Kingly House

Kingly House provides accommodation for up to 17 adults with acquired brain injuries and neurological conditions. The staff team includes occupational therapists, a speech and language therapist and a physiotherapist to assist people with their support and rehabilitation. There were 16 people using the service at the time of our visit.

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

People’s care and support needs may not always be met in a timely manner due to the high use of agency staff. This was because they didn’t know people well and were unable to provide them with the same care regular staff could. A number of people commented on how the inconsistent use of regular staff affected the quality of the service.

People felt well cared for and staff had a caring and compassionate approach to those they were supporting and people felt confident in raising their concerns and that they would be investigated.

People felt safe at Kingly House and staff protected them from avoidable harm. People received their medicines safely and were protected from the risk of infection.

Regular staff had the skills and experience to support people and staff were recruited safely and had good training to support their role.

People had comprehensive care plans in place however, documentation within them didn’t always correspond, providing inaccurate information to the reader. This compromised the support provided by agency staff. Risks to some people’s health were compromised by the lack of monitoring of their assessed risks.

Regular staff knew people’s health needs and ensured they received treatment from the necessary health professionals to keep them well.

People’s nutritional needs were met with food plentiful and well balanced. The environment was homely and plans to improve the décor and presentation of the service had begun.

Staff gained consent from people prior to delivering care. 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.

People were provided with a comfortable and homely place to live. A refurbishment plan was in place to improve the environment for people.

The service was without a registered manager therefore the providers operations manager was acting as manager. The overall monitoring of the service was not robust, and some monitoring had not yet been put in place.

Staff meetings and meetings for the people using the service had been held, though records of these were not always available. The management team worked in partnership with others for the benefit of the people using the service.

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 outstanding (report published 2 August 2017).

Since this rating was awarded the provider has changed its legal entity. We have used the previous rating to inform our planning and decisions about the rating at this inspection.

Why we inspected:

The inspection was prompted in part due to concerns received around staffing levels and the overall management of the service. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive and well led section of this full report.

The overall rating for the service has changed from outstanding to requires improvement. This is based on the findings at this inspection.

Enforcement:

We identified a breach of the Health and Social Care Act (Regulated Activities) Regulations 2014 relating to Staffing. Details of the action we have asked the provider to take can be found at the end of this report

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.

Kingly House provides accommodation and personal care for up to 17 people who require support because they have suffered brain injuries or have neurological disabilities. It, and three other services run by Kingly Partnership, are a centre of excellence for organisations that support people with similar needs. Kingly House is a 1920s detached property that has been extensively modernised and adapted for people who use wheelchairs and other specialist equipment. Accommodation is on two floors connected by a stairway with a stair lift. People have access to an enclosed landscaped garden.

The service has a registered manager. 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 and associated Regulations about how the service is run.

People consistently experienced care that met their unique needs. People’s lives had been enhanced as a result, often with outstanding outcomes which changed their lives. The service supported people with their rehabilitation in a meaningful way and helped them to achieve their aims no matter how challenging those aims were. People achieved increasing levels of independence because of the care and support they received.

The registered manager, the senior managers and the staff had a strong and visible person centred culture that was at the core of the service. People using the service felt the benefit of this through their experience of consistently outstanding care. Staff were motivated because they felt supported by a management team they felt inspired them.

People using the service knew what the aims of the service were and they were involved in developing the service. The service was exceptionally well led by the registered manager and senior team of qualified professionals. There were effective procedures for monitoring and assessing the quality of service and there was a commitment to continually improving the service. Feedback we received from a local authority that was that Kingly House was a ‘high performing and well led service.’ People’s and relative’s feedback from a recent satisfaction survey rated the service as outstanding.

The provider was an active participant of three regional and national forums, all specialising in raising awareness of brain injury and neurological disabilities. This helped the provider to ensure that care practice was in keeping with the latest research and a ‘flagship’ provider. They had been shortlisted for awards for best service in three different categories in three consecutive years, 2014, 2015 and 2016. The service provided preceptorships for newly qualified NHS occupational therapists. The service was a centre of excellence for this type of service.

People using the service felt safe and were protected by effective safeguarding procedures that staff were fully conversant with. Staff also helped people to make choices about how they wanted to be supported and how they spent their time. People were supported to participate in activities that developed and increased their independence. Where those activities included risks these were managed to protect people from injury.

People were supported by sufficient numbers of experienced and professionally qualified staff who understood their needs. The provider had effective procedures for the safe management of medicines.

Staff were well trained and supported by the management team and the directors of Kingly Partnership, all of whom were professionally qualified and specialists in neurological disability who participated in research in that area. People were supported by rehabilitation support workers (RSW) and professional occupational therapists that had extensive professional training about neurological disabilities. People were therefore supported by highly skilled and knowledgeable staff that consistently provided outstanding care.

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 support this practice. The registered manager’s contribution to a complex court case involving the Mental Capacity Act 2005 had been acknowledged in a court’s decision.

People were supported with their dietary and nutritional needs. Staff made special efforts to ensure people had meals they enjoyed. Staff supported people to access health services when they needed them.

Staff were caring and compassionate. They understood people’s needs and developed caring professional relationships with people. They supported people to express their views and took account of what they said. People and their relatives consistently reported that staff were kind and compassionate.

Staff respected people’s privacy and dignity. The provider had policies and procedures that supported this practice.

People received care and support that was focused on their individual needs. The support they received had made a significant difference to the quality of their lives. People had developed skills which dramatically increased their independence as a direct result of the care and support they received.

People knew how to raise concerns and express their views. Their views were acted upon.

People using the service knew what the aims of the service were and they were involved in developing the service. The service was exceptionally well led by the registered manager and senior team of qualified professionals. There were effective procedures for monitoring and assessing the quality of service and there was a commitment to continually improving the service.

Feedback we received from a local authority that was that Kingly House was a ‘high performing and well led service.’ People’s and relative’s feedback from a recent satisfaction survey rated the service as outstanding.

People using the service were satisfied with the meal arrangements and felt the food provided was of a good standard. One told us, 'I think it is good here. The food is good, you get a choice.'

The provider cooperated with other services to help ensure the health and wellbeing of people using the service.

The building was adequately maintained and secure. People were happy with the way the building was decorated and furnished. One person commented to us that the lounge and dining area had recently been redecorated, 'This has all been done out. I think they have made a nice job, it is lovely.'

Effective recruitment processes were followed when new staff were appointed and appropriate checks were taken up before they started work.

People using the service told us that felt able to raise any complaints or concerns with staff, should they have the need to. One said, 'If I wasn't happy I would talk to a team leader, but there is nothing to worry about here. It is very good, I really like it here.'

Detailed assessments were completed to identify people's specific needs and to explain how their support was to be provided. There were mechanisms in place to help ensure that support was delivered reliably and in line with people's preferences.

The people using the service were satisfied with the care and support they received at Kingly House. They felt that staff were capable and genuinely caring in their approach towards them.