We carried out a comprehensive inspection of this service on 11 and 17 July 2017. The first day of our inspection was unannounced. We informed the home manager we would be returning to complete our visit on 17 July 2017.
Our last inspection took place in February 2016 where we reported improvements had been made and the service was meeting the legal requirements we checked. We indicated that we would require a longer term track record of consistent good practice before we were able to revise ratings for the service.
The Kensington Care Home provides nursing care, respite and accommodation for up to 53 older people. The home is located in a Victorian terraced property, converted and arranged over three floors. All floors have lift access. The provider’s website states that it is able to provide specialist dementia staff and ‘respectful pro-active care for residents and relatives in their last days of life.’
There were 29 people living in the home at the time of our visit. Occupancy levels were lower than usual due to a planned and extensive home refurbishment programme which began in July 2016.
The home manager informed us that building works (which include room redesign, redecoration throughout, new carpeting, furniture, fixtures and fittings) are likely to continue until September 2017. As a result, people living in the home, visitors and staff are subject to a certain degree of ongoing disruption and disturbance. The home manager told us the home remains open to new admissions during this period.
At the time of our visit, staff working on the two upper floors of the home were providing care and support to elderly frail adults some of whom are living with dementia and other long-term health conditions. People receiving respite care are accommodated on the ground floor. People have their own rooms with en-suite shower facilities and are able to access shared bathroom facilities should they prefer a bath. The home has a spacious open plan reception area, communal seating and dining areas and a large garden.
The home manager in post had begun the application process with the CQC to become the registered manager. 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 and associated Regulations about how the service is run. The home manager was supported in her role by a clinical services manager, a resident experience manager and three unit managers.
People's needs were assessed before they moved into the service and further assessments were conducted once people had moved into the home and were feeling settled. This information was used to develop individual care and support plans that evidenced consultation with people and their relatives.
Risk assessments were carried out and management plans were in place where risks to people and/or others were identified. Risk assessments were reviewed and updated in line with the provider’s policies and procedures.
People were encouraged to mobilise independently or with assistance where this was required. However, staff were not always using recommended techniques when providing people with moving, sitting and standing support.
The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.
The provider had policies and procedures in place that ensured staff had guidance if they needed to apply for a Deprivation of Liberty Safeguards (DoLS) authorisation to restrict a person’s liberty in their best interests. Staff received training in mental health legislation which covered consent and capacity issues.
We observed warm and caring interactions between staff and people living in the home. However, some staff were less skilled at delivering kind and respectful care and not all staff were seeking consent from people before providing them with care and support.
People were provided with opportunities to meet members of the local community, including school children and volunteers. We were told that musical performances, birthday parties and other celebrations took place at various times within the home and outside in the gardens when the weather permitted.
People’s comments in relation to the quality of the food provided were mostly positive. However, we observed inconsistencies in the way mealtimes were organised and the way in which people who were unable to eat and drink independently were supported by staff.
People were supported to access GP and other healthcare services. There were procedures in place to respond to people’s changing healthcare needs and medical emergencies.
People were supported to discuss their end of life wishes and where appropriate, ‘Do not attempt cardiopulmonary resuscitation’ (DNACPR) forms had been completed and reviewed by people’s GPs.
Staff recruitment processes were followed ensuring people received their care and support from staff who were suitable for employment at the service. Sufficient numbers of staff were deployed to the service in order to meet people's needs.
Staff completed mandatory training and annual appraisals were taking place. Some staff were not always being supervised on a regular basis and the home manager was aware that some training and supervision was overdue.
Satisfactory processes had been implemented to ensure the safe management, storage and administration of people's prescribed medicines.
People and their relatives were provided with information about how to make a complaint. There were systems in place to investigate and resolve complaints, and where applicable to learn from these incidents.
There were quality assurance systems in place to monitor the quality of the service and seek the views of people and their representatives. These systems were not always identifying, managing and resolving issues we highlighted during the inspection process.
Most of the relatives we spoke with provided positive feedback as to the way care was delivered to their family members and the way in which the home was managed.