The inspection of Kings Mill Court took place on 7 November 2016 and was unannounced. The service was previously inspected in April 2015 and found to be in breach of Health and Social Care Act 2008 Regulations 9, 12, 17 and 18. The service had been rated as requiring improvement overall with well led being inadequate due to a lack of appropriate management oversight. During this inspection we looked to see if improvements had been made.

Kings Mill Court is a complex of 12 self-contained flats in the Newsome area of Huddersfield. The service provides personal care and support for up to 12 people with complex physical needs, behaviours that challenge and/or learning disabilities. People live in tenancies agreed with a landlord. The flats have a communal lounge and kitchen on the ground floor and secure gardens which provide a private leisure area. The service was fully occupied on the day we inspected.

Although there was a registered manager assigned to the service we found they had left and a new manager was in post who was in the process of applying to be registered with the Care Quality Commission. 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 was much improved from the previous inspection as people appeared to be more settled and calm. We found staff to have a good understanding of what constituted a safeguarding concern and how to report these, along with learning from such incidents where things could be improved. The service had supported people effectively through such situations, offering additional support where necessary.

Risk assessments were focused in individual need and promoted the benefits of risk taking as much as the likelihood of harm, to ensure decisions were balanced and proportionate. Measures were in place where required to reduce risks so people could undertake different activities.

Staffing levels were much improved and we observed much positive interaction during the day. All staff had a clear understanding of who they were supporting and when, which showed the service had developed a robust allocation system of staffing hours against people’s required support needs. The service felt defined which helped support people by giving guidelines and structure.

Medication was administered in line with current guidelines and storage and checks were all correct.

We found evidence of regular supervision and training offered to all staff and this knowledge was embedded in observed interactions between them and people using the service. This was supported by an accurate use of the Mental Capacity Act 2005, again promoting people taking as many decisions for themselves as possible.

People were supported with nutrition and accessing external organisations as required. We saw evidence of regular and in-depth reviews of care needs with people and their appointed representatives. Care records reflected individual need and guided staff to provide effective support.

Although the registered manager had left, the new manager showed they had a firm grasp of the service, how it ran and where changes had been needed. They had continued and implemented improvements such as with medication administration and the service structure to ensure people’s needs were met as they should be.

The inspection of Kings Mill Court took place on 23 April 2015 and was unannounced.

Kings Mill Court is a complex of 12 self contained flats in the Newsome area of Huddersfield. The service provides personal care and support for up to 12 people with complex physical needs, behaviours that can challenge and/or learning disabilities. People live in tenancies agreed with a landlord. The flats have a communal lounge and kitchen on the ground floor and secure gardens which provide a private leisure area. On the day of our inspection 11 flats were occupied.

There was a registered manager who had been registered since 3 June 2014 but at the time of our inspection they were being removed from the CQC register as they were no longer in post. There was an application in place for a different registered manager which was being processed. This person had been managing the home since the end of last year but had not been registered with CQC for this location. 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 not in work on the day of our inspection so we were unable to talk to them. However, there were two senior support workers who were providing management support.

People told us they felt safe living in Kings Mill Court as there were various means of getting help if needed such as through pendants and alarms. They also felt staff would support them. It was evident through information we looked at that staff knew how to respond when people raised concerns and reported any safeguarding concerns appropriately.

We observed a small staff team, some of whom seemed very busy. We were told that there was a shortage of regular staff and each day staff teams comprised bank and agency staff. This meant that people had little continuity of support. Staff were frequently asked to cover shifts and this led to them working long hours. We also found an inexperienced member of staff was covering the night time.

This is a breach of Regulation 18(2) Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as we found staff working shifts who were not appropriately experienced and that the service was not able to provide adequate staffing levels on a daily basis, relying on people doing extra shifts or using agency staff.

We also had concerns with medicine administration. While it was clear that people were receiving their medicine correctly the systems of recording information about this were not robust, and had the potential for errors to occur.

This is a breach of Regulation 12(g) Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as we could not be certain that there was proper and safe management of medicines as when we checked the systems in place they did not correspond.

We found people were supported by properly inducted staff who received ongoing supervision and training. Staff had a good understanding of capacity issues and were supportive with people in relation to arranging healthcare appointments.

During the course of the inspection it became increasingly apparent that staff were under constant demand and this led to strain showing in interactions with people. It was not clear at times whether the service was being run as supported living, or a care home due to the lack of clarity around what tasks were needed and when. This lack of clarity was emphasised in people’s own view as to whether they were receiving the correct support as expectations were high but this was not reflected in staffing levels, or indeed staff responses at times.

This is a breach of Regulation 17(2)(c) Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as records were not able to relay what support someone was receiving and how decisions had been taken.

The service felt chaotic at times and the provision haphazard. It was often difficult to determine if people’s needs were being met as they should have been as staff were busy and very reactive, and records did not always detail what support someone should receive.

This is a breach of Regulation 9 Health And Social Care Act 2008 (Regulated Activities) Regulations 2014. People were not always receiving support in a person-centred way, often finding their staff member being called away to support someone else and they were not consistently involved in discussions around their support needs.

In this report we have been asked by the provider to refer to people using the service as clients.

On the day of our inspection there were 11 clients living at King’s Mill Court. During our visit we spoke with the registered manager, the area manager, two clients living at King’s Mill Court and two support workers. We found Kings Mill Court was a new facility, which had opened in March 2013.

Throughout our observations we saw that clients appeared relaxed in their surroundings and were engaged in different activities. We observed interactions between clients and staff that were positive, people frequently laughed or smiled. Staff gently reassured and supported people if they became unsettled or anxious.

We saw client’s individual needs were assessed thoroughly and care and support was developed from an assessment of their needs. People appeared well-dressed and well cared-for.

There were sufficient numbers of staff with the right knowledge, experience, skills and qualifications to support people at all times. Staff had received appropriate training for their role and understood the importance of reporting suspected abuse.

The two support workers we spoke with told us they felt well-supported. One of them said St Anne’s Community Services was a good company to work for and they felt confident the service provided at King’s Mill Court was good. We saw evidence that staff received appropriate training for their role.

The two clients we spoke with told us they felt safe living at King’s Mill Court. One of them told us they had only being living there for nine weeks. They said “I’m slowly getting the hang of being more independent.”

The other client we spoke with told us they went to the local club every week with other people living at the home. They told us staff supported them to do this. They said “We leave here about 7pm and go on the bus. Staff help me with my wheelchair.”