Kingdom 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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

The provider was previously in breach of the legal regulations in relation to the management of risk, person centred care and staff training. Improvements were found at this assessment and the provider was no longer in breach of these regulations.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Relatives told us the service had improved in recent months and their family members were more settled. They attributed this to the new members of the management team. One relative commented, “They [managers] are very open. They keep me informed.”

The provider had processes to record accidents and incidents, which were reviewed by managers, including incidents where people experienced distress. The managers were aware of people’s known triggers and responses and worked positively with people, to manage and prevent further incidents.

 

The provider had a proactive and positive culture of safety, based on openness and honesty. The manager listened to concerns about safety and investigated and reported safety events. Lessons were learnt to identify and embed good practice.

Records show staff helped people to gain access to healthcare services when needed, such as the doctor and dentist. There was evidence of involvement from other health care professionals in people’s care records.

Guidance was available to enable staff to support people with specific health conditions and people had care plans, which supported their care in the event people transitioned from the service, or were admitted to hospital.

The manager communicated with health partners. We received positive feedback from professionals, for instance, a specialist healthcare professional told us, “I found the manager very caring and very engaged with working with our team.”

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different services.

The service was in the process of changing from paper based care planning and records to an electronic system. Although, some progress had been made, up to date care plan documentation was not easily available to staff, some was out of date or was outside of the system. The quality of people's care and risk management records required further improvement.

People told us they felt safe and were happy, and we saw staff were friendly and polite when interacting with people. People and their representatives were involved in decisions about their care and relatives said their family members were safe and happy living at Kingdom House. They told us staff supported their family members to keep in contact and visit them on a regular basis. One relative said, “Kingdom House is wonderful place. [My family member] feels really settled and safe there.”

Staff received training to protect people’s right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect.

The manager had good oversight of people’s experience, and independent advocacy was often sought to support people’s rights. People were supported to gain access to independent advocacy services.

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. ?

Information to help people understand abuse and how to report it was provided in formats that were accessible for people and there was clear guidance in place for staff around safeguarding.

Relatives told us about improvements made in the service. One person’s relatives told us their family member was less anxious, and had experienced fewer incidents of distress since the new manager had been in post. They felt this was because the manager worked very positively with their family member.

The team worked positively with other professionals, such as psychologists, to provide person centred care. The provider employed specialist workers to support staff’s understanding and practice of positive behaviour support (PBS) for people.

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.

The staff team worked with people to understand and manage risks. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

The manager had made sure staff had access to key information and guidance, outside of the system, because of the changes from paper to electronic records. This provided information for staff to follow in relation to de-escalation and distraction techniques when people experienced distress, in place of restrictive interventions.

Each person’s individual sensory needs had been assessed and considered, so the environment could be adapted. Consideration had been given to what people could see, hear, feel, smell and taste.

Staff told us people had been consulted about the environment to make sure adaptations and reasonable adjustments could be made to meet their individual needs.

People’s individual sensory needs had been considered. There were adaptations and reasonable adjustments made to enhanced people’s quality of life. People were able to have their sensory needs met to avoid overload and feel relaxed when at home.

The service had systems in place to detect and control potential risks in the care environment. This helped to make sure facilities, equipment, and technology supported the delivery of safe care. Overall, systems in place to monitor the safety and upkeep of the premises were predominantly effective. For instance, checks were completed by the provider to make sure the environment and equipment was safe for people to use.

However, we saw some equipment was rusty, such as toilet grab rails and a shower chair. The provider’s systems had not identified this. This was addressed by the manager, who provided evidence that new equipment was purchased because of our feedback.

There had been a turnover of staff as the manager became established, addressed issues and introduced improvements. Despite these changes, people’s comments included, “The staff are nice” and “I like them.” The relatives we spoke with told us their family members had dealt with the changes well and appeared happy and more settled. They said people were supported to get out and about in the community and do the activities they enjoyed

Staff we spoke with said they worked well together. One staff member told us they had formal staff supervision meetings and felt well supported.

We observed interactions between people and staff where people appeared to be relaxed.

Recruitment procedures were in place, so people were cared for by suitably qualified staff who had been assessed as safe to work with people. People had high levels of 1 to 1 staffing and there were enough staff to support people.

The provider did not always make sure staff received effective support, supervision and development. Overall, staff received effective support, supervision and training. Although, not all of the team had received training in how to interact with people with learning disability and autistic people at a level appropriate to their role in line with the requirement introduced by The Health and Care Act 2022. The regional manager told us they would address this as a matter of priority.

People indicated staff helped them to keep their home clean, safe and comfortable.

Staff told us they supported people to keep their houses clean, involving them in day to day upkeep of their home, where possible. Staff were aware of good practice on the use of personal protective equipment (PPE).

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly. The service did not always assess and manage cleanliness well. There was no evidence people had been harmed, however, at our first visit we found cleaning was not effective in some areas of the home. In the main kitchen we found the cooker, cupboards and some fridge seals were not clean.

Three people’s en-suites required cleaning. Some cleaning products containing chemicals were kept in the cellar, which was very damp. Mops were stored in a bucket rather than being rinsed and stored upright to dry.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading. The service did not always assess and manage cleanliness well. There was no evidence people had been harmed, however, at our first visit we found cleaning was not effective in some areas of the home. In the main kitchen we found the cooker, cupboards and some fridge seals were not clean.

Three people’s en-suites required cleaning. Some cleaning products containing chemicals were kept in the cellar, which was very damp. Mops were stored in a bucket rather than being rinsed and stored upright to dry.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. People and relatives said staff involved them in planning, including when changes happened.

The provider understood and implemented the principles of STOMP (stopping over-medication of people with a learning disability, autism or both) and made sure people's medicines were reviewed by prescribers in line with these principles. People’s medicines and treatments were safe and met people’s needs, capacities and preferences and there were clear processes in place for the use of emergency medicines, such as epilepsy rescue medicines.

The provider had made improvements in relation to the safe handling and recording of medicines, and systems and processes were in place for their safe storage and administration. Staff received training in administering medicines and their competence was assessed.