Kismet House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last inspection we rated this key question requires improvement. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Overall, the provider had a positive culture of safety; however, incidents and lessons learnt were not always well documented to record actions, identify learning and embed good practice. People and staff told us they felt able to raise concerns with the management team; however, we found incidents were recorded inconsistently and not in line with the provider’s procedure. We identified several incidents documented within care notes on the electronic care planning system which had not been formally recorded as incidents. Some of the incident records we reviewed were incomplete and were not signed off by management in a timely way. Although immediate actions had been taken to manage risk, they were not always well documented. Audits of incident records were not sufficiently robust in order to identify trends, patterns or learning. We reviewed records of complaints which had been responded to appropriately; however, they were not recorded in line with the provider’s procedure. Staff told us incidents and lessons learnt were discussed at meetings, however learning was not well documented. We raised our concern with the management team, and during the assessment, policies and procedures relating to incident reporting were updated to ensure staff had clear guidance to refer to.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. The service had procedures to support staff with new referrals to the service. People were assessed to ensure the service could meet their needs before admission. Professionals we contacted told us they had good communication and positive working relationships with the service, which supported continuity of care for people. One professional said, “Kismet House staff have always worked effectively with me. When the person first moved in, there were regular review meetings, staff were open about what they struggled with and were very open to advice from me, [person’s] advocate and family about the best way to support. It was clear they wanted the best for the person.” People and their relatives felt confident health needs would be met with the involvement of relevant health professionals. One relative said, “All [person’s] medical needs are supported.”

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately. People appeared comfortable and safe within the service. People told us they felt safe and were confident they could raise any concerns with staff. A person said, “Yes I do.” A professional commented, “I feel Kismet House is a safe place to live.” While incidents were recorded inconsistently, appropriate referrals were made in response to safeguarding concerns. This included informing the local authority safeguarding team and notifying the CQC as required. The registered manager and provider told us they maintained a regular presence within the service to monitor interactions and people’s wellbeing. The provider had an appropriate safeguarding policy which provided staff clear guidance on how to safeguard people from abuse. Staff had received training in safeguarding adults and understood their responsibility to report any concerns. Where people were deprived of their liberty, appropriate referrals had been made to the local authority to ensure this was done lawfully and in the least restrictive way.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Overall risks associated with people's care and support were assessed and managed. For example, risk assessments relating to people's mental health support needs were person centred, reflected people's changing needs and provided clear guidance for staff to support people in the least restrictive way. We identified 2 people’s risks relating to nutrition and hydration which required more robust monitoring and recording, the registered manager told us they would address this. Records showed care plans were regularly reviewed and staff told us they provided sufficient information. One staff member said, “Yes definitely, I find them detailed.” We observed a calm environment, where staff had developed positive relationships which supported people to take positive risks. Professionals who worked with the service shared examples of the service responding promptly to risks. They described the provider as responsive when issues arose and as working collaboratively with people, demonstrating a positive and proactive approach to risk management. One professional said, “Kismet House staff are good at problem solving when [person] demonstrates new, potentially risky behaviours.” Another professional commented, “I have found that the team at Kismet have managed risk with my client very well. They consider risk carefully but are also not too restrictive.”

The provider did not always detect and control potential risks in the care environment. Improvements had been made to manage environmental risks, and shortfalls identified at the previous inspection had been addressed. However, we identified some further areas for improvement. For example, the information held in the emergency grab bag was not up to date for staff to use effectively in the event of an emergency. We also found some areas of the service required maintenance and redecoration, including communal spaces and a bathroom. Feedback regarding the service environment was mixed, some people and relatives told us they were satisfied whilst others told us some redecoration was required. One person said, “I don't like the front room much, it could do with being decorated.” Some staff made similar comments. A staff member said, “It could do with a freshen up.” We raised this with the provider, who responded promptly to update the grab bag. They informed us flooring had recently been replaced, and there were plans to redecorate other areas identified. Other health and safety and fire safety records we reviewed were satisfactory.

The provider made sure there were enough skilled and experienced staff, however, they did not always make sure staff received effective support, supervision and development. We observed there was sufficient staff available to meet people’s needs, which was confirmed by feedback from people, relatives and staff. A relative commented, “There seems to be.” A staff member said, “All good, we try and help out during annual leave, we're quite a small team.” Staff told us they felt supported and had completed an induction, which included shadowing a colleague and undertaking the provider’s mandatory training. However, records showed staff supervision meetings were not taking place regularly in line with procedure, and induction records were not always fully completed. While staff reported having access to sufficient training opportunities, records showed not all staff had completed or refreshed their required training. We raised these concerns with the management team, who told us they would take steps to make improvements. Despite these shortfalls, we observed staff were sufficiently competent and people and relatives spoke positively of the support provided. One person said, “Lovely people look after me here, make sure I'm well. Grateful, can't find fault. Staff are really supportive.” Staff were recruited safely by the provider, with relevant checks completed before new staff began working at the service. These included criminal record and employment history checks to ensure staff were suitable for the role.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. At the last inspection we found areas of the service were not kept clean. At this assessment we found improvements had been made. The service was clean and free of any malodours. Records confirmed regular cleaning took place, and we observed personal protective equipment (PPE) was available and used appropriately. There was an infection prevention and control policy and staff had completed training. People and their relatives told us the service was regularly cleaned. One person commented, “My keyworker is really good at cleaning.” A relative said, “I think [person's] room is very nice, staff go in to clean it very regularly.”

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.Improvements had been made since the last inspection. A new electronic medication administration record (eMAR) system had been introduced to help address recording issues previously identified. Medicines were stored securely, and a review of administration records for several people found the recorded stock levels matched the medicines held by the service. Shortfalls identified at the last inspection, such as issues with PRN ‘as required’ medicines, risks associated with paraffin based topical creams, and temperature monitoring had been addressed. However, we identified some further areas for improvement. One person was receiving medicine covertly, which had been previously agreed in the person’s best interests. Covert administration is when medicines are administered in a disguised format hidden in food or drink. We found the decision had not been reviewed, and the service did not have all relevant documentation. There was no risk assessment for a person who self-administered their medication, and further documentation was needed to support staff administering topical medicines. Staff had completed medicines training and reported feeling confident to administer medicines safely, although not all staff had their competency assessed or refreshed within the past year. People and their relatives did not raise any concerns about support provided with medicines. During the assessment, the provider took prompt action to address the shortfalls identified.