Care service description

Kingston House is a residential care home for up to nine people with a learning disability. At the time of the inspection there were six people living at the service with dementia and/or physical disabilities. Due to people’s complex needs everyone had a room on the ground floor.

Rating at last inspection

At the last inspection on 26 November 2014, the service was rated overall Good, with outstanding in caring.

Why the service is rated Good

The service 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.

Risks to people’s safety were assessed and managed appropriately. Assessments identified people’s specific needs, and showed how risks could be minimised. Regular environmental and health and safety checks took place to ensure 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.

Medicines were managed and administered appropriately. People received their medicines as intended by their doctor.

Staff had received training in infection control and understood how to use this knowledge in practice.

People’s health needs were effectively monitored and professional advice sought and acted on. 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. Meal times were managed effectively to make sure that people received the support and attention they needed and enjoyed their meals.

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 service. 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.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were at the centre of the service. Staff prioritised developing positive relationships with people and people valued these relationships. Particular attention was paid to staff understanding people’s past histories as people were not able to communicate them. People benefitted from a core staff team who was stable and had supported them for many years. Staff were highly motivated to treat people with kindness, respect and compassion and ensured their choices and preferences were met.

People were offered an appropriate range of activities which focused on stimulating their senses, such as music. As people had complex health needs and found it difficult to go out, the service ensured people from the community visited on a regular basis.

The home was well led . Quality assurance systems were robust and there was a culture of continuous improvement. There was an open and positive culture and the registered manager was passionate about providing care for the people who used the service. Staff knew how to put the aims and values of the service into practice so people received personalised care.

There was a core team of staff who had worked at the home for a number of years and a low staff turnover.

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’.

The people living in the home were unable to verbalise to tell us about their experiences. We spent time with the people and observed interactions between the people and the staff.

We found that the people at the home were all becoming increasingly frail and elderly. The amount of personal care and support they needed had increased.

People who use the service indicated that they were happy at the home. We saw that people were relaxed and responsive in the company of staff. They were able to let staff know what they wanted and we saw staff respond in a caring and positive way. Staff knew the people well and were able to communicate with them using a range of methods. Staff we spoke with had knowledge and understanding of people's needs and knew people's routines and how they liked to be supported.

People's health needs were supported and the service worked closely with health and social care professionals to maintain and improve people's health and wellbeing.

We saw records that confirmed that medicines were given to people when they needed them in a safe way.

Staff recruitment records showed that new staff had been thoroughly checked to make sure they were suitable to work with vulnerable people.

The quality assurance and monitoring systems ensured that the service was safe. Staff asked people regularly and checked that everything was alright for them. The home was safe and well maintained and suited people's needs.

There were five people living at the service on the day of the inspection.

We found that the people at the home were all becoming increasingly frail and elderly. The amount of personal care and support they needed had increased.

Most of people living in the home were unable to verbalise to tell us about their experiences.

We spent time with the people and observed interactions between the people and the staff.

People who use the service indicated that they were happy at the home. They were relaxed and responsive in the company of staff. They were able to let staff know what they wanted and we saw staff respond in a caring and positive way. Staff knew the people well were able to communicate with them using a range of methods. If people were unhappy about something the staff were able to recognise the signs and take the appropriate action to resolve any issues.

Staff we spoke with had knowledge and understanding of people's needs and knew people's routines and how they liked to be supported.

Some people were participating in activities which they indicated that they enjoyed.

People received support to maintain a healthy, active lifestyle. They were supported to attend health care checks and community health professionals were involved to provide advice and support when needed.

There was enough staff on duty to meet support and meet people’s needs.

Some people living in the home were unable to verbalise to tell us about their experiences. We spent time with the people and observed interactions between the people and the staff.

People who use the service indicated that they were happy at the home. They were relaxed. Some people were participating in activities which they indicated that they enjoyed.

We saw that people were relaxed and responsive in the company of staff. They were able to let staff know what they wanted and we saw staff respond in a caring and positive way.

The staff we spoke to had knowledge and understanding of people's needs and knew people's routines and how they liked to be supported.