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Archived: Kingston House Requires improvement


Inspection carried out on 10 October 2018

During a routine inspection

Kingston House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection. The service accommodates up to 11 older people, some of whom may be living with dementia related needs.

Kingston House is situated in a quiet residential area and is close to the seafront and amenities. The premises are on two floors with each person having their own individual bedroom and communal areas are available within the service. At the time of our inspection, eight people were using the service.

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.

At our last inspection in April 2016, we rated the service ‘Good’ with the key question ‘Is the service Safe?’ requiring improvement. At this inspection, we found that the service was no longer rated as ‘Good.’

At this inspection we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Improvements were needed to ensure that all risks from the environment and to people's health, safety and welfare were effectively assessed and action taken as required.

People’s needs were met by sufficient numbers of staff, however their deployment required review to ensure that people were stimulated and engaged.

The environment required further development to ensure that it was appropriately designed and adapted to meet people’s needs. We have made a recommendation that the service explores current guidance from a reputable source on improving the design and decoration of accommodation and the engagement of people living with dementia.

Care plans had not been reviewed and updated as people’s needs changed and did not reflect peoples’ current support needs. We have made a recommendation that the service consults guidance to further develop the Accessible Information Standard (AIS).

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible, however staff would benefit from additional training to develop their understanding.

End of life planning required further improvement. We have made a recommendation that the service consults a reputable source to further develop end of life planning.

Audits of the service were not being completed to check that the service provided high quality care and that records were up to date.

People were cared for by staff who had been recruited and employed after appropriate checks had been completed. There were systems in place to minimise the risk of infection. Medication was administered safely and by staff who had received training to do so.

People were cared for and supported by staff who knew them well and who had received training to support people to meet their needs. Staff had a good understanding of people’s preferences. People were supported to eat and drink enough to ensure they maintained a balanced diet and referrals to other health professionals were made when required.

Staff, people and their relatives spoke very highly of the registered manager.

Inspection carried out on 13 April 2016

During a routine inspection

Kingston House provides accommodation and personal care for up to 11 people. It is a service without nursing for older people who may have dementia. There were 8 people living in the service when we inspected on 13 April 2016. This was an unannounced inspection.

There was a registered manager in post. The registered manager was also the provider. 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.

There were procedures and processes in place to ensure the safety of the people who used the service. However, people did not have personal evacuation plans to guide staff on how to support them in the event of a fire. Staff were trained and supported to meet the needs of the people who used the service and there were sufficient numbers of staff to meet people’s needs. Recruitment processes checked the suitability of staff to work in the service. There were appropriate arrangements in place to ensure people’s medicines were obtained, stored and administered safely. However, guidance for staff on how and when to administer as and when required medications was not always in place and the recording of when these were taken was not always clear.

People were supported in accordance with the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). People’s nutritional needs were assessed and met and they were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment. Staff had received supervision from the manager, however these were not always recorded or records were not available.

Staff knew people well and had good relationships with people who used the service. Staff respected people’s privacy and dignity and interacted with people in a caring, respectful and professional manner.

People were provided with personalised care and support which was planned to meet their individual needs and were involved in making decisions about their care and support.

A complaints procedure was in place. People’s comments, concerns and complaints were listened to and addressed in a timely manner.

Staff understood their roles and responsibilities in providing safe and good quality care to the people who used the service. The service had a small staff team and any issues were discussed and resolved promptly. As a result the quality of the service continued to improve.

Inspection carried out on 9 January 2014

During a routine inspection

We found that people who lived at Kingston House had choices and were well cared for. One person told us, �I enjoy living here. I would not want to be anywhere else.�

Care plans were individual to people and up to date. It was evident that people accessed a range of care professionals in order to meet their needs. We found that Kingston House was clean and procedures were in place to keep people safe from infection.

Staff told us they enjoyed their work and felt supported. We saw that arrangements were in place to ensure staff received appropriate training and supervision. We found that a complaints system was in place and that people and their relatives were able to discuss concerns with staff.

Inspection carried out on 18 October 2012

During a themed inspection looking at Dignity and Nutrition

We spoke with people who told us what it was like to live at this home. They described

how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met. The inspection team was led by a CQC inspector and an "expert by experience" (people who have experience of using services and who can provide that perspective).

We spoke with four people who were using the service and two visiting relatives. Everyone we spoke with confirmed that the staff treated them with respect and provided them with choices wherever possible. People spoken with were complimentary about the care and attention that they received

One person told us, �All the information about the home and the level of care I could expect was given both verbally and in writing�. They went on to say, �Staff are very, very good. I couldn�t ask for a better place to be in. It�s a homely place, there is nothing but happiness here�. Whilst they did not know the details of their care plan, they did know that their records were kept in the office and was certain that they only had to ask the manager if they had any queries and that any problems would be sorted out immediately saying, �Staff will help me at any time�.

A visiting relative told us, �I can go away on holiday now, knowing that my relative is well cared for� and went on to say, �As far as I�m concerned there is nothing bad about this place, it�s all good�.

Another person said, �I have no complaints about the staff, they never hurry me and treat me so well�, adding, �This home's excellent 100%, I�m very happy with my room, I get clean clothes every day. My daughter visits me and takes me out and she is very happy with the care I receive. I feel safe and content here, it�s like a family home�.

One person told us that, �I like the food, it�s always hot and portions are adequate, I clear my plate�, they added, If fish is on the menu and you don�t want it they will cook you an omelette�.

None of the people that we spoke with had any concerns about their safety in the service and we received a number of positive comments from people. For example, one person told us that, �I feel very, very safe here. There is definitely no abuse either physically or mentally. I would speak to the manager if I had any concerns�. Another person told us, �You can�t fault the care here�. A third person told us that, �I have no concerns but if I had I would speak to staff and I am confident they will help me�. A further comment received from a person using this service was, �I know my records are kept in the office and if I had any concerns I would speak to the manager and I am confident they would be quickly resolved".

Everyone we spoke with thought highly of the staff in the service. A visitor told us that, �Staff are absolutely brilliant, they always make me feel welcome and they are very attentive to my friend�. One person who didn't know where their care plan was, told us that, �I don�t know where my records are kept, but the staff will know�.

Inspection carried out on 27 May 2011

During a routine inspection

During our visit on 20 May 2011 we saw that people were being well cared for and treated with respect. One person told us, �I have no complaints about anything.�

One person told us that the owner supported them to get a small fridge for their bedroom as they like to keep their own supply of fresh foods. They also told us that they enjoy a brandy at bedtime every evening.

Someone who completed a satisfaction survey issued by the home as part of their quality assurance processes said, �Food looks good and always smells appetising.� One person with whom we spoke told us, �Love the food. Excellent.�

People with whom we spoke on the day of our visit were relaxed, confident and comfortable with staff. We saw that there were good interactions between members of staff and people living in the home. People with whom we spoke told us staff treated them well. One person said, �They are very good.�

One person with whom we spoke told us, �It�s very good here. I don�t want to move.�

People who completed a satisfaction survey issued by the home rated the service as �good� or �excellent� and there were no complaints. One person said, �It has not been necessary to complain so far.�