The inspection was unannounced. At the previous inspection in November 2013, we found that there were no breaches of legal requirements.
Kingston House provides accommodation and personal care for up to nine adults with a learning disability. There were six people living at the home at the time of inspection, including older people with complex care needs. The accommodation is over two floors, but everyone had a downstairs bedroom as people were either wheelchair users or were not able to manage the stairs safely. There was a communal lounge, dining room and a garden with seating.
The home was run by a registered manager who was present on the day of our visit. 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 provider had taken steps to make sure that people were safeguarded from abuse and protected from risk of harm. Staff had been trained in safeguarding adults and knew what action to take in the event of any suspicion of abuse. Professionals told us that people were cared for in a way that ensured their safety.
Risks to people’s safety were assessed and managed appropriately. Assessments identified people’s specific needs, and showed how risks could be minimised. The manager also carried out regular environmental and health and safety checks to ensure that the environment was safe and that equipment was in good working order. There were systems in place to review accidents and incidents and make any relevant improvements as a result.
Medicines were managed and administered appropriately. People received their medicines as intended by their doctor.
The provider was effective in monitoring people’s health needs and seeking professing advice when it was required. Health care professionals said that staff always followed the advice that they gave. Assessments were made to identify people at risk of poor nutrition and for other medical conditions that affected their health.
People were supported to have a nutritious diet. A lot of care was taken by staff to make sure that people had enough time to enjoy their meals. Meal times were managed effectively to make sure that people received the support and attention they needed.
New staff received a comprehensive induction, which included shadowing more senior staff and an individual introduction to the care needs of each person at the home. Staff had regular training and additional specialist training to make sure that they had the right knowledge and skills to meet people’s needs effectively.
CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The Mental Capacity Act aims to protect people who lack capacity, and maximise their ability to make decisions or participate in decision-making. The Deprivation of Liberty Safeguards concern decisions about depriving people of their liberty, so that they get the care and treatment they need, where there is no less restrictive way of achieving this. Care plans contained mental capacity assessments and DoLS applications had been made for everyone who lived in the home to ensure that people were not deprived of their liberty.
People’s care, treatment and support needs were clearly identified in their plans of care. They included peoples choices and preferences. Staff knew people well and understood their likes and dislikes. Particular attention was paid to all staff understanding people’s past histories. Staff treated people with kindness, respect and compassion. Relatives and visitors all commented on the caring nature of the home and the positive relationships between staff and people who lived at the home.
People were offered an appropriate range of activities. As most people were not able to go out into the community on a regular basis due to their health, the home ensured that people from the community visited on a regular basis. Activities focused on sensory activities such as aromatherapy, crafts and music.
The home was well led. Relatives and visiting professionals told us that the manager was approachable and that they could drop in at any time. Staff understood the aims of the home, their roles, were motivated and had confidence in the management of the home. They said that there was good communication in the staff team and everyone helped each other, which was essential to the effective running of the home. There was a core team of staff who had worked at the home for a number of years and a low staff turnover.
Quality assurance systems were robust and there was a culture of continuous improvement. There were systems in place to review the quality of all aspects of the service regularly. This was carried out by the registered manager and two representatives from the company. Improvement plans were developed where any shortfalls were identified and continuously monitored to make sure that improvements were made and sustained.
The provider sought feedback from people and their representatives by using a quality questionnaire. These were sent by the registered manager and also separately by the company. The results of these surveys were that everyone was satisfied with the care provided at the home and people rated aspects as ‘good’ or ‘excellent’.