CQC report explained · a nursing home
What the CQC found at Kensington House
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People were protected from abuse and their care risks were assessed and reviewed. Medicines were generally managed safely, although the controlled-drugs register had not been completed in full and was corrected after the inspection.
- Effective?
- Good
- People's needs and choices were assessed and reviewed. Staff received training, people were supported with meals and healthcare, and mental capacity records had improved.
- Caring?
- Good
- This area was not assessed during this focused inspection, so no new rating was given.
- Responsive?
- Good
- This area was not assessed during this focused inspection, so no new rating was given.
- Well-led?
- Good
- There was a clear management structure, regular checks and evidence that the provider had acted on problems found previously. Staff, people and relatives knew who to speak to and felt listened to.
What inspectors found, July 2021
Kensington House is Rated Good; inspectors found improvements in safety, care arrangements and management, with one medicines record corrected after the visit.
This was an unannounced focused inspection on 22 June 2021. Two inspectors, a nurse specialist adviser and an Expert by Experience spoke with people, relatives and staff. They also observed care and checked care, medicines, recruitment and management records.
Inspectors found people were protected from abuse and avoidable harm. Risks were assessed, staffing was sufficient, medicines were generally managed safely, and infection control arrangements were in place. People received support with food, drink, healthcare and decisions about their care.
The home had improved since its previous rating of Requires Improvement in 2019. Inspectors said it was no longer in breach of the regulations identified previously. The overall rating was Good, but this inspection only looked at Safe, Effective and Well-led. Ratings for the other areas were carried forward from the previous comprehensive inspection.
Safeguarding
Staff understood how to recognise and report possible abuse. The manager was recording and reporting safeguarding allegations to the relevant organisations.
“People were provided with safe care. Care staff understood how to report and recognise signs of possible abuse.” from the report
Staff availability
Inspectors found enough staff to support people without delays or rushing. Staff also spent time chatting with people.
“Care staff had time to support people without rushing and spent time chatting with people in the communal area.” from the report
Management checks
The management team had introduced regular checks and took action to improve the service. Staff understood their roles and responsibilities.
“There was a clear management structure in place who had now made regular checks to ensure people received their care in a safe environment and took action where needed to make improvements.” from the report
Controlled medicines record
minorThe controlled-drugs register was not complete when inspectors visited. The manager confirmed after the inspection that this had been corrected.
“The provider had not completed the controlled drugs (CD) register in full. Following our inspection, the registered manager confirmed this had now been corrected.” from the report
Recruitment policy review
minorThe provider agreed to review its policy about when DBS checks should be reviewed, in line with best practice guidance.
“The provider agreed to review the DBS policy in relation to when these are needed to be reviewed in line with best practice guidance.” from the report
- 01How do you now check that the controlled-drugs register is complete and accurate?
- 02Has the review of your DBS policy been completed, and what is the current policy?
- 03This report says nursing care was not being provided at the time. What nursing support could you provide if my relative needed it?
- 04How are my relative's risks, care plan and mental capacity records reviewed when their needs or wishes change?
- 05What feedback has been received from people and relatives since this inspection, and what changes were made as a result?
This was a focused inspection of Safe, Effective and Well-led only; the other ratings used in the overall rating were carried forward from the previous comprehensive inspection. This explanation was written from the published report of 28 July 2021 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, August 2019
Rated Requires Improvement; inspectors found kind, personalised care but gaps in safety checks, infection control and oversight.
This was an unannounced planned inspection on 23 January 2019. Inspectors spoke with people, relatives, staff, managers and healthcare professionals. They observed care and checked records, staff files and safety and management information.
People generally felt safe and staff were caring. Medicines were managed safely, staffing levels met people's needs, and care plans were mostly detailed and person-centred. Activities, healthcare support and complaints systems were available.
However, inspectors could not initially find evidence of important building safety checks. Legionella risks had not been assessed, shared moving and handling slings were not cleaned between uses, and some safeguarding notifications had not been sent to CQC. Food was not always hot, activities could be repetitive, and some mental capacity records were incomplete.
The overall rating fell from Good at the previous inspection, published in June 2016, to Requires Improvement. Safe, Effective and Well-led were rated Requires Improvement, while Caring and Responsive were rated Good.
Safe medicines
Inspectors found that medicines were given as prescribed and records were complete.
“Medicines were managed safely. Medicines records were completed and showed people had received their medicines as prescribed.” from the report
Enough staff
Staffing was based on people's needs, with an extra trained worker available to support nurses.
“There were enough staff on duty to meet the needs of people.” from the report
Personalised care
Most care plans contained detailed information about people's needs, choices and preferences.
“Care plans were person-centred and contained detailed information to guide staff on how to deliver support.” from the report
Kind interactions
Inspectors observed staff treating people kindly and speaking with them warmly. Relatives also described staff as caring.
“Throughout the inspection we observed staff treat people with kindness and engage with people in a warm and compassionate way.” from the report
Building safety evidence
seriousThe home could not initially show that required electrical, gas and other premises checks had been completed. New electrical and gas checks were arranged after the inspection.
“Evidence was not available at the time of the inspection to show premises checks had been completed.” from the report
Infection control
seriousShared moving and handling slings were not cleaned between uses. Inspectors identified this as an infection control risk.
“Moving and handling slings were shared and not laundered between each use. This was an infection control risk.” from the report
Incomplete oversight
seriousThe provider did not notify CQC about all safeguarding allegations, and its quality checks had not identified important problems.
“An effective system was not in place to ensure notifications were submitted to CQC; the registered manager and provider did not understand their legal responsibilities in what they had to notify to CQC.” from the report
Mental capacity records
needs fixingBest-interest decisions were not consistently recorded, including shortfalls in one person's mental capacity records.
“Mental capacity assessments were carried out and documented but the process for making best interest decisions were not consistently recorded.” from the report
Food and activities
needs fixingSome people said meals were sometimes too cold, and feedback suggested activities could be more varied.
“However, we did receive feedback that food was not always served at a hot temperature and was too cold.” from the report
- 01Have all electrical, gas and legionella checks and risk assessments now been completed, and when were they last reviewed?
- 02How are moving and handling slings cleaned or allocated to prevent infection risks?
- 03How do you now make sure every safeguarding allegation is notified to CQC when required?
- 04How are mental capacity assessments and best-interest decisions recorded and checked?
- 05What changes have been made to make activities more varied and ensure meals are served hot?
This was an unannounced planned inspection covering all five CQC questions, including both the premises and the care provided. This explanation was written from the published report of 16 August 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Kensington House
3 rated inspections over 5 years: the service has held its Good rating throughout.
- July 2021Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- August 2019Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementWell-led: Requires improvement
- June 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- June 2014
Registered with the Care Quality Commission on 21 June 2014.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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At least 100 live-in carers within about an hour of Worcestershire
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £980 to £1,260 a week. 85 can care for a couple. 9 years' experience on average.
“I have never met a person who is so kind and thinks about others before himself to such an extent as Chris Malagala.”
“She was very caring, kind and patient to all his needs, she built up a wondetful rapport with him, she was dedicated and was there for him through good times as well as through the tough times”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.