Kenward House

Updated 13 August 2019

Kenward House is owned and operated by the charity Kenward Trust.

Kenward House provides residential rehabilitation programmes for men and women recovering from alcohol and drug dependencies. Usually, the service used two different buildings, Kenward House to accommodate males and Naomi to accommodate females. However, prior to the inspection, the provider had made the decision to close Naomi due to low occupancy levels. Therefore, at the time of our inspection, both men and women were accommodated in Kenward House. Women had been allocated bedrooms on the first floor and men were allocated bedrooms on the ground floor. Bedroom doors could be locked and had ensuite bathrooms so that the dignity and privacy of residents was maintained. At the time of the inspection there were five male residents and five female residents.

Since our warning notice in February 2019, the provider had installed a wet room and fire doors had been repaired in Naomi. However, concerns remained as to whether the building was fit for purpose due to steep, narrow staircases and the general state of the bedrooms. After the inspection, the provider confirmed that Naomi would remain closed for the foreseeable future and they would advise CQC if this situation changed.

Kenward House has 31 bedrooms including 22 single bed en-suite rooms. There is a chair lift so that clients with mobility issues could access the building. There is a range of rooms in the building including two TV rooms, an arts and crafts room, counselling room, quiet room and a group room. The TV lounge on the first floor became a female only lounge after 8pm.

There is an education centre where staff supported clients to use computers to access education and training, courses including the driver theory test, creating CVs, job search and social housing applications. The building is also used as a recreation room and contained a darts board, games and a pool table.

Kenward House provides a recovery-based programme that combines elements of the 12-step model, cognitive behavioural therapy, personal objective setting and life skills development. The treatment programme is delivered over a period between six and 24 weeks, dependent upon funding. A dedicated team provides social enterprise activities.

Kenward House accepts self-referrals, although most of their referrals were from professionals.

Kenward House is registered for the regulated activity: accommodation for persons who require treatment for substance misuse since 19 April 2011.

In February 2019, Kenward House was issued with two warning notices that related to the following regulations under the Health and Social Care Act (Regulated Activities) Regulations 2014:

Regulation 12, Safe Care and Treatment

Regulation 17, Good Governance

We had serious concerns about the safety of patients due to a lack of robust assessment and planning relating to the safety, health and well-being of clients; lack of adherence to the providers admission criteria; environmental risks; a lack of skilled and experienced staff and a lack of robust governance processes to oversee the quality and safety of the service.

The current manager registered with CQC on 27 May 2015.

Updated 13 August 2019

In February 2019 we undertook a comprehensive inspection of Kenward House. We did not publish a report following the inspection, as we were unable to produce a report within our timeframes. However, we did issue two warning notices to the provider because we had serious concerns about the safety of patients due to a lack of robust assessment and planning relating to the safety, health and well-being of clients; lack of adherence to the providers own admission criteria; environmental risks; a lack of skilled and experienced staff and a lack of robust governance processes to oversee the quality and safety of the service.

We undertook a comprehensive inspection on 1 July 2019. During the inspection we looked at whether the provider had made the improvements required to comply with the regulations.

During this inspection we found that the provider had acted on the warning notice and made the improvements required.

We rated the rated Kenward House good because:

• Risk assessments were comprehensive and tailored to the needs of individual clients. Risk assessments included consideration of physical health, mental health, social, substance misuse, financial and criminal justice history. The majority of staff had completed risk assessment training.
• The service had appropriate equipment available to support the monitoring of physical health. This included weighing scales and blood pressure monitors. Staff had completed training in the management of diabetes and epilepsy.
• Staff completed monthly environmental health and safety audits., Documentation had been improved and actions were now easily identifiable. Work was taking place to improve the décor in the bedrooms and ensure essential repairs and maintenance was completed in a timely manner. The door to the main kitchen was kept locked.
• The provider had introduced a ligature point risk assessment guidance and confirmed that staff had now completed environmental ligature point risk assessments.
• The provider had made changes to improve the admissions process to make sure the service was able to meet the needs of clients.
• There was a comprehensive system to manage planned and unplanned exit from treatment. It included information about what staff should do if a client left the service before they had completed their treatment.
• An inspection by the fire service had taken place and the provider now complied with. The Regulatory Reform (Fire Safety) Order 2005.
• Staff issued clients with wrist alarms so that clients could contact them in an emergency.
• Staff reported incidents appropriately. Managers investigated incidents and shared lessons learned with staff and the wider service. Staff completed a root cause analysis for serious incidents. We saw an example of learning from medicine incidents shared with staff.
• Managers completed regular audits of care records to make sure that staff were adhering to the provider’s health and wellbeing strategy and that client records were accurate and up to date. In addition, there was an annual audit programme and effective oversight mechanisms to ensure improvements were made.
• The provider used systems and processes to safely prescribe, administer, record and store medicines. Medicines errors were minimal and were reported, investigated and lessons learned.
• Staff had a good understanding of safeguarding procedures and knew what to report and how to report it. The provider was in the process of reviewing its policy at the time of the inspection.
• There was a comprehensive group activity programme between 9am and 4.30pm Monday to Friday. The provider had developed links with the careers service who facilitated basic literacy and numeracy courses at the service. Social enterprise projects were available for clients to increase their recovery and support their return to independent living.
• Clients said that staff treated them with compassion, dignity and respect. They said that staff were supportive in their recovery journey and the treatment had changed their life.
• The provider produced a regular newsletter with information about the service and forthcoming events. The service planned to introduce an information pack for families and carers of clients.
• Managers were visible, approachable and had the knowledge and experience to perform their roles. There was a clear framework of what should be discussed at team, manager and board level to ensure that essential information was shared. The chief executive attended weekly meetings to provide service updates for staff. There was commitment towards continual improvement and innovation. Staff were able to contribute to the strategy and service development.

However:

• Information provided by the service showed that only 66% of staff had completed mandatory training. Less than 50% of staff had completed the training for self-harm and suicide, mental health first aid, and naloxone. Staff had not completed training in the Mental Capacity Act. After the inspection, the provider confirmed that it had made arrangements for staff to complete this training.
• Records of admission panel meetings lacked detail and did not provide a clear rationale of the decision-making process about whether clients should be admitted or not.