This inspection took place on 26 November 2018 and was unannounced.

King Street Care Home, is a care home for a maximum of 17 people with physical disabilities. The home is a two-storey building with en-suite bedrooms, and communal lounges and dining rooms on each floor. At the time of our visit, 16 people lived in the home.

People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The home 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 2008 and associated Regulations about how the service is run. The registered manager was managing the service at our previous inspection.

At our last inspection we rated the service as ‘good’. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service continued to be safe. Staff understood how to safeguard people from harm. They understood the risks to people’s health and wellbeing and took action to lessen each risk. They also worked with positive risk taking to enable people to have fulfilling lives. There were enough staff on duty to meet people’s needs; and checks had been made on staff before working for the service to make sure they were safe to work with people. People received their medicines as prescribed. The home was clean and tidy and staff understood infection control practice. The premises were well-maintained.

The service continued to be effective. Staff received training to support them work effectively with people who lived at the home. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The principles of the Mental Capacity Act (MCA) were followed. People had access to different health and social care professionals when required, and good relationships had been formed between the service and those professionals. People received food they enjoyed, and were involved in cooking some of the meals.

The service continued to be caring. People received care from staff who were kind, and treated them with dignity and respected their privacy. Staff had developed positive relationships with the people they supported, they understood people’s needs, preferences, and what was important to them. The service supported people to maintain and develop relationships with their family.

The service had improved its responsiveness, and was now ‘outstanding’. People’s needs were assessed and planned for with the full involvement of the person. Care plans were very informative and helped staff understand the complexities of people’s care and support needs. People were empowered to have as much control in their life as possible and live life to the full. People had many opportunities to pursue their interests and hobbies, and a very good range of daily social activities were offered. There was a complaint procedure and complaints had been dealt with appropriately. Procedures were in place for end of life care; and staff had recently supported a person’s end of life with heartfelt care and kindness.

The service continued to be well-led. The registered manager and deputy worked hard to ensure a good quality of service was maintained. They provided good support to the staff group, and to people who lived at the home. Checks were made to ensure the service met its obligations to provide safe accommod

This was an unannounced comprehensive inspection that took place on 13 July 2016. At the last inspection completed on 14 July 2014, we found the provider had not met the regulations for three areas; medicines storage, assessing and monitoring the quality of service provision and infection control. At this inspection we found the provider had made the required improvements and the regulations were being met.

The service provided accommodation for up to 17 adults living with physical or neurological disabilities. There were 17 people using the service at the time of our inspection.

The service had 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 2008 and associated Regulations about how the service is run.

People who used the service were safe. There was a good standard of cleanliness. The premises and equipment people used were consistently cleaned and maintained. Staff had a good understanding of the provider’s procedure to keep people safe from harm and abuse and knew how to report and respond to any concerns about people’s safety and welfare.

People received the support that they required to take their prescribed medicines. The provider has safe practices for the storage, administration and recording of people's medicines.

People had the appropriate level of staff support they required to meet their assessed needs. The provider had safe and thorough recruitment practice to ensure that staff were suited to the people that used the service. They involved people in staff recruitment and completed relevant pre-employment checks which assured them that staff were safe to work with people.

Staff and volunteers had effective training and support that equipped them with the skills they required to look after people. They understood the Mental Capacity Act (MCA) 2005 and how they would practice it in their role. They supported people in accordance with relevant legislation and guidance.

People had access to a choice of nutritionally balanced meals. Staff provided the support people required to have timely access to health care services when they needed to. People had access to specialist equipment they required. The premises were adapted to meet their mobility needs.

People were complimentary of the caring attitudes of the staff that support them. Staff made them feel like they mattered. They provided the information and support that people required to make their own choices.

Staff were knowledgeable about the needs of the people that used the service. They treated people with respect and dignity. They also understood and promoted people’s right to privacy.

People’s care plans reflected their individual needs. Their care plans included comprehensive details of how they would like to receive their care and support. People planned their own care where required, and chose their preferred staff who supported them with their care planning. Staff supported people as they stated in their care plans. They tailored support to the person's needs and helped them achieve their ambition and be included as part of the local community. People had opportunities to use and contribute their skills in running the home and to make financial gains and economic contributions through using their skills.

The registered manager with support from the volunteer coordinator developed links with the local community. This enabled them to acquire monetary contributions from local organisations and volunteers to provide the support that people required. They also maintained partnerships with other specialist learning disability college to provide support that offered their students the experience and support that they require to access future employment opportunities.

People, their relatives and staff had v

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was unannounced and planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to pilot a new inspection process being introduced by the Care Quality Commission, which looks at the overall quality of the service. Where we have found breaches you can see what action we told the provider to take at the back of the full version of the report.

Accommodation and personal care is provided at this location for up to 17 adults with physical and/or learning disabilities. At our inspection there were 16 people with physical disabilities living at the home.

There is a registered manager in post at this service. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

We found that the law relating to infection prevention, the management of medicines and monitoring the quality and safety of people’s care was not being met. Not all areas of the home were clean or hygienic and people’s medicines were not always safely stored or recorded. Regular checks of the quality and safety of people’s care were made, but they were not sufficient to fully protect people against the risks of acquiring a health associated infection or from risks associated with the unsafe use and management of medicines.

People told us that they were happy and felt safe living in the home and knew who they could speak with if they had any concerns about their care and safety, or that of others.

Staff understood and met people’s care needs. They usually followed the provider’s aims and values for people’s care, choice and rights, but did not always maintain confidentiality for people’s care.

Staff followed the Mental Capacity Act 2005 (MCA) to obtain people’s consent for their care and to ensure that important decisions about people’s care were made in their best interests when required. The MCA is a law providing a system of assessment and decision making to protect people who do not have capacity to give consent themselves. People were protected against unnecessary restrictions to their liberty and staff had a basic understanding of the Deprivation of Liberty Safeguards (DoLS). This is a law that requires assessment and authorisation if a person lacks mental capacity and needs to have their freedom restricted to keep them safe. There were no people either subject to, or requiring authorisation for this at our inspection.

Risks to people’s safety and their health needs were shown in their written care plans and effectively managed. Staff understood people’s health needs and people were supported to maintain good health and to access health care services when required. When necessary, staff sought advice for people’s care from relevant health and social care professionals and staff followed their instructions from this where required.

People received the care they needed and were satisfied with the food and drinks provided. People received the support they needed for their nutrition in a way that promoted their independence and enjoyment. They were also supported to maintain their hobbies and interests and contacts with families and friends. People’s care plans reflected their individual needs, choices and preferences and were regularly reviewed with them and their representatives where appropriate. Staff knew how to communicate with people in the way that met with their needs and preferences.

There were robust procedures for the recruitment of staff and volunteers, who were trained, supported and supervised. Staff understood their roles and responsibilities and knew how to report any concerns they may have about people’s care or safety. Sufficient care staff were provided and action was being taken to recruit additional staff to improve catering, laundry and domestic arrangements at the home.

Staff and people using the service were positive about the management of the home. They were asked for their views about the care provided and were kept informed about any changes or improvements to be made from this. Improvements in progress at our inspection included, to ensure people’s confidentiality and that all people knew how to complain; development of food menus for healthier eating and to increase people’s opportunities to access the local and wider community.

We inspected four outcomes during this inspection. The outcome areas were: care and welfare, safeguarding people who use services from abuse, supporting workers and complaints. All the outcome areas were compliant apart from one outcome safeguarding people who use services from abuse. We found safeguarding policies and procedures were not current and the provider had not informed the Care Quality Commission about a recent allegation of abuse.

The expert by experience spoke with seven people who used services. She reported that she chatted with people and ascertained that they all felt supported, happy and settled in their environment.The expert by experience spoke with people in the presence of staff and on their own. Staff seemed very knowledgeable about each person and behaved in a respectful manner to them. We saw the full complaints procedure reflected established principles of good complaint handling. We saw some people managed their own money and their independence and choices were upheld. Every bedroom was provided with a lockable facility for holding valuables and money. This meant people who use services were protected from financial abuse. Staff were provided a range of training that was based on the needs of people using the service.

Some people were unable to give their views about the service due to their disabilities. We observed them taking part in activities and undertaking their daily pursuits. However we did speak with four people about their experience at the home.

All of the people we spoke with us told us they were happy at the home and were well supported. We saw one person was writing a letter on the computer with the assistance of a volunteer. We saw a group of people playing dominoes with staff outside under the sun canopy. We were told one person was going to the Paralympics early the next morning.

Two people told us they felt safe at the home. One person told us if they had any complaints they would tell the manager who would always give them some feedback so they knew it had been dealt with.

There were sixteen people living in the home on the day of our visit. We spoke with four service users and three staff.

People told us they liked their home, and the staff and managers that supported them. They were able to develop their pursuits with trips to places of interests, day centres, cooking activities and workshops. They also had opportunities to take part planned social activities in their spare time.

People who use services told us:

“I am offered a choice of meals.”

““My volunteer does embroidery with me.”

“It’s safe here. I can complain to staff if I have to.”

Staff told us they were well trained and supervised and supported. One staff member told us “There is loads of staff training.” Training updates are being arranged for senior staff for one type of special medicine.

The home is updating their staff guidance and policies and procedures around safeguarding and service user’s finances. This will ensure safer systems for service users and the staff that support them.

Part of the homes quality assurance systems offers a customer support helpline, audits and inspections. The home is regularly monitored to ensure better understanding of the needs and preferences of the people who use services.