they liked the staff and that they were kind to them; our observations confirmed this. Independence was encouraged and supported, and people’s confidence had grown as a result of using the service. People were supported to have 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 received their medicines as prescribed, had access to regular and effective healthcare and were protected from the risks associated with infectious diseases. They participated in the community and had open access to an outdoor space. Whilst the home was suitable for most that lived there, at the time of the inspection, some were struggling to access the upper floors. The home was welcoming, and people had their own private spaces personalised to their choice. Décor, however, was tired in places.

All the people we spoke with were happy with the delivery of care provided at Kensington Lodge however, improvements are required in a number of other areas to meet regulations and legislation and fully protect people from the risk of harm.

We have made a recommendation about the use of accessible information.

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 good (report published 5 January 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified four breaches in relation to the safe care and treatment of people, identifying and managing potential allegations of abuse, staff recruitment and the governance and management of the service.

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 service to understand what they will do to improve the standards of quality and safety. We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.