Kismet House

Kismet House is a residential service providing personal care and accommodation for up to 9 people with mental health support needs. The service consists of an adapted building, which includes individual bedrooms and communal spaces and an accessible outdoor space. At the time of our inspection there were 7 people using the service.

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

People and their relatives told us people were safe with the care and support they received from the service. However, despite positive feedback we found we found shortfalls with environmental risks, medicines management, infection prevention and control and quality assurance systems which placed people at increased risk of harm.

Systems in place to monitor the quality and safety of the service were not fully effective in ensuring shortfalls were addressed.

Medicines were not managed safely in line with national guidance. Infection control measures were not fully effective in minimising risks to people.

The provider had systems in place to assess risks to people before undertaking their care and support. However environmental risks including fire safety were not always safely managed.

Appropriate staff recruitment procedures were in place; however, recruitment records were not always well documented. There was enough staff to keep people safe, people spoke positively of the support they received.

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.

The service had a positive culture, staff told us they felt supported and morale within the staff team was good. People and their relatives told us they were satisfied with 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

The last rating for this service was good (published October 2017). There was a targeted inspection since this inspection, published February 2021. This did not change the rating.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

Enforcement

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

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 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The provider had not had an outbreak of coronavirus within in the home. At the time of the inspection all residents and staff had tested negative. All residents had received their first coronavirus vaccination.

When staff came on shift, they checked their temperature and sanitised their hands on entering the building. At the time of our inspection staff were able to maintain social distance because people living at the service didn’t need close support with their personal care needs. Staff wore masks at all times.

Staff had received training in infection control, including how to safely put on and take off personal protective equipment (PPE) such as face coverings, gloves and aprons (if needed). The registered manager and provider carried out regular observations to check on good practice.

We saw staff wearing masks and they described how they would change their PPE if supporting anyone who had coronavirus. Due to the recent increase in coronavirus infections the provider had stopped all visitors coming into the home to reduce the risk of the virus entering the home. People were supported to go out safely by staff.

People living in the home were deemed to have capacity and understood the importance of maintaining social distance in public and wearing masks. People had agreed to limit their usual activities in the community to remain safe. The provider had a policy and procedure in place to check visitors’ temperatures, ensure they sanitised their hands, wore PPE and maintained social distancing.

The registered manager and provider told us they would isolate individuals in their room should there be an outbreak of coronavirus. They had contingency plans to manage shared bathrooms safely; this included extra staff to carry out thorough cleaning after each use. Regular testing was carried out, weekly PCR testing for staff and monthly testing for people living in the home, this was in line with coronavirus testing guidance. Staff also undertook a lateral flow test at home before coming on shift.

One person had recently been admitted. They were tested on admission and supported to isolate in their room for 10 days.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

Why the service is rated good:

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 supported this practice.

Risks to people were assessed and where required a risk management plan was in place to support people manage an identified risk and keep the person safe.

Staffing numbers were sufficient to meet people’s needs and this ensured people were supported safely. People told us they felt safe living at the service.

The provider ensured that new staff completed an induction training programme which prepared them for their role. Staff completed training which ensured people at the service were safe. Staff were supported through a supervision programme. Supervision is where staff meet one to one with their line manager to discuss their work and development.

People were supported to maintain good health and had access to external health care professionals when required.

Staff were caring towards people and there were good relationships between people and staff. Staff demonstrated an understanding of the needs and preferences of the people they cared for.

Support provided to people met their needs. Supporting records highlighted information about what was important to people and how to support them. People were involved in activities of their choice.

There were systems in place to assess, monitor and improve the quality and safety of the service. Staff described the deputy manager and the provider as supportive. Comments from people confirmed they were happy with the service and the support received.

Further information is in the detailed findings below.

We found that following an audit of the care plans the registered manager had identified the need to develop new consent forms for people to sign. We saw this was being action by staff.

We saw each person had a personalised care plan which described the care and support they required. Records maintained by staff showed that care was delivered in line with the person's plan.

People spoken with told us they felt safe living at Kismet House. Staff understood the various signs of abuse and knew what action they needed to take to ensure people were safe.

At the inspection on 23 October 2012 we were told there was no system in place to regularly assess and monitor the quality of the service. At this inspection we found the provider had systems in place to assess and monitor the service provided. This system included obtaining opinions of people who lived in the home.

At the inspection on 23 October 2012 we found the home was responsive and dealt with incidents but they were failing to inform the correct people as required by law. During this inspection we found the registered manager had informed all the correct people when an incident had occurred.

We visited the service on 29 November 2012 to follow up the warning notice. We found the warning notice had been complied with and that people were now protected from the risk associated with the unsafe use and management of medicines. This is because the provider has reviewed and changed the arrangements for recording, safe keeping, dispensing and safe administration of medicines.

At our last visit in October 2012 we were told there was no system in place to regularly assess and monitor the quality of the service. We judged this to have a moderate impact on people using the service and issued a compliance action requiring the provider to take appropriate action to address this area. We also found the service was responsive and dealt with incidents but failed to inform the correct people as required by law. We judged this to have a minor impact on people using the service and issued a compliance action requiring the provider to take appropriate action to address this area.

These compliance actions will be followed up at a later date.

Each person had a plan which described the care and support they required and how staff should provide it. We saw there were risk assessments in place for some people which promoted well being and prevented crisis.

Staff spoken with were aware of issues of abuse and knew how to report any worries or concerns.

People had access to a spacious lounge and dining area. Communal areas had been comfortably furnished and were well maintained. The environment promoted a homely feel for the people who lived there.

We saw that the processes for administration of medication were inadequate.

We saw there was an ad hoc approach to assessing the quality of the service. We were told there was no system in place to regularly assess and monitor the quality of the service. The service was responsive and dealt with incidents but they were failing to inform the correct people as required by law.

We have made compliance actions requiring the provider to take appropriate action to address these areas.