Kilkenny House extra care housing scheme was rated Good overall, with four of five key questions rated Good, but Well-led dropped to Requires Improvement due to insufficient provider-level governance oversight and absent PRN medicine protocols. The registered manager demonstrated strong day-to-day leadership and people and relatives reported consistently positive experiences of kind, person-centred care.
Concerns (4)
moderate
Medication management
: “Where people were prescribed medicines to be given as required (PRN), people did not have PRN protocols in place to give details to staff about what the medicine was used for”
moderateGovernance: “There was a lack of oversight at provider level. Areas identified at this inspection had not been picked up by the provider, for example, omissions of PRN protocols and missing details from risk assessments.”
minorCare planning: “1 person's records noted an allergy to a particular food but did not provide further details as to how this impacted upon the person.”
minorPerson-centred care: “The provider had completed a service user questionnaire in 2022, however there was no action plan to evidence feedback was used to improve the service.”
Strengths
· People felt safe and staff understood safeguarding responsibilities, with appropriate referrals made to the local authority.
· Medicines were administered, stored, and disposed of safely with regular staff competency checks.
· Staff received appropriate training, regular supervision and support, and a robust induction.
· People were treated with kindness, dignity and respect, with highly positive feedback from people and relatives.
· Strong personalised and responsive care, including a new support worker role for social needs and community activities.
Quality-Statement breakdown (24)
safe: Assessing risk, safety monitoring and managementGood
safe: Using medicines safelyGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely care; Supporting people to live healthier livesGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesGood
responsive: Meeting people's communication needsGood
responsive: Supporting people to develop and maintain relationships to avoid social isolationGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Engaging and involving people using the service, the public and staffRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: How the provider understands and acts on the duty of candourGood
This was a targeted COVID-19 IPC inspection of Kilkenny House, which was inspected but not rated. The provider demonstrated strong IPC practices overall, though monthly infection control audits and specific risk assessments for clinically vulnerable staff had not been completed.
Concerns (2)
moderateInfection control: “Monthly infection control audits were not completed to ensure infection risks to people were thoroughly assessed and managed.”
moderateInfection control: “for staff in high risk groups such and those who were clinically 'extremely vulnerable', specific risk assessments had not been completed to check whether reasonable adjustments were required.”
Strengths
· Registered manager ensured staffing was sufficient to fully meet people's needs, with staff working flexibly.
· Provider supported people to engage with the vaccination programme using appropriate communication.
· Provider followed relevant COVID-19 testing guidance for staff, people using the service and visitors.
· Isolation, cohorting and zoning used to manage the spread of infection.
· Staff received IPC training, wore PPE and sanitised hands regularly; PPE stations and sufficient stocks were available.
Quality-Statement breakdown (2)
safe: StaffingNot rated
safe: How well are people protected by the prevention and control of infection?Not rated