Kent House Residential Home

Kent House is a residential care home providing personal care to 17 older people or people living with dementia at the time of the inspection. The service can support up to 25 people. Accommodation is arranged over three floors and a lift is available to assist people to get to the upper floors.

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

People told us they were happy and felt safe living at Kent House. One relative told us, “I can’t fault the care”. We found improvements had been made and people were no longer at risk of harm.

The registered manager had left the service in September 2022 and the provider was looking to appoint a replacement. No applications from appointable candidates had been received and the provider continued to seek a new manager. In the interim they had arranged for the service to been led by an experienced manager. The manager had worked with the staff team to make improvements at the service.

People were at the centre of everything that happened at the service and staff now worked as a team to ensure people received a good standard of care. Staff felt supported and appreciated.

There were enough staff with the required skills and experience to meet people’s needs. People told us staff were “helpful” and “They help me”. Relatives told us staff were, “nice and good and caring”, “friendly and responsive” and “They really do care”. They also told us staff were gentle when they supported people.

People’s needs had been assessed with them before they moved into the service. Risks to people had been assessed and care had been planned with them to keep them as safe as possible. People’s medicines were managed safely and people received the medicines and health care they needed to stay well. Staff knew how to identify safeguarding concerns and were confident to raise these with the provider and outside organisations.

People told us they enjoyed the food at the service. Meals were prepared to meet people’s needs and preferences.

Regular checks and audits had been completed and any shortfalls identified. Action had been taken to address these. When things had gone wrong the provider learnt lessons and took action to prevent them from happening again. People and their relatives had received an apology.

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 received visitors when they wanted to and went out with friends, family and staff.

The building had been adapted to meet people’s needs. It was clean and staff followed best practice guidance to protect people from the risk of the spread of infection.

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 15 December 2022). We applied a condition to the provider’s registration requiring them to send us a monthly report on the actions they had taken to improve the quality of the service. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. 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 undertook a focused inspection to review the key questions of safe, effective and well-led only.

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 changed from requires improvement to good based on the findings of this inspection.

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

Follow up

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

Kent House is a residential care home providing personal care to up to 25 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 18 people using the service. Accommodation is arranged over 3 floors and a lift is available to assist people to access the upper floors.

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

The management and oversight of the service continued to be inconsistent. There was no registered manager and the area manager was providing limited management support. Staff did not always follow the provider’s infection control policy when the area manager was not present at the service.

There had been some improvements within the service, but further improvements were required. Potential risks to people’s health and welfare had been assessed and the guidance for staff had improved to mitigate the risks.

Regular checks and audits had been completed on the quality of the service. When shortfalls had been found an action plan had been created to rectify the shortfalls.

There were enough staff to meet people’s needs, any gaps were covered by regular agency staff who knew people.

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 requires improvement (published 31 August 2022) and there were breaches of regulation.

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about cleanliness and risk management. The overall rating for the service has not changed following this targeted inspection and remains Requires Improvement.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

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

Follow up

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

Kent House Residential Home is a care home providing personal care to up to 25 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 21 people using the service. Accommodation is arranged over three floors and a lift is available to assist people to get to the upper floors.

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

Relatives view of the service varied. One relative told us they were angry and upset by the care their relative had received. Another relative told us their loved one was “well looked after”.

The service was not consistently well managed and this left people at risk. A poor culture had developed, and care was not always centred around people’s needs and equality and diversity rights. Records of people’s care were not accurate and complete.

Some areas of the service had improved since our last inspection. However, some areas had deteriorated, and others required further improvement. The provider’s checks and audits had identified shortfalls and where improvements had not been made. The registered manager had not followed the provider’s action plans to address all the shortfalls we found at the last inspection.

Sufficient action had not been taken to ensure people were consistently protect people from identified risks, including choking or injuring themselves. Lessons had not been learnt when things had gone wrong, such as following incidents. People had not been supported to remain as healthy as possible. There had been delays in contacting health care professionals or recognising changes in people’s health care needs.

Medicines management processes had improved, and people’s medicines were now stored and applied safely. People were offered a balanced diet. However, they had not been consulted about any changes they may want to the menu during the very warm weather. Assessments of people’s needs had been completed using recognised tools.

Staff recruitment processes had improved, and people were now protected from staff who were not of good character. People told us there were always enough staff on duty and the staff were kind and caring. Staff had been supported to develop the skills they needed to meet people’s needs.

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.

Some areas of the building had been redecorated since our last inspection and people told us they enjoyed using the garden.

The provider had demonstrated their duty of candour. They had apologised when things had gone wrong and invited relatives to work with them, to develop new ways of working to make sure issues did not arise again.

People, their relatives and staff had been asked for feedback on the service. People and relatives’ feedback in response to survey’s had been positive. The provider had noted a deterioration in staff’s experiences of the service and was working to address these.

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 inadequate (published 7 April 2022) and there were breaches of regulation. 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 some improvements had been made but they remained in breach of regulations.

Why we inspected

We carried out an unannounced focused inspection of this service on 16 February 2022. Breaches of legal requirements were found. We served warning notices in relation to safe care and treatment and good governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve staff recruitment processes.

We undertook this focused inspection to check the provider had acted to comply with the warning notices we served following the last inspection. We also checked they had followed their action plan. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

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.

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 changed from inadequate 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 Kent House Residential Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to identification and management of risks, record keeping, and monitoring and improving the quality and safety of the service at this inspection.

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

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Requires improvement’. However, this service remains in ‘special measures’. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Kent House Residential Home is a care home providing personal care to up to 25 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 21 people using the service. Accommodation is arranged over three floors and a lift is available to assist people to get to the upper floor.

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

People told us they were happy and felt safe living at Kent House. However, we found the service was not consistently well managed and this left people at risk. The registered manager did not know people well and did not have the required oversight of their care. The provider had not achieved their aim of continued improvement and the quality of the service had deteriorated since our last inspection.

Checks and audits of the service had not always been effective and some shortfalls we found had not been identified. The registered manager had not always completed the required actions to improve the quality and safety of the service. Staff had not always been recruited safely and checks on their character and conduct had not been consistently completed before they worked with people. When concerns had been identified by the provider, action had been planned to address these.

We did not find people had come to harm at the service however, action had not been consistently planned to protect people from identified risks, including choking, pressure ulcers and epilepsy. Medicines were not always stored or applied safely. People received their medicines when they needed them.

Infection control risks at the service were not consistently managed. For example, the registered manager allowed people into the building before confirming a negative COVID test result. They were not following national guidance for new people moving into the service and had not assessed and mitigated any risks in relation to this.

People had been asked for their views of the service and these were positive. Communication from the registered manager was not always clear. People were not always aware of changes at the service. Staff did not have all the information they needed to keep people safe and well. Including how to check pressure relieving equipment was working effectively.

There were enough staff working at the service to provide the care people needed. People told us staff were kind and caring and they felt safe in their company. Staff worked together as a team and shared their knowledge of people to provide their care consistently. The provider was open and honest about improvements they had identified and the action they were taking to make the improvements.

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 2 September 2017).

Why we inspected

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. This included checking the provider was meeting COVID-19 vaccination requirements.

We received concerns in relation to leadership, identifying and managing risks, the accuracy of records and the effectiveness of quality assurance processes. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. 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 changed from good to inadequate based on the findings of this inspection.

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 Kent House Residential Home on our website at www.cqc.org.uk.

We undertook this inspection at the same time as CQC inspected a range of urgent and emergency care services in Kent and Medway. To understand the experience of social care providers and people who use social care services, we asked a range of questions in relation to accessing urgent and emergency care. The responses we received have been used to inform and support system wide feedback.

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 monitor the service and will take further action if needed.

We have identified breaches in relation to identifying and managing risks, medicines management, infection prevention and control and safe staff recruitment at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

Special measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Kent House Residential Home provides accommodation and personal care for up to 25 older people and people living with dementia. The service is a large converted property. Accommodation is arranged over three floors and a lift is available to assist people to get to the upper floor. There were 21 people living at the service at the time of our inspection.

The registered manager was leading the service and was supported by a deputy manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the care and has the legal responsibility for meeting the requirements of the law. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People and their relatives told us they were very pleased with the service they received at Kent House Residential Home. One person’s relative told us, “It’s more home, than it is ‘a home’”. Staff were kind and caring and treated people with dignity and respect. One person’s relative told us, “[My relative] is well looked after, respected and loved. The staff have so much patience and empathy”. People had privacy and staff provided the supported their needed discreetly.

The service had been purchased by a new provider in February 2017. Many of the people had been living at the service since before this time. They told us they liked the improvements the new provider had made. Staff told us the changes the provider had made, such as introducing electronic care records, had improved people’s lives and given them more time to spend with people.

People were involved in planning what happened at the service. Staff and people planned the activities on offer at the service together. People told us they had enough to do every day and were planning outings. Some people continued to do domestic tasks they had done at home, such as dusting their bedrooms and laying the tables.

Assessments of people’s needs and any risks to them had been completed. Staff acted on health care professionals advice to manage risks. People's care was planned and reviewed with them to keep them safe and help them be as independent as possible. People were supported to have regular health checks such as eye tests.

People received the medicines they needed to keep them safe and well. They planned menus with staff and were offered a balanced diet. People told us they enjoyed the food and there was a wide variety of food on offer. Meals were prepared to meet people preferences and spiritual and cultural needs.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager had applied to the supervisory body for a DoLS authorisation when people who lacked capacity to consent were restricted. People were supported to go out and could move around the service and grounds freely. Staff followed the principles of the Mental Capacity Act 2005 (MCA) and supported people to make choices in all areas of their life.

Plans were in place to keep people safe in an emergency, including plans to evacuate people from the building. Staff practiced these regularly. Staff knew the signs of possible abuse and were confident to raise concerns they had with the registered manager or the local authority safeguarding team.

Systems were in place to manage complaints received. People and their representatives were confident to raise concerns and complaints they had about the service.

People, their relatives and visiting professionals were asked for their views of the service regularly. Everyone was satisfied with the service provided. Staff had regular opportunities to share their experiences of the service and told us the management team supported them to try new ideas they had.

The registered manager supported staff to provide a good level of care and held them accountable for their practice. Staff were clear about their roles and responsibilities. They shared the registered manager and provider’s view of a good quality service and were motivated.

Checks on the quality of all areas of the service had been completed to make sure they were of the standard the registered manager required. Action was taken quickly to address any shortfalls found.

There were enough staff, who knew people well, to provide the support people wanted. People’s needs had been considered when deciding how many staff were required to support them at different times of the day. Staff were clear about their roles and responsibilities and worked as a team to meet people’s needs.

The provider had recruitment procedures although no new staff had been recruited since the provider took over.

Staff had completed the training and development they needed to provide safe and effective care to people and held recognised qualifications in care. Staff met regularly with the registered manager to discuss their role and practice and were supported to provide good quality care.

Accurate records were maintained about the care and support people received and about the day to day running of the service. Information was available to staff to help them provide safe and consistent care to people.

Services that provide health and social care to people are required to inform the CQC, of important events that happen in the service like a serious injury or deprivation of liberty safeguards authorisation. This is so we can check that appropriate action had been taken. The manager understood when CQC should be notified of some significant events and we had received notifications are required.