Archived: Kingdom House

Kingdom House is comprised of two separate services managed from one location, Kingdom House and Butterfields Home Services. Kingdom House is a residential care home registered to provide personal care for up to three people with a learning disability and/or autism. One person lived there when we visited.

Butterfields Home Services is a domiciliary care agency. It specialises in providing end of life care services for people in their own homes across Somerset. At the time of our inspection they were supporting 45 people who were reaching the end of their lives. People are referred to Butterfields Home Services by Somerset Continuing Health Care (CHC) team following an assessment of their end of life needs. The service provides multiple day time visits and night sitting services, according to people's changing needs. The agency is in the process of moving to a new location in Wellington. The Care Quality Commission (CQC) are processing a registration application from provider to manage personal care from this new location.

At a previous inspection in November 2019 widespread concerns were identified about safety and leadership at the service. Seven breaches of regulations found relating to recruitment, safe care and treatment, staff skills, quality monitoring systems and failures to notify CQC.

Since the last inspection the operations director had taken over the role of managing and reorganising both services. They were working with the provider to reorganise the service and arrange for Butterfields care agency to move to a dedicated office, separate from the care home. They had applied to the Care Quality Commission to become the registered manager of both services. People’s experience of using this service and what we found.

People, relatives, staff and commissioners all reported improvements since the last inspection. Comments included; “Its improved greatly,” “We consistently receive good feedback from families about the end of life care service” and “The provider has continued improvements to deliver a service that is of a high standard.” People and families praised staff and the quality of care. Comments included; “Staff are so dedicated’,” “You get to know them, (staff) and develop that relationship.”

Key staff had been appointed to lead and support the staff teams and improve training and supervision. Improvements in recruitment had been made so people were supported by staff with the right skills and attitudes

People received a safe effective service because training, supervision and ‘spot checks’ ensured staff had the qualifications, competence, skills and experience to provide people with safe care and treatment. Risk management systems had improved and people’s risk assessments and care plans provided staff with more detailed, up to date information about how to safely care for each person.

People felt safe with the staff who supported them and received their prescribed medicines safely and on time. Staff understood the signs of abuse and felt confident any safeguarding concerns reported were listened to and responded to. We were assured the service were following safe infection prevention and control procedures to keep people safe with regard to the current COVID 19 pandemic. The service had ongoing monitoring arrangements to ensure all aspects of infection control followed best practice guidance.

Staff monitored people's health and wellbeing and worked with other professionals to make sure people received the treatment they required.

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 guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. Improvements had been made to the environment at Kingdom House to make it more suitable and accessible to the person who lived there. Experienced staff worked with the person, family and specialist professionals to review, personalise and improve the person’s care.

Staff spoke about ways they promoted the person to be more independent and try new experiences. Staff said, “We are always thinking about how we can enhance life of [Name of person].” [Person] is doing a lot now, loves their new activity room, has freedom and goes out a lot, they are happy.” A relative said, I have absolute confidence with [person’s] team, staff are so dedicated and meet their needs well.”

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 felt well supported and reported improved communication, team working and staff morale. Where mistakes were made, staff were supported to learn lessons and improve practice through further training and support.

Improved quality assurance and monitoring systems were being used effectively to make continuous improvements and ensure the provider had a good oversight of the safety and quality of the service. All seven breaches of regulations found at the previous inspection had been addressed.

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

Rating at last inspection: Requires improvement. (Report published December 2019). At this inspection the rating has improved to Good.

Why we inspected

This was a focused inspection to check whether improvements had been made since we last visited. 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 reviewed the Safe, Effective, Responsive and Well-led domains only. Our report is based on the findings in those areas at this inspection. The ratings from the previous comprehensive inspection for the Caring key question was not looked at on this occasion.

Follow up: 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.

Kingdom House is comprised of two separate services based at the same address. Kingdom House is a residential care home which is registered to provide personal care for up to three people with a learning disability and/or autism. One person lived there when we visited. It is a two-storey domestic home in a residential area.

The second service, Butterfields Home Services is a domiciliary care agency, which is managed from an upstairs office at the home. This service was previously registered at a different address. It moved to Kingdom House and started operating in January 2019, following a period of dormancy. It now specialises in providing end of life homecare services for people in the last weeks of life in the Taunton, Wellington, Minehead, Ilminster, Chard and Yeovil areas. People are referred to Butterfields Home Services by Somerset Continuing Health Care (CHC) team, following an assessment of their end of life care needs. The service includes multiple day time visits and night sitting services, according to people’s changing needs.

Since the last inspection the previous registered manager had died. A new registered manager had been appointed but four attempts to recruit and register a second manager to manage the domiciliary care agency were not successful. On the first day of the inspection, a new care manager had been appointed and was undergoing induction.

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

A lack of management support and changes to the agency to provide end of life care without the proper support systems in place had destabilised the service and created potential risk to people’s quality of care and safety.

People were at increased risk because many of the quality monitoring systems previously in place had lapsed. This meant the provider had not sufficiently mitigated risks relating to the health, welfare and safety of people using the service. During the inspection, we identified seven breaches of regulations in relation to safe care and treatment, good governance, staffing, recruitment and a failure to notify Care Quality Commission in three areas. Further actions were needed to address risks and make required improvements.

People said they felt safe and we found no evidence that people had been harmed. However, systems were either not in place or were not robust enough to demonstrate safety was effectively managed. People's care records and risk assessments lacked detail to instruct staff about their care and treatment needs. For example, about moving and handling, pressure ulcer prevention and equipment risks. Newly recruited staff were not thoroughly checked before they began to work with people, staff performance concerns were not followed up robustly.

People were at increased risk of not receiving effective care. The provider systems did not ensure staff had the qualifications or competencies, to enable them to carry out their role. Staff did not receive all the appropriate support, training, supervision and appraisals needed for their ongoing development.

Homecare agency records did not provide detailed personalised information about people’s current care and treatment needs. For example, re catheter care, moving and handling needs or about how to manage a skin wound. There was also a lack of personalised details about each person, which would make it harder for staff to get to know them.

Kingdom House has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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. Although staff understood principles of best interest decision making, for people who lacked capacity, improvements in documentation were needed to capture best interest decisions.

People and relatives praised the care people received and said staff were caring and compassionate, and treated people with dignity and respect. They said the service was responsive to their needs.

Following the inspection, the provider sent us an action plan of improvements already under way, and outlined the steps they planned to take to make further improvements

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

Rating at last inspection - This is the first inspection of Butterfields Home Care services, since the agency was registered at Kingdom House in October 2018 and started operating in January 2019. Previously, these services were registered at separate addresses when we last inspected them. Kingdom House was rated Good (April 2018). Butterfields Home Care Services was rated Good (report published 2017).

Why we inspected

The inspection was brought forward because of concerns raised with the Care Quality Commission about poor recruitment, leading to potentially unsuitable people working with vulnerable people. Also, a lack of staff training, particularly in relation to medicines management, moving and handling autism and the use of restraint. Concerns were also raised about leadership and quality monitoring at the service. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Following the inspection, the provider sent us an action plan outlining steps being taken to address these risks.

The overall rating for the service has changed from Good to 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 Kingdom House and Butterfields on our website at www.cqc.org.uk.

Follow up

We will request an updated action plan for 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.

This was the first inspection of the service since it registered with the Care Quality Commission in June 2016.

Kingdom House 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 care home is able to accommodate up to three people and specialises in the care of people who have a learning disability. At the time of the inspection there were two people living at the home

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a registered manager 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.

The management team worked alongside care staff which enabled them to constantly seek people’s views and monitor the quality of the service offered. Staff and relatives described the management of the home as very open and approachable.

There were adequate numbers of well trained and experienced staff to ensure people received the care and support they required. The service was flexible to meet people’s changing needs and wishes.

People were cared for by staff who were kind and caring. One relative told us, “The staff are all lovely and friendly I just can’t fault them.” Throughout the inspection we observed staff interacted with people in a friendly and caring way. Staff talked about people with genuine affection and obviously knew the people they cared for extremely well. One member of staff said, “It’s bit like family really.”

People received their care and support safely because staff followed risk assessments to enable people to take part in day to day life and activities with minimum risk to themselves and others. Risks of abuse to people were minimised because staff knew how to recognise and report concerns and the management team took all concerns seriously.

The staff worked in partnership with other professionals to assess and plan people’s care. There was a small and consistent staff team who knew people well and how they liked to be supported. Relatives told us they were kept up to date and involved in all decisions about their relative’s care.

People were cared for by staff who felt well supported and received the training needed to effectively meet people’s needs and maintain their safety. Staff were positive and well-motivated which helped to create a happy atmosphere for people to live in.

People were supported to maintain good health and well-being. People had access to healthcare professionals to meet their individual needs. One relative told us, “With medical needs they [staff] are spot on.” Staff knew how to support people who were unable to make decisions for themselves and acted in accordance with the law.