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Inspection carried out on 28 June 2018

During a routine inspection

This inspection took place on 28 June 2018 and 04 July 2018 and was unannounced on the first day. At our last inspection we found a breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014; Premises and equipment as the premises were unsafe and unsuitable in some areas. At this inspection we found that improvements had been made and the service was no longer in breach of the regulation.

Kingsley House is a three storey Victorian property providing care and support for up to 16 people with mental health needs. The home is situated in the centre of New Brighton close to shops and community facilities and to the river-front. There are good public transport links to all parts of the Wirral and Liverpool. At the time of the inspection there were 15 people living in the home.

Kingsley House 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.

Kingsley House had a registered manager who has worked at the home for a number of years. 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.

We looked at how the service managed it’s recruitment of new staff and had minor concerns over how some records were maintained. The manager was open to the feedback and was making improvements whilst the inspection was taking place.

We spoke with five people who lived in the home who all gave positive feedback about the home and the staff who worked in it. They told us that the staff supported people to live their lives as independently as possible.

Staff spoken with and records seen confirmed training had been provided to enable them to support the people with their specific needs. We found staff were knowledgeable about the support needs of people in their care. We observed staff providing support to people throughout our inspection visit. We saw they had positive relationships with the people in their care.

We found medication procedures at the home were safe. Staff responsible for the administration of medicines had received training to ensure they had the competency and skills required. Medicines were kept safely with appropriate arrangements for storage in place. We did suggest that the service ensured that two staff check and sign hand written medication records.

The registered manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they were working within the law to support people who may lack capacity to make their own decisions. We saw that people were supported to make their own decisions and their choices were respected.

Care plans were person centred and driven by the people who lived who lived in the home. They detailed how people wished and needed to be cared for. They were regularly reviewed and updated as required.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included regular audits of the service and staff meetings to seek the views of staff about the service. They also regularly spoke with the people who lived in the home. The provider also provided close scrutiny of the service and was a regular presence in the home providing activities for people such as swimming and the gym and providing support for the manager.

Inspection carried out on 6 April 2017

During a routine inspection

This was an unannounced inspection carried out on 6 and 7 April 2017. At our last inspection on 22 January 2015 we found that policies and procedures were not up to date to reflect the service provided, and that there was no effective quality monitoring system. The provider had updated the monitoring systems in February 2017 and a deputy manager had been recruited to ensure that there was continuous monitoring of the service.

Kingsley House is a three storey Victorian property providing care and support for up to 16 people with mental health needs. The home is situated in the centre of New Brighton close to shops and community facilities and to the river-front. There are good public transport links to all parts of the Wirral and Liverpool.

During our visit we saw that the home was in need of redecoration and bathrooms and communal areas looked unkempt and required new fixtures and fittings to provide a safe and comfortable home for people to live in.

This is a breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Premises and equipment. You can see what action we told the provider to take at the back of the full version of this report.

Safeguarding incidents were recorded properly and the local authority had been notified as required. The manager had not informed the CQC of two incidents that had occurred.

We recommend that the provider ensures that notifications of safeguarding referrals and other incidents are sent to the CQC as required so that we can check that relevant action has been taken.

Personal emergency evacuation plans (PEEPs) were in place for all of the people living at the home, however there was no information relating to people smoking in their bedrooms, which was a risk to all living at the home.

We recommend that the provider implements a robust system to ensure staff monitor people smoking in their rooms to ensure the safety of all living at the home.

There was a range of quality assurance systems in place to assess the quality and safety of the service and to obtain people’s views. A satisfaction questionnaire had been sent out in 2016 and people’s feedback had been positive.

We recommend that the provider maintains a record of actions taken to address issues identified in audits and house meetings and to show the improvements made.

At the time of the inspection 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.

During our visit we spoke with four people who lived at the home. They all spoke positively about the home and the staff supporting them. People told us the staff were kind and caring. They said their needs were responded to promptly and whenever they asked for help, staff were always on hand to provide it. We observed interactions between staff and people who lived at the home that were pleasant, kind and compassionate. It was clear that people felt comfortable with the staff who supported them. Staff we spoke with spoke fondly of the people they cared for.

People’s care records were person centred and contained information about their needs and preferences and information about how to manage people’s individual risks. People’s care plans contained information about what people could do independently and provided guidance to staff on how to support this.

Accidents and incidents were recorded appropriately. The records had not been updated to reflect that appropriate action was taken by the manager and staff to prevent further incidences. Staff knew what to do if any difficulties arose whilst supporting somebody or if an accident happened.

The home used safe systems when recruiting new staff. These i

Inspection carried out on 22/10/2014 27/10/2014

During a routine inspection

Kingsley House is a three story Victorian building providing care and support for up to 16 people with mental health needs. The home is situated in the centre of New Brighton close to shops and community facilities; it’s also very close to the riverfront. There are good public transport links to all parts of the Wirral and Liverpool.

This unannounced inspection took place on the 22 and 27 October 2014. At the time of this inspection there were 15 people living at Kingsley house. During the two days we spoke with eleven people who lived at the home, we also spoke with six members of staff. We spent time with the new manager who is currently registering with the CQC to be the registered manager. There has been no registered manager in post since May 2014. The manager applied to the Commission to be registered on 3 November 2014, after our visit. 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.

The inspection was carried out by an Adult Social Care (ASC) lead inspector and an expert by experience. An expert by experience is a person who has experience of using or caring for someone who uses this type of care service.

We reviewed the Provider Information Record (PIR) and previous inspection reports before the inspection. The PIR is a form that asks the provider to give some key information about the service, what the service does well and the improvements they plan to make. We also reviewed the information we held about the home.

At the last inspection carried out in October 2013 we found that the service was not meeting all of the essential standards that we assessed Including the safety and suitability of the premises. We spent time in all areas of the premises and could see that the home had implemented works to decorate all areas. There was a cyclical plan in place to decorate all areas of the location and we could see areas that had been decorated including peoples bedrooms.

Staff recruitment files had been audited in October 2013 and did not contain all of the relevant checks for staff. The manager was in the process of completing a quality audit on all areas of staff recruitment, support and training. There had been no staff recruited in the last 6 months as they were fully staffed.

People using the service told us they felt safe. Staff were knowledgeable in recognising signs of potential abuse and followed the required reporting procedures. We asked the manager to make improvements to ensure that the safeguarding policy was updated and that staff were training in safeguarding vulnerable adults.

Although people’s needs had been assessed and care plans developed these did not always adequately inform staff what they should be doing to meet people’s needs effectively. However all of the six staff we spoke with knew the people very well and in discussions were able to tell us what care and support they provided. Staff also liaised with other healthcare professionals to obtain specialist advice to ensure people received the care and treatment they needed.

Although the provider monitored the service and planned improvements there was no formal quality assurance process in place. The manager was working closely with the Wirral Local Authority Quality Assurance team to improve the audit procedures.

Inspection carried out on 22 October 2013

During a routine inspection

At this inspection we discussed arrangements in place for people to give consent and were told that they were able to agree or disagree to care and treatment offered and provided. We spoke with 12 of the 16 people who used the service and they told us "Staff always ask or explain something" and "They make sure I understand and ask if I don't." We reviewed six care records and saw that people had been involved in the care planning process and had signed to say they agreed their plan.

Records reviewed showed that an assessment of people's needs and abilities had been undertaken. Care plans showed how the needs of people were to be met. Plans covered physical, emotional, mental health, social, communication and behavioural needs and each care plan had its own associated risk assessment. There was instruction to staff about how needs and risks should be managed. People told us "I love being here, it is my home" and "I didn't feel safe before I came here. I want to stay, it is a good place".

We were notified by Wirral Borough Council prior to inspection about a safeguarding incident. We found that the incident had been investigated and addressed appropriately and that immediate action had been taken to ensure people's safety.

We found that premises were not of an adequate standard to ensure people's comfort and safety. We discussed this with the provider who said that improvements to the premises were already planned and our findings would be included in that plan. We asked the provider to send us a copy of the improvement plan.

There were systems in place to appraise and supervise staff and staff spoken with felt well supported to carry out their role. However not all necessary documentation was in place to ensure people were protected by staff whose identity had been clarified and who were appropriately skilled to carry out the role. We discussed this with the manager who said that action was being taken to make sure the missing documentation was received.

We saw that audits of staff files, care plans, medication and finance had been implemented over the last few months and these were to continue on a regular basis. A new system was being introduced whereby each member of staff would be responsible for a different audit such as first aid, fire safety, food hygiene and infection control. We saw evidence that these had begun.

Inspection carried out on 1 March 2013

During an inspection to make sure that the improvements required had been made

We carried out this inspection to see what progress the provider had made to improve the care and welfare for people who used the service and how the provider had improved arrangements to safeguard the people who lived in the home.

We found that care records were improved, the information contained in plans had been written in a person centered way. We saw that reviews were taking place monthly and included the service user. We saw from records and from conversations with individuals that people were more involved with organising their lives and achieving new goals.

We saw from staff training records that staff were better equipped to recognise signs of abuse as they had completed training for safeguarding vulnerable adults, deprivation of liberty and the Mental Capacity Act.

Inspection carried out on 2 May 2012

During an inspection to make sure that the improvements required had been made

People told us that they were happy living in the home. Four residents told us that they liked the improvements that had been made to the environment. One person told us that they were happy that some sanctions in respect of their smoking had been removed and they could take be more responsible.

Inspection carried out on 29 December 2011

During a routine inspection

People living in the home told us that they liked living there. One person told us that the staff are very good. One person told us that they were kind as they gave her cigarettes and scratch cards.

People went to great lengths to tell us that they liked living in the home. One gentleman told us it was alright better than where he was before. One person told us that he was happy at the home and enjoyed helping people with maintenance or window cleaning.

We spoke with people living in the home who told us that they felt safe.

People told us that they get their medicines as they need them; they told us that they come to the office for them.

People living in the home told us that they could complain to the staff or the owner if they needed to but had nothing to “moan” about.

Reports under our old system of regulation (including those from before CQC was created)