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Kingston House Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 24 October 2018

Kingston House is registered to provide accommodation and personal care for up to 46 people. At the time of our inspection there were 42 people living at the service. Kingston House is divided into three sections, Primrose, Tulip, and Lavender Lodge. Primrose and Tulip are residential areas of the home, with shared lounges and a dining room. People living in Lavender Lodge have a diagnosis of dementia. Lavender Lodge was accessible through key coded secure doors. Lavender Lodge had a separate lounge and dining room, although the whole home came together for some activities.

This inspection was unannounced and took place over two days. The inspection commenced on 19 September 2018 and we returned 20 September 2018. We previously inspected the service in April 2017 and found three breaches of The Health and Social Care Act 2008. At this inspection we found two breaches in regulation, one of these was a repeated breach from the previous inspection.

At the previous inspection, in March 2017, we found the service to be in breach of three regulations. We found that there were not sufficient staff to meet people’s needs. Where people lacked the mental capacity to consent to care and treatment, decisions were not always made by someone with the appropriate legal authority. The quality and consistency of records meant that there was no overview of the support people received. People’s care plans did not reflect their care needs. Also, the systems in place to monitor the quality of the service failed to identify the shortfalls found during the inspection.

During this inspection, we found improvements had been made so that the service was no longer in breach of two regulations. There was appropriate mental capacity assessment documentation in place. Where people had representatives with Lasting Power of Attorney (LPoA), this was documented, with a copy kept on file. This meant the service knew who to contact in relation to decisions and the LPoA had the legal authority to act on the person’s behalf. There were also improvements in staffing and the service was fully staffed.

We found a continued breach of Regulation 17 of the Health and Social Care Act 2008, regarding good governance. This was because appropriate action had not been taken to address shortfalls in quality monitoring systems. There were areas of concern identified at the inspection that had not been recognised as part of the audit and monitoring checks completed by the management team. We also found breaches in Regulations 9 regarding person-centred care and 12 for safe management of risk.

Risks were identified where people could not use their call bell. However, there were no directions for staff around how they should reduce these risks.

Where people were prescribed creams and lotions, the protocols did not explain where and when staff should administer these. Record keeping for cream and lotion administration was not always completed, and did not evidence that people received their prescribed cream as directed.

Where accidents happened, these were recorded and monitored; however, body maps for injuries were not followed up. Where injuries had occurred, these were recorded, but there were no progress notes. We saw reference to a carer finding bruising on a person in the daily notes. There was no body map or accident form completed regarding this. Where one person had experienced frequent falls, the accident form stated in the management notes that a risk plan would be implemented. We saw that this had not been implemented following the accident.

Food and fluid intake monitoring for people who were at high risk of malnutrition and weight loss was not documented in a consistent manner. The recording system was not being used appropriately. This meant that there was no overview of how the service was meeting people’s identified needs with regards to their nutrition.

Record keeping around activities and social interactions varied in quality and consistency. Th

Inspection areas

Safe

Requires improvement

Updated 24 October 2018

The service was not always safe.

Medicine processes, protocols and records were not always managed in accordance with best practice guidance.

Administration, audits and stock checks did not identify areas of concern for medicines. Staff did not raise concerns regarding the lack of PRN protocols for five people.

Treatment and Escalation Plans were in place.

People had Personal Emergency Evacuation Plans detailing the support they would require to evacuate in the event of an emergency.

There were appropriate numbers of staff to support people’s needs.

Effective

Requires improvement

Updated 24 October 2018

The service was not always effective.

The training matrix showed gaps in essential training. Two members of staff responsible for administering medicines were out of date in their medicine training.

People living in Lavender Lodge did not receive as positive a dining experience as those living in Primrose and Tulip.

There were mental capacity assessments and best interest decisions in place for people who lacked capacity to consent to receive care and treatment.

Staff sought consent from people before providing care interventions.

Caring

Good

Updated 24 October 2018

The service was caring.

People and their relatives told us staff were kind and caring.

We saw positive interactions between people and staff.

Staff clearly knew people and their needs well.

Responsive

Requires improvement

Updated 24 October 2018

The service was not always responsive.

Action had not been taken to address concerns identified at the previous inspection.

Record keeping was inconsistent and prevented an overview of the support a person received from being produced.

There were strong community relationships and a varied activities programme.

Well-led

Requires improvement

Updated 24 October 2018

The service was not always well-led.

Action had not been taken to address shortfalls in the quality monitoring processes. There was not a clear management oversight of how some people’s needs were being met.

There was a registered manager in post, supported by a deputy manager and care lead.

Staff spoke positively about the support they received from the registered manager.

Meetings took place with people, their relatives, and the staff, to discuss feedback and any concerns.