Archived: Kingdom House

Updated 3 December 2020

The inspection

We carried out this focused inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act.

Inspection team

One inspector visited Kingdom House.

Service and service type

Kingdom House is a ‘care home’ and an ‘end of life’ specialist domiciliary care agency. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. A domiciliary care agency provides personal care to people living in their own houses and flats.

The service does not currently have a registered manager but the operations director, who manages both the care home and the agency has applied to register. Registered managers and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was announced. We announced the inspection before we visited to plan the inspection to take account of the safety of people, staff and the inspector with reference to the COVID 19 pandemic. We visited the service on 3 November 2020.

What we did before the inspection

We reviewed information we had received from the provider and others since the last inspection. We sent the provider an inspection poster with our contact details to circulate to people, relatives and staff to seek their feedback. We requested a range of information from provider about the ongoing monitoring of safety and quality. We sought feedback from the local authority about their quality monitoring and from commissioners about the end of life home care services. We visited the agency’s new office in Wellington, where we met some staff there and looked at records.

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all this information to plan our inspection.

During the inspection

We met one person at Kingdom house. We and spoke by telephone with three other people cared for by Butterfields Home Services and with six relatives to hear about their experiences of care provided. We looked at five people’s care records and at two medicine records. At Kingdom House we used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We spoke with the operations manager and with 12 members of staff which included a care manager, care supervisor, care and office based staff. We looked at seven staff files including recruitment records and at information about staff training, supervision and spot checks. We reviewed a range of quality monitoring records, such as audits, regular checks, policies and procedures as well as servicing and maintenance records for Kingdom House. We sought feedback from commissioners, health and social care professionals and received a response from seven of them.

Updated 3 December 2020

About the service

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.