Princess Louise Kensington Nursing Home

Princess Louise Kensington Nursing Home is a residential care home providing personal and nursing care to up to 44 people. The service provides support to older people, people living with dementia, and people requiring treatment of disease, disorder, or injury. At the time of our inspection there were 43 people using the service.

The care home accommodates 43 people in one adapted building over 3 floors. There were 2 units per floor, with units on the ground floor specialising in providing care to people living with dementia.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Right Support: 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. Staff supported people to make decisions following best practice in decision-making. Staff communicated with people in ways that met their needs.

Staff supported people to play an active role in maintaining their own health and wellbeing.

Right Care: People received kind and compassionate care. Staff protected and respected people's privacy and dignity. They understood and responded to their individual needs.

Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. The service had enough appropriately skilled staff to meet people’s needs and keep them safe.

Right Culture: People were kept safe from avoidable harm because staff knew them well and understood how to protect them from abuse. The service worked well with other agencies to do so. People could take part in activities and pursue interests that were tailored to them. The service gave people opportunities to try new activities that enhanced and enriched their lives. People were supported by staff who understood best practice in relation to sensitivities people with learning disabilities or autistic people may have. Staff knew and understood people well and were responsive, supporting people to live a quality of life of their choosing wherever possible.

At the inspection, we noted that the lift was faulty and did not go to the top floor. This was highlighted to the registered manager who immediately arranged for the fault to be fixed.

We observed that the home was clean, and people appeared comfortable with staff and care workers. People said that they felt safe at the service and thought it was a nice place to live. One relative said, “[Family member] is happy. The place is looked after. I am in touch with 5 other people who see [family member]. Everyone says how nice the home is.”

Care plans were person-centred and included information about support needs and aspirations. We saw care workers supporting people to socialise and take part in daily activities in a relaxed and unrestrictive manner.

People and their relatives said they thought the service was caring. One relative said, “The care if first class. They make [family member] very relaxed and content. Very impressed first-class team caring staff.

Regular face to face meetings were held with care workers, staff and relatives and people to ensure concerns or good practice was discussed and shared. Throughout the inspection we observed a friendly relaxed atmosphere. Relatives were free to visit people throughout the day.

People said that they thought the home was well-led. One health care professional said, “The home is well liked by families. After discharge to assessment have been completed, many families wish for [people] to remain in the home.”

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

Rating at last inspection

The service was inspected but not rated, the overall findings at the time of inspection was requires improvement (published 08 March 2022)

Why we inspected

The inspection was prompted by a review of information we held about the service.

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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

Staff received training and supervision of infection control practice, including observations of handwashing and were encouraged to discuss best practice at team meetings.

A full time member of staff had been recruited to carry out testing for COVID-19.

The provider had a large reserve of bank staff which meant they were able to respond to high numbers of staff shortages caused by a recent outbreak.

Princess Louise Kensington Nursing Home is a residential care home providing personal care and accommodation for up to 44 adults with complex continuing care needs. There were 41 people living at the service on the day we carried out our site visit.

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

People were not always being protected from avoidable harm. Although we did not observe people being mistreated during our site visit, a sustained pattern of whistleblowing allegations and an incident of abuse witnessed by the registered manager mean that we can not be assured that people are safe all of the time.

People's medicines were safely managed.

People were protected from the transmission of infectious diseases including COVID-19 and the service was complying with government policy for safety within care home settings.

The registered manager ensured detailed audits were undertaken and took appropriate action where improvements were required.

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 good (published 23 March 2018). At this inspection, the overall rating for this service is requires improvement.

Why we inspected

We received concerns in relation to how the provider protected people from the risk of abuse, neglect and harm, including how people were safely supported with medicines and their moving and positioning needs. Concerns were also brought to our attention as to whether the service was managed in a transparent, proper and safe manner. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 coronavirus and other infection outbreaks effectively.

We have judged that the provider needs to make improvements in the key area of safe. We made a recommendation in relation to learning from past incidents and reporting procedures. Based on our findings at this inspection, and in conjunction with the ratings from our previous comprehensive inspection for the key questions of effective, caring and responsive, the overall rating for this service has now changed from good to requires improvement.

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

At this inspection we found improvements had been made in relation to medicines management. People using the service and their relatives told us staff were kind and caring and that the service had improved. However, plans to re-install kitchen facilities within the home had stalled. This meant the service was unable to provide meals that were freshly prepared and cooked on site. People’s views were not always positive when asked to comment on the quality of the food provided at mealtimes.

We rated the service ‘Good’ overall.

This inspection took place on 22 and 26 February 2018. The first day of the inspection was unannounced. The registered manager was informed that we would be returning for a second day to complete our visit.

Princess Louise Kensington Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service is set out over three floors and provides nursing and accommodation to 44 adults with complex continuing care needs. An NHS rehabilitation unit occupies most of the ground floor and is operated as a separate registered service which was not visited as part of this inspection. Two upper floors are divided into four units. The first floor is primarily for people living with a diagnosis of dementia with the second floor providing nursing care and support to elderly frail residents. The home is fully accessible, with a lift serving all floors. There were 40 people living at the home at the time of inspection.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Where possible, people were involved in decisions about their care and how their needs would be met. Where appropriate, relatives and healthcare professionals contributed to the care planning process.

Systems were in place to identify and reduce risks to people living in the home. Risk assessments and management plans were in place to mitigate risks in relation to people’s mobility, nutrition, personal care, physical and mental health and well-being.

People were protected from avoidable harm and abuse because the provider had effective safeguarding systems in place. Staff understood how to recognise the signs of abuse and told us they would speak to nurses and the registered manager if they had concerns about a person’s safety or welfare.

People's medicines were managed and administered safely. People's current medicines were recorded on medicines administration records (MAR) along with their allergy status in order to prevent any inappropriate prescribing. Medicines audits were completed weekly and checked by senior staff members.

The service was complying with the Accessible Information Standard (AIS). The AIS applies to people using the service who have information and communication needs relating to a disability, impairment or sensory loss.

Recruitment practices ensured the right staff were recruited to support people to stay safe. Staff were appropriately trained and skilled to care for people and understood their roles and responsibilities. Staff received supervision and guidance where required and confirmed they felt supported by the registered manager.

Staff had received training on the Deprivation of Liberty Safeguards (DoLS) and the Mental Capacity Act 2005 (MCA). These safeguards are there to make sure that people receiving support are looked after in a way that does not inappropriately restrict their freedom.

People's human rights, privacy and dignity were respected and promoted. Staff told us they always asked people’s permission before providing support and respected people’s individual preferences.

Staff supported people to attend healthcare appointments as required and liaised with people’s relatives, GPs and other healthcare professionals to ensure people’s needs were met appropriately.

The provider maintained positive relationships with multi-disciplinary professionals, commissioning and safeguarding teams.

Staff sought advice and guidance from palliative care teams when needed to ensure people remained comfortable and supported at the end of their lives.

The service employed a full-time activities co-ordinator and a range of one to one and group activities took place within the home. Staff demonstrated a good knowledge of the people they cared for and encouraged them to maintain their usual routines.

People and their relatives, visitors and staff were asked for their views about the running of the service via regular meetings, feedback forms and annual surveys. People were positive about the home environment and the support they received from staff.

People and their relatives felt able to raise concerns and were confident that any issues would be dealt with satisfactorily and in a timely manner.

Monthly audits were carried out across various aspects of the service; including the administration of medicines, care plans, infection control and health and safety checks.

Good infection control practices were followed. The home was clean and tidy and free from any unpleasant odours.

We have made one recommendation in relation to meeting people’s nutritional and hydration needs.

Princess Louise Kensington Nursing Home is set out over three floors and provides nursing and accommodation to 45 adults with continuing care needs. An NHS rehabilitation unit occupies most of the ground floor and is operated as a separate registered service which was not visited as part of this inspection. Two upper floors are divided into four units. The first floor is primarily for people living with a diagnosis of dementia with the second floor providing nursing care and support to elderly frail residents. The home is fully accessible, with a lift serving all floors. There were 40 people living at the home at the time of inspection.

The service had a manager in post that had completed the application and interview process to become the registered manager of the home. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Medicines were not always being recorded and stored safely. Following a discussion with the registered manager we were informed that systems to better manage people’s medicines would be implemented to ensure that people consistently received their medicines safely, and as prescribed.

Where possible, people were involved in decisions about their care and how their needs would be met. Where appropriate, family members and health and social care professionals contributed to the care planning process. People using the service and their relatives held various different views in regards to the care their family members received, comments were not always positive in regards to staff and the support received.

Risks to people had been identified and management plans were in place to mitigate these risks. A range of risk assessments were completed in relation to the environment, people’s mobility, pressure area care, physical and mental health and well-being.

Steps had been undertaken to help ensure staff were safe to work with people living in the home. Staff were appropriately trained and skilled to care for people and understood their roles and responsibilities. Staff received supervision and guidance where required. Staff confirmed they felt supported by the manager who we were told was accessible and approachable.

Staff received training in safeguarding adults and policies and procedures were in place for staff to follow if they suspected harm. Staff understood how to recognise the signs of abuse and told us they would speak to nurses and the manager if they had concerns about a person’s safety or welfare.

Staff had received training on the Deprivation of Liberty Safeguards (DoLS) and the Mental Capacity Act 2005 (MCA). These safeguards are there to make sure that people receiving support are looked after in a way that does not inappropriately restrict their freedom. Services should only deprive someone of their liberty when it is in the best interests of the person and there is no other way to look after them, and it should be done in a safe and correct way.

Staff supported people to attend healthcare appointments as required and liaised with people’s family members, GPs and other healthcare professionals to ensure people’s needs were met appropriately.

People were provided with a choice of food and drink, and were supported to eat when this was needed. However, people’s views varied when asked to comment on the quality of the food provided at mealtimes. People’s dietary needs and preferences were not always respected and catered for. There were plans to re-install kitchen facilities in the near future so that all meals could be prepared on site.

The service employed a full-time activities co-ordinator and a full range of activities took place within the home.

Monthly audits were carried out across various aspects of the service; these included the administration of medicines, care plans, infection control and health and safety checks.

There was a complaints policy which the registered manager followed when complaints were made to ensure they were investigated and responded to appropriately. People and their relatives felt able to raise concerns and were confident that any issues would be dealt with satisfactorily.

People and their relatives, visitors and staff were asked for their views about the running of the service via regular meetings, comment feedback forms and surveys.

We made one recommendation in relation to medicines.