About the service:

Keepence Homes is a care home that was providing personal to people with a learning disability. Four people were living in the home at the time of the inspection.

People’s experience of using this service:

¿ Risk assessments for people were available, however did not contain enough specific detail for staff to be aware. Where there was a more serious risk we found there was not always an assessment in place. Health and safety records demonstrated that appropriate action was not always undertaken in a timely manner.

¿ We saw that learning outcomes from incidents were not recorded to prevent a reoccurrence or risk assessments updated in light of this. The service had not made the required notifications to CQC when events had occurred in the service in order for these to be effectively monitored, this included one allegation of abuse, three serious injuries and one event that stopped the running of the service.

¿ Medicines administration was not always safe. There were no pictorial pain assessments in place to help people who could not communicate verbally indicate they may be in pain.

¿ Recruitment checks were not always thoroughly completed before staff started working for the service. Staffing levels were negatively impacting on people’s involvement in external activities and support.

¿ The service was not always working within the principles of the Mental Capacity Act and assessments had not always been completed appropriately.

¿ People were treated with kindness and compassion and were comfortable and relaxed in the presence of staff. We observed staff interacting with people in a friendly and respectful way.

¿ People were not supported to attend activities of their choosing or spend time outside of the service on a regular enough basis.

¿ Staff we spoke to felt supported by the registered manager and told us they were approachable and listened to them.

¿ The provider did not have evidence of how they monitored, reviewed and improved the quality of care people received.

More information is in Detailed Findings below.

Rating at last inspection:

Good (report published 7 October 2016).

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We have told the provider they must take action to improve the service. We will continue to monitor the service and complete a further inspection to assess whether the improvements have been made.

Keepence Homes is a care home, registered to provide personal care for up to four people who have learning disabilities and autistic spectrum disorder.

The inspection was unannounced and took place over two days on 20 July and 16 August 2016.

The service had a registered manager who was responsible for the day to day running of the home. 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.

At the last comprehensive inspection in May 2015 we identified the service was not meeting a number of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider did not have suitable arrangements in place to act in accordance with the Mental Capacity Act 2005, the premises used were not maintained to an appropriate standard of hygiene and the service did not have fully effective systems in place to assess, monitor and improve the quality and safety of the service.

At this inspection we found that the provider had taken action to address the issues highlighted in the action plan. The provider had made Deprivation of Liberty Safeguards (DoLS) applications to the local authority where appropriate and had started making improvements to meet the requirements of the Mental Capacity Act 2005. We found that mental capacity assessments had been completed for decisions around people’s financial management, but this was not consistently done where people lacked capacity to make specific decisions around their care or medical treatment.

We found the premises were maintained to a higher standard of hygiene and a cleaning schedule was in place. The registered manager told us there were plans for further decoration of the premises. The registered manager had introduced audits to assess, monitor and improve the quality and safety of the service.

People appeared happy and contented living at the home. Relatives spoke positively about the care and support their family member received. Staff showed concern for people’s wellbeing in a caring and considerate way, and they responded to their needs quickly. Staff told us that people were encouraged to be as independent as possible.

People had access to sufficient food and drink and were supported to maintain a balanced diet. Where people had special dietary requirements, staff ensured these were met.

Safe recruitment practices were followed before staff were employed to work with people. Checks were undertaken to ensure staff were of good character and suitable for their role. People received care and support from staff who had access to training and supervision to develop the skills, knowledge and understanding needed to carry out their role.

There were safe medicine administration systems in place and people received their medicines where required. There were processes in place to support people who were able to self-administer their medicines. People’s care records showed relevant health and social care professionals were involved with people’s care.

People had a range of activities they could be involved in. People were able to choose what activities they took part in. Staff were encouraged to support people in expanding the range of activities available to them.

The manager investigated complaints and concerns. People, their relatives and staff were supported and encouraged to share their views on the running of the home. The provider had quality monitoring systems in place. Accidents and incidents were investigated and plans put in place to minimise the risks or reoccurrence.

We were not able to speak to people who used the service as they had complex needs and difficulty communicating. We gathered evidence of people's experiences of the service by reviewing records, observing care practices and talking with the manager and staff on duty.

During our visit we observed there was a relaxed atmosphere with people choosing where they wished to spend time. One person was seen to be enjoying colouring in the dining room and another watching telly in the lounge. One person was being supported by the manager to complete the weekly food shopping.

We observed staff treating people with affection, kindness and patience. Staff demonstrated how well they knew people's needs and ensured people were treated with privacy and dignity. We looked at people's records and noted that they incorporated their care plans, risk assessments and health care needs. We found that they encompassed the safety and well-being of people who used the service. Staff and people's relatives knew how to raise a concern or complaint and felt confident in doing so.

We reviewed all records held which ensured that people who used the service could be confident that their personal records which encompassed their care, treatment and support were properly managed.

We were not able to speak to every person using the service because some had complex needs and difficulty communicating. We gathered evidence of people’s experiences of the service by reviewing records, observing care practices, talking with staff, relatives and a social care professional.

During our visit we observed there was a relaxed atmosphere with people choosing where they wished to spend time. One person was seen to be enjoying the sunshine in the conservatory. Another person was being supported by a member of staff to go shopping.

We observed staff treating people with affection, kindness and patience. Staff demonstrated how well they knew people’s needs and ensured people were treated with privacy and dignity.

We spoke with one relative of one of the people living at Keepence Homes. They told us they were satisfied with the care and support provided. They told us Keepence Homes was “homely”.

The relative and social care professional were complimentary about the staff. Examples of comments were: "The staff interact with people and know them well.” “Activities and involvement within the local community is good.”

People we spoke with told us they had plenty of opportunities to get involved in having their say about how the service was run. They also told us they were confident if they reported any problems, they would be dealt with promptly and effectively.

Shortly after our visit we spoke to a healthcare professional who told us the staff were good at involving people and ensuring people were able to make choices and decisions about their health and treatment.

People looked content on the day of their visit. We were unable to communicate with them verbally but we saw them being treated with respect and kindness.

Relatives told us that they were happy with the home saying they had no complaints and complimenting the staff for their efforts.

Day services staff we spoke with told us that the home communicates well with them about people’s care and ensures that when no one will be at the house, that they have contact details.

19 Wilcot Road is a care home, registered to provide personal care for up to four people who have learning disabilities and autistic spectrum disorder.

The inspection was unannounced and took place over two days on 15 and 18 May 2015.

The service had a registered manager who was responsible for the day to day running of the home. 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 service had the size and feel of a family home; people who use the service had all lived at 19 Wilcot Road for several years. The atmosphere in the home was calm and relaxed. The service had a very low turnover of staff and did not use agency staff.

On inspection we found that the service did not maintain a clean environment. This was a breach of Regulation 15 of the Health and Social Care Act (2008) Regulations 2014. The provider took immediate action to improve the cleanliness of the home. You can see what action we told the provider to take at the back of the full version of the report.

The Mental Capacity Act 2005 sets out what must be done to make sure that the rights of people who may lack mental capacity to make decisions are protected. CQC is required by law to monitor the application of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. This includes 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. DoLS require providers to submit applications to a ‘Supervisory Body’; the appropriate local authority, for authority to do so.

The service did not follow the requirements set out in the Mental Capacity Act 2005 when people lacked the ability to give consent to living and receiving care at 19 Wilcot Road. This was in breach of Regulation 11 of the Health and Social Care Act (2008) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The registered manager of the service worked as part of the care team on a daily basis but this left little time for managerial duties. The service did not have fully effective systems in place to evaluate and improve the quality of the service. This was a breach of Regulation 17 of the Health and Social Care Act (2008) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Family members were complimentary about the service received by their relatives. There had been no complaints since our last inspection. One person said they were, “more than thrilled” with the service and that their relative was settled and happy. Family members said that if they needed to raise an issue they felt confident that they would be listened to, and their concern would be acted on.

People were unable to tell us whether they felt safe at the service. However we observed they were relaxed and interacted happily with staff. Family members said that people had established good relationships with staff.

The service had arrangements in place to ensure people were protected from abuse and avoidable harm. Staff showed a good understanding of and attitude towards safeguarding and management of risks.

Staff acted in a caring manner and people who use the service were helped to make choices where possible, and to make decisions about how their care was provided. Family members said the care provided at 19 Wilcot Road was good. One relative said they were “absolutely delighted” with the care.

Each person who used the service had their own personalised care plan which promoted their choices and preferences. People were not always able to communicate their choices and people’s care plans showed that importance was placed on staff using different ways to maximise communication with people. People who use the service were assisted to go out into the community to enjoy leisure time and also to attend health appointments. The service had its own vehicle for the provision of transport.