Kensington Lodge

Kensington Lodge is a residential care home providing personal care to up to 18 people. The service provides support to people living with dementia, mental health conditions and age related frailties. At the time of our inspection there were 14 people using the service.

People’s experience of using this service and what we found

Quality assurance processes were not always effective to provide managerial oversight of systems and drive improvements. Areas of improvement highlighted from our last inspection were not fully resolved, records were not always confidentially stored. Audits of medicine management and the environment were not always accurate. It had not been identified some care records contained inconsistencies. The registered manager told us how they would make changes to make improvements on these issues

People’s health risks were not consistently assessed and managed safely. Some assessments were inaccurate, for example, where people had experienced weight loss, associated assessment tools were not always consistent with this. Despite the inaccuracies, care plans were detailed, reflected people’s needs and guided staff on how to safely support them. People told us they felt safe and were comfortable to speak with staff or the registered manager if they had any worries or concerns. One relative told us, “I’m thankful to all of them. She’s safe and she’s adjusted to being there. They’ve made a great effort with her.” Staff received safeguarding training and understood their duty on how to prevent and report potential concerns of abuse.

People received their medicines by staff who were trained and competent to administer them safely. People and their relatives were aware of any changes to their medicines. One relative told us, “It’s good and [registered manager] keeps us up to date.” People were protected from the risk of infection such as, the COVID-19 pandemic. Staff followed policies to keep people safe, wore personal protective equipment (PPE) and practised good hand hygiene. The registered manager told us they would review their policy of the continued use of face masks to reflect current government guidance.

People were supported by enough staff who knew them well. Staff were recruited safely and received training relevant to their role. People were complimentary of the care staff. One person told us, “I talk to them a lot. I know them.” A relative commented, “They’ve got to know [person] and me. They make an effort to chat. I have a good relationship with them. If I’m not able to go in, they ring and tell me how my relative has been. They’re lovely.”

People and their relatives were involved in planning their care and were given opportunities to give feedback on the service. People, their relatives and staff told us they felt comfortable to make suggestions, they were confident the management team would deal with any ideas or problems. Relatives told us staff and management kept them up to date with changes to their loved ones. One relative said, “The way they communicate with me, with the families. They make you feel very comfortable so you can talk freely with them.”

Staff and the management team worked closely with health and social care professionals to improve people’s care, safety and well-being. One visiting health care professional told us, “When I have asked them to review something they have always followed my instructions. Staff seem caring, I haven't had any concerns.”

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 19 November 2021). We found a breach of regulation 17 (good governance). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found the provider remained in breach of regulation 17.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We carried out an unannounced comprehensive inspection of this service on 15 October 2021. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Kensington Lodge on our website at www.cqc.org.uk.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement

We have identified a breach in relation to good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Kensington Lodge is a residential care home providing personal care for 16 older people, the majority of whom had a diagnosis of dementia. The service can support up to 18 people in one adapted building.

People’s experience of using this service and what we found

Staff were not following government guidance in all aspects of infection prevention and control. Staff were not wearing masks when working or supporting people in communal areas of the home. This put people at risk of infection.

The date of opening was not recorded on some medicines, so it was not clear when some topical creams or suspensions had started to be used. The temperature inside the medicines trolley was not monitored to ensure medicines were stored within safe limits. We found some confidential information had been left in a communal lounge. Records relating to people’s food and fluid consumption were not accurately maintained. Audits were generally effective in monitoring and measuring the care people received and the service overall. However, they had not identified all the issues found at this inspection.

These issues were addressed during the inspection. The manager confirmed by email to us what actions they had taken to tackle the concerns after the inspection.

There were sufficient staff to keep people safe. New staff were recruited safely.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were comfortable in the company of staff who were kind and caring in their approach. People were encouraged to be involved in all aspects of their care.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 22 August 2019).

Why we inspected

The inspection was prompted in part due to a concern we had received about infection prevention and control. A decision was made for us to inspect and examine the risks. When we arrived at the home we found that staff were not wearing masks when walking around the home or in communal areas.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well Led sections of this full report. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection. We discussed the issues that were of concern during the inspection, and the provider has taken steps to address these. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Kensington Lodge on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach in relation to good governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Kensington Lodge is a care home that provides personal care for up to 18 people in one adapted building. At the time of the inspection 16 people were living in the care home. Most people were living with dementia.

People’s experience of using this service:

People were supported by staff who had the skills and knowledge to meet their needs safely and effectively. Views of people, relatives and health professionals were valued and used to make improvements to the care and support people received.

People's care needs were being met in line with their personal preferences. The service responded promptly when people’s needs changed. The service worked very well with other health professionals to make sure people’s care needs were met.

People were actively involved, as much as they were able, in making decisions about their care. Where people were unable to make their wishes known, staff supported them in the least restrictive way and in their best interests.

Staff felt they were valued and respected by the registered manager and the deputy manager, who sought their involvement to improve and develop the service.

People were supported by staff who were caring, kind and thoughtful, who showed respect for dignity and privacy, and promoted independence.

The service was very well managed, by a registered manager and deputy manager who were described as, ‘very professional’ and, ‘brilliant’. Quality assurance systems, including audits, feedback from people who used the service, staff and health professionals were all used to make continuous improvements to the quality of the service people received.

Rating at last inspection: The last rating for this service was good (published December 2016).

Why we inspected: This was a planned inspection. The service was rated Good overall. This was based on the findings at this inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Kensington Lodge is a residential care home registered to provide accommodation and care for up to 18 older people with a variety of health needs, including people living with dementia and/or mental health needs. At the time of our inspection, 17 people were living at the home. Kensington Lodge is situated in a residential area of Rustington, with access to the seafront, local amenities and town centre. Except for one shared room, all bedrooms are of single occupancy with the majority have en-suite facilities. Communal areas comprise a large sitting room, quiet lounge and dining area, with easy access to outside space and patio area.

A registered manager was in post. 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 2008 and associated Regulations about how the service is run.

People said they were safe living at the home and staff had been trained to recognise the signs of potential harm and abuse; they knew what action to take. Risks to people were identified, assessed and managed appropriately and were updated on a monthly basis or as needed. Staffing levels were sufficient to meet people’s needs and keep them safe. New staff were vetted before they commenced employment to ensure they were safe to work in a health care role. Medicines were managed appropriately and medication audits and staff competency to administer medicines were carried out.

Staff were trained in a range of areas to provide effective care to people. New staff completed the Care Certificate, a universally recognised qualification. Staff had regular supervision meetings and annual appraisals; they attended staff meetings. Staff had received training in the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards and understood the requirements and their responsibilities to people under this legislation. People were supported to have sufficient to eat and drink and had a choice of food from a menu planned over a four weekly cycle. People had access to a range of healthcare professionals and services. The home had been adapted to meet the needs of people living with dementia.

People were looked after by kind and caring staff who knew them well. Relatives spoke highly of the staff and the management team. People were encouraged to be involved in all aspects of their care. When people became upset, anxious or distressed, staff supported them in a comforting and sensitive manner. People were treated with dignity and respect.

People’s care needs and the support they required from staff were documented in their care plans which were reviewed monthly. Activities were structured and included music and themed activities delivered by external entertainers, as well as activities organised by staff. Advice had been sought from the local authority on meaningful and stimulating activities for people living with dementia. Complaints were investigated, responded to and managed appropriately.

People and their relatives were involved in developing the service and their feedback was obtained through formal questionnaires. Staff were also asked for their views and felt supported by the management team. Quality was integral to the service’s approach and a number of compliments had been received from relatives and friends. A range of audits was in place to monitor and measure the quality of the service overall.

We looked at people's care records and found that they provided a comprehensive account of the care that had been delivered to people. The records assured us that people were receiving the care they required and that they had good access to external healthcare professionals.

When we observed lunch being served, we saw that staff provided appropriate assistance whilst also encouraging people to do as much as possible for themselves. Lunch looked nutritious, with locally sourced meat and fresh vegetables.

The home was clean. We saw that bedding was freshly laundered and free from stains. We noticed that the clothes people were wearing were clean.

Lavatories and bathrooms were clean and free from unpleasant smells. Waste was disposed of safely and appropriately.

People's records were well maintained and stored securely. Information that we requested was readily available and presented in a logical and easy to understand format.

We looked at feedback from relatives and saw that is was very positive. The majority of people living at the home were not able to talk to us about their experiences of living at the home but those that could told us that the home was a nice place to live. One person said, 'This is a lovely place; the girls are kindness itself. I have to behave myself or they might ask me to move somewhere else. I wouldn't want that.'

One of the relatives we spoke with told us that they visited regularly and had no concerns about the care and the way staff treated people. They said, 'I think it's a lovely place, not home but the next best thing.'

We had been contacted by a relative of a person who used to live at Kensington Lodge. They raised some concerns about the care people were being provided with at the home. We checked all the things they told us about and did not find any concerns about the issues they raised.

During our visit we observed care being given during the late morning and lunchtime period in the communal areas. We saw that staff treated people with kindness and patience. Staff were seen to be responsive to people's needs and wishes, treating them with respect as individuals.

We looked at the care records of four people. We saw evidence of up to date risk assessments and care plans based on the individual needs of each person.

We spoke with three members of staff who worked at the home. They all said they liked working there and felt there was always enough staff on duty for them to be able to meet people's needs.

When we looked round the home we saw that it was clean and well maintained. There was a calm and friendly atmosphere.

We undertook observation of care using the SOFI tool during the late morning and lunchtime and found the care given to be appropriate and safe. There was good interaction between the staff and the people living there. We observed that staff responded appropriately to people's requests for support.

The staff we spoke with were happy working at the home. They had received training and were familiar with procedures for safeguarding vulnerable adults from abuse.

Staff were aware of how to respect people's privacy and dignity, however, we found that people's privacy and dignity could not always be respected with regard to using the toilet in their own room. Our review of records showed that people's care was not always planned and delivered in line with their individual care plan. We also had concerns that the premises was not being adequately maintained.

There was an effective complaints system available. People had their comments and complaints listened to and acted on