Kingston 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

This means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question Good. At this assessment the rating has remained Good: This meant people were safe and protected from avoidable harm.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. Incidents and accidents were recorded and reviewed by the manager. Learning from incidents was shared with staff to ensure they understood what steps needed to be taken to support people safely.

Several people had recently experienced falls. These had been recorded and risk assessments reviewed. However, the manager had not completed a falls analysis which could have demonstrated some common themes and trends. This was discussed during the inspection, and they felt this could lead to greater learning in relation to falls.

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. Leaders ensured there was effective communication between services when people needed support and had engaged with such services as physiotherapy and speech and language as needed for people.

There was evidence of safe transfers from hospital with a service procedure in place and records of discharge reviews.

One relative told us the provider supported their family member well during a transition to hospital and their return, including providing transport for them.

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 and their relatives said they felt safe in the service. Staff demonstrated a good level of understanding in relation to their safeguarding responsibilities and attended regular training. Staff were confident managers would act appropriately if they shared safeguarding concerns and were aware of how to escalate concerns if managers did not act.

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. People and their families were involved in risk planning to enable positive risks to be taken. Staff understood what risks people faced and could talk about how to ensure these were effectively managed. As a result of positive risk planning people regularly left the home for such things as trips, lunches and activities.

Risks within the home were generally well managed in partnership with people. However, while falls were risk assessed and reviewed, leaders had not analysed the information to look for themes and trends. This meant people’s risks, in relation to falls, were not always managed as safely as possible. Leaders agreed to ensure this analysis was completed in the future.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. The home was clean and generally well maintained. The registered manager had identified some areas that needed to be refreshed and had an improvement plan for this. The provider had effective fire risk assessments and regularly completed checks on water systems and equipment such as wheelchairs hoists and slings. The provider regularly sought external assessments for fire and legionella.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always work together well to provide safe care that met people’s individual needs.

At times there were not always enough permanent staff to fulfil the needs of the service. When this occurred, managers used agency staff to cover the shortfall. At times having agency meant medicines were being administered by staff unfamiliar with the services systems. This had led to several medicine errors, many of which were recording errors. This had been addressed by leaders by ensuring they used a regular team of agency staff. This had led to a reduction in incidents.

However, people and their families told us they felt there was enough staff with the right skills to support them safely. Staff recruitment was completed safely with the appropriate pre-employment checks being completed. New staff received an induction, and all staff had attended mandatory training courses. Staff shared they received regular supervisions and were confident to speak to the registered manager between supervisions if needed.

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. We saw the service was clean and saw staff following good infection control practice. There was an adequate stock of personal protective equipment (PPE). Staff could tell us how to use the PPE safely and knew how to access any equipment they needed. People told us they saw staff using the appropriate protective equipment when they were being supported.

Concerns had been raised to the Care Quality Commission about medicines management. The provider told us that at times having agency meant medicines were being administered by staff unfamiliar with the services systems. This had led to several medicine errors, many of which were recording errors.

However, during this inspection we found the provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Medicines were administered as prescribed by trained senior carers. Medication rounds were completed regularly using an electronic system for most medicines. There were some medicines such as some creams that were recorded on paper records. Staff were trained with annual competency assessments, supported by external assessors and e-learning. Three successful competency assessments were required prior to administration. Monthly audits were conducted locally, with bi-monthly external audits.

Medicines were stored securely in a designated clinical room. Fridge and room temperatures were recorded daily. Sharps bins were in place, and returns were managed monthly via the nominated pharmacy.

There were risk assessments available in relation to flammable creams. As required (PRN) topical meds had appropriate protocols. Parkinson’s medicines had specific timing considerations, and the service followed a local protocol requiring double witnessing. This occasionally caused small delays in medicines being administered.
The home had medicine-related policies which they worked in line with. Medication incidents were centrally logged, with trends such as Parkinson’s medicine delays and PRN usage being monitored. There was evidence of clinical oversight, including visits from a named GP and paramedic. (PRN) protocols were in place, although there were some inconsistencies. These inconsistencies were shared with the manager, who stated they would be addressed.

Medication administration records (MAR) and care plans were complete, with appropriate allergy documentation and consent forms.