Archived: Kensington Care Home

We looked at ten care plans of people who used the service. We found people's needs were not being met and care and treatment was not being delivered in line with their care plans.

We saw there were policies available for reporting safeguarding issues. Staff we spoke with said they were aware of their responsibilities to report safeguarding issues and concerns to the senior care assistant or the manager. However, not all safeguarding incidents had been reported.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

We found that the provider had not taken reasonable steps to provide care in an environment that was suitably designed and adequately maintained.

People were not cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Not all staff had received the appropriate training to meet people's needs and this had not been updated.

The provider did not have an effective system to regularly assess and monitor the quality of the service that people received.

People's views and experiences were taken into account in the way the service was provided and delivered in relation to their care. People's privacy, dignity and independence were respected.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. People we spoke with confirmed they were able to raise concerns with the manager and these would be acted upon.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

People who use the service, staff and visitors were protected against the risks of unsafe or unsuitable premises. Feedback we received from people who used the service and relatives about the environment provided was, on the whole positive.

The provider had an effective system to regularly assess and monitor the quality of service that people received. There was evidence that learning from incidents / investigations took place and appropriate changes were implemented. The provider took account of complaints and comments to improve the service.

We looked at five care files of people who used the service and found them to be formatted in different ways and were inconsistent in respect of how information was made available and retained.

Staff told us they had received training and were knowledgeable about what constituted abuse and how they would report any signs of abuse. They told us they had not seen anything of concern to them.

We saw prescribed medication was stored in locked trolleys in a locked cupboard and medicines that were intended for return to the pharmacy were retained in the locked cupboard along with the returns documentation.

During our tour of the building we found a number of issues relating to health and safety, and general maintenance.

Regular audits of the medication, healthcare records, cleanliness and health and safety had yet to be fully established.