Kingsway Care Home

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and 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 supporting people with a learning disability and autistic people and providers must have regard to it.

About the service

Kingsway Care Home is a residential care home providing personal care to 11 people. At the time of the inspection 9 people were living at the home. The service provides support to people with a learning disability and autistic people. People had their own bedrooms with en-suite bathroom and shared communal facilities in 2 lounges, dining areas and landscaped gardens.

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

Right Support

Systems and processes to ensure good management oversight required improving. The provider had not recognised safeguarding incidents when people became upset with each other. The provider had recorded and investigated the incidents and taken appropriate action to keep people safe. However, they had failed to inform the local authorities of the physical altercations between people because they had not recognised some behaviours had met the threshold for a safeguarding alert.

Risks to people had been assessed and people’s care plans had been regularly reviewed and updated. Staff supported people to maintain their health and wellbeing by accessing healthcare services. Staff knew their legal responsibilities to keep people safe.

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.

Right Care

People's needs were assessed prior to them receiving care and support from the service. Staff understood how to promote people's independence and ensured the care they provided treated people with dignity and respect. People were supported to express their views. People's communication needs had been considered and met. People’s medicines were managed safely. The provider had sufficient infection, prevention and control measures in place and staff had access to a good supply of personal protective equipment.

Right Culture

It was clear the registered manager, the general manager and all the care staff cared passionately about the people they supported at Kingsway Care Home. People and their family members told us how supportive the provider was and how much they enjoyed living at the home. Regular feedback was sought from family members. Staff felt supported by the provider. Complaints had been listened to and acted upon.

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 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last 2 consecutive inspections.

Why we inspected

This inspection was prompted by a review of the information we held about this 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.

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

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

Enforcement and Recommendations

We have identified breaches in relation to safeguarding people from potential risk harm at this inspection and a failure to notify.

We have made a recommendation about advanced safeguarding training for the management team and care home staff to aid their understanding.

The provider has taken immediate action to mitigate the risk.

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.

Kingsway Care Home provides personal care (without nursing) for up to 11 people with a learning disability or autism. The home is adapted from a domestic residential property and does not present externally as a care home.

The service had not been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance as it initially opened before this guidance became available. Registering the Right Support 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. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 11 people. Ten people were using the service at the time of our inspection. This is larger than current best practice guidance, but the size of the service having a negative impact on people was mitigated by the home fitting into the residential area where it was sited. There were no identifying signs, with only the industrial bin indicative this was other than a family property. Staff did not wear anything that suggested they were care staff when coming and going with people, with use of domestic, family style cars for transport.

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

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

The service didn’t always apply the principles and values of Registering the Right Support (RRS) and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people did not fully reflect the principles and values of RRS for the following reasons; Some people’s perception was they did not always have a choice as to daily routine and their involvement in care planning could be improved. We saw the staff had sought people's views and preferences however and there were best interest decisions in place for use of any restrictions to keep people safe. There were many areas where we saw people had choice though.

People and relatives told us they had a positive experience in respect of the care and support they received. They told us they received support from staff in a timely way and were not kept waiting for assistance. We saw people looked comfortable in the presence of staff and people told us they felt safe at the home. Staff were knowledgeable about potential risks to people and were able to tell us how these would be minimised.

People were supported by staff who were kind and caring and staff were seen to respect people and promote their privacy, dignity and independence. People and staff had a warm, friendly relationship.

People were supported by care staff who had a range of skills and knowledge to meet their needs, although would benefit from further training in core areas of knowledge, which the provider had planned. Staff understood their role, felt confident and well supported. Staff received supervision and felt supported by the provider. People's health was supported as staff worked with other health care providers to ensure their health needs were met.

Staff were knowledgeable about people’s needs and preferences. People’s records needed improvement to reflect people’s involvement and how the care we saw was planned. The provider was working to develop more accessible care records, but we heard from people they had limited involvement in these documents.

People were not always sure how to complain but their relatives did. The current complaints procedure was not in accordance with the Accessible Information Standard. Staff knew how to identify and respond if people were unhappy with the service. People were able to communicate how they felt to staff, and said staff were approachable and listened to what they had to say. Relatives told us when they had raised concerns these had been addressed appropriately.

People, relatives and staff overall gave a positive picture as to the quality of care people received and said management and staff were approachable.

Quality monitoring systems had improved although there was scope to continue this improvement and the provider had employed a consultant to review these and gave an objective view of the service. The provider was honest and open with us about the service, barriers to improve and what they could do better.

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 13 April 2019). 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 improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

The inspection was prompted in part due to the concerns we had at the previous inspection in respect of fire safety, risk assessment, care planning, gaining consent, medicines, staffing and Governance. This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well led sections of this full report.

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

Follow up

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

Kingsway Care Home provides accommodation for up to eleven people who need help with their personal care. The home supports people who live with a learning disability and other complex support needs. At the time of the inspection eleven people lived in the home. The home has a combined communal lounge and dining area, a second quiet lounge for people to share and a back garden for people to enjoy.

People’s experience of using this service:

The overall rating for this service is ‘inadequate’ so therefore the service is in special measures. This was because the service was found to be in breach of Regulations 9, 11, 12, 17 and 18 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

There was no adequate or effective systems and processes in place to monitor the quality and safety of the service. This resulted in people being exposed to ongoing risks with regards to their care.

The provider’s fire safety arrangements were unsafe. There was no evidence that any staff had practiced how to evacuate people from the home in an emergency for over two years. People who lived in the home also did not have personal emergency evacuation plans in place. This meant should an emergency arise, emergency personnel would not have important information about people’s needs and support requirements in an emergency situation.

People’s needs and risks were not properly assessed or managed. Where people had health conditions, their care plans did not always contain sufficient information about these conditions and the support they required.

Records showed that the support some people received was inconsistent and unreliable. People’s care was not personalised to their needs as staff lacked adequate information on what these were in order for them to do so.

People’s support was not always appropriate. CCTV was used to monitor people’s movements in communal areas without their consent and the language used in some care records was not very respectful.

Where people’s capacity to consent to decisions about their care was in question, the provider had not always followed the Mental Capacity Act 2005 to ensure that any decisions made on people’s behalf were legally consented to and in the people’s best interests.

The management of medication was not safe and the manager failed to demonstrate that they understood safe medication practices within the home.

The provider’s complaints procedure did not meet the Accessible information standard and did not provide relevant information to people on how to complain to in the most suitable way for them to understand.

There was little evidence that information about the service such as accident and incident information, safeguarding and resident meetings were used to learn from and improve the service.

Information in respect of people’s eating and drink needs was limited and the preparation of one person’s special diet did not follow recommended advice. People told us they were happy at the home and said they got enough to eat and drink. During our inspection, we saw that staff members treated people kindly and with respect.

People had the support of other health and social care professionals. For example, dentists, opticians, GP’s as well as specialist medication teams for any medical conditions.

Staff told us they felt supported by the manager and records showed staff received supervision in their job role. Staff received training and training was up to date.

Regular meetings took place with people who lived at the home and their views and opinions on the activities they would like to become involved in sought. We saw that people enjoyed a range of social and recreational activities. For example, knitting, horse riding, barbecues and college.

The atmosphere at the home was warm and homely.

You can see what action we told the provider to take at the back of the full version of the report.

Rating at last inspection and why we inspected: This was the first inspection of the service since it registered as a regulated provider with CQC as El Shaddai Limited. It was previously registered under a different name.

Follow up: Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.

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.