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We are carrying out a review of quality at Kings Hill. We will publish a report when our review is complete. Find out more about our inspection reports.

Inspection Summary


Overall summary & rating

Inadequate

Updated 29 April 2021

About the service

Kings Hill is a domiciliary care service providing personal care to people in their own homes. At the time of the inspection there were four people receiving personal care. This included older people and people with a learning disability. Care and support hours varied from a few hours a week to 24 hours a day. Care and support were provided in West Kent and Medway.

CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

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 not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. Staff did not always have access to information about people’s past history which helps to provide person-centred care. It was not clear who was managing the service as there was no registered manager in post. There were no checks on the care and treatment provided to one person who was not always able to express themselves clearly.

People’s experience of using this service

There continued to be widespread shortfalls in the way the service was led as the provider did not have full oversight of the service. There continued to be no registered manager, the nominated individual was absent, and it was unclear who was managing the service in their absence. A positive culture was not consistently promoted throughout the service.

We raised a safeguarding with the local authority before the inspection visit as we were unable to contact the provider or anyone else at the agency for four days.

Quality monitoring systems continued to be insufficient to identify shortfalls and drive continuous improvement in the service. Shortfalls in risk management, records, medicines and providing person-centred care continued at this inspection. In addition, we found shortfalls in staffing and staff recruitment.

Staff who worked alone were not regularly checked to make sure they had the skills necessary for their role to provide a satisfactory standard of care. Records about people’s care were not audited to ensure staff responded appropriately to people’s changing needs. People’s records were not always available to staff.

People were at potential risk of harm as there continued to be a limited approach to assessing and acting on risks to people’s safety. This included not identifying potential hazards at people’s homes, and not acting to minimise risks when they had been identified.

Staff training records showed staff were up to date with all mandatory training. However, it was not possible to concur all staff had been trained as there was not a definitive list of staff who supported people. The provider had not regularly checked medicines records or staff’s competency in administrating medicines.

Some staff had started to support people unsupervised, before their suitability to work with vulnerable people had been checked.

The views of people, relatives, staff and health and social care professionals had not been actively sought to make improvements to the service.

Feedback from a relative was that they would recommend the service and the provider responded when they contacted them.

Staff knew people well and said that the staff team worked well together. They said other team members and the provider was easily contactable for advice and support.

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 11 May 2020). The provider had sent us an action plan after the last inspection to show what they would do, and by when, to improve. At this inspection not enough improvement had not been made and the provider was still in breach of multiple regulations.

Why we inspected

We carried out an announced inspection of this service on 1 February 2021. This was a focused inspection to check the provider 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 of Safe, Responsive and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Inadequate. 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 Kings Hill 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 breaches in relation to quality monitoring, assessing risk, medicines, providing personalised care, records, staffing levels, staff recruitment, protecting people from harm and changes to the provider’s registration.

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

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.

Inspection areas

Safe

Inadequate

Updated 29 April 2021

The service was not safe.

Details are in our safe findings below.

Effective

Requires improvement

Updated 29 April 2021

Caring

Requires improvement

Updated 29 April 2021

Responsive

Requires improvement

Updated 29 April 2021

The service was not always responsive.

Details are in our safe findings below.

Well-led

Inadequate

Updated 29 April 2021

The service was not well-led.

Details are in our safe findings below.