The inspection was carried out on 2 October 2018, and was unannounced.

Kingsdown House is a ‘care 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.

Kingsdown House is registered to provide accommodation and personal care for up to nine people aged between 18 and 65 years, who have a learning disability. The service is situated in a residential area with shops and local amenities within walking distance. People who lived in the service had autism and different levels of communication difficulties.

Kingsdown House was designed, built and registered before registering the right support. Therefore, the service had not been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance.

Although the service had not been originally set up and designed under the Registering the Right Support guidance, they were continuing to develop their practice to meet this guidance and used other best practice to support people. They have applied the values under Registering the Right Support. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At the last Care Quality Commission (CQC) inspection on 19 April 2016, the service was rated Good. At this inspection, the rating remains Good.

There was a manager at the service. 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 and associated Regulations about how the service is run.

Without exception, relatives and people who lived in the service told us staff were consistently very caring and kind towards them. Staff recognised people as individuals and went the extra mile to include them in the service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

Staff encouraged people to actively participate in activities, pursue their interests and to maintain relationships with people who mattered to them. Relatives and visitors were welcomed at the service at any reasonable time.

People received an effective care based on current best practice for people living with autism. Staff knew the people they worked with very well and involved them in decisions about their care and support throughout their interactions, greatly enhancing their quality of life.

Medicines practice was safe. Medicines records were accurately signed with no gaps in recording. Staff had detailed knowledge of the system in place. The environment was well maintained and infection control procedures were adhered to. All required safety checks were completed.

Staff received regular training and were provided with appropriate support and supervision as is necessary to enable them to carry out their duties.

People were protected from the risk of abuse at Kingsdown House. Staff knew what their responsibilities were in relation to keeping people safe from the risk of abuse. Staff recognised the signs of abuse and what to look out for.

There were enough staff to keep people safe. The registered manager had appropriate arrangements in place to ensure there were always enough staff on shift.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The provider and staff understood their responsibilities under the Mental Capacity Act 2005.

People received the support they needed to access healthcare services. Each person had an up to date

We inspected this home on 19 April 2016. This was an unannounced inspection.

Kingsdown House is registered to provide accommodation and personal care for up to nine people aged between 18 and 65 years, who have a learning disability. The home is situated in a residential area with shops and local amenities within walking distance. There is on street parking and there is a private secure garden to the rear of the property. People who lived in the home had autism and different levels of communication difficulties.

There was a manager at the home. The manager took up this position about six months prior to our visit and was undergoing registration with the commission when we visited 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.

There were sufficient staff, with the correct skill mix, on duty to support people with their needs. Staff attended regular training courses. Staff were supported by their manager and felt able to raise any concerns they had or suggestions to improve the service to people.

Effective recruitment processes were in place and followed by the manager. Staff had the opportunity to discuss their performance during one to one meetings and annual appraisal so they were supported to carry out their roles.

People were protected against the risk of abuse. We observed that people felt safe in the home. Staff recognised the signs of abuse or neglect and what to look out for. Both the manager and staff understood their role and responsibilities to report any concerns and were confident in doing so.

The home had risk assessments in place. This was to identify and reduce risks that may be involved when meeting people’s needs such as inability to verbally communicate, which could lead to behaviour that challenges and details of how the risks could be reduced. This enabled the staff to take immediate action to minimise or prevent harm to people.

Medicines were managed safely. The processes in place ensured that the administration and handling of medicines was suitable for the people who used the service. People had good access to health and social care professionals when required.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. People were supported to make decisions about all aspects of their life; this was underpinned by the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff were knowledgeable of this guidance and correct processes were in place to protect people

Staff encouraged people to undertake activities and supported them to become more independent. Staff spent time engaging people in conversations, and spoke to them politely and respectfully.

People’s care plans contained information about their personal preferences and focussed on individual needs. People and those closest to them were involved in regular reviews to ensure the support provided continued to meet their needs.

People were able to make choices about the food and drink they had, and staff gave support when required.

People were involved in assessment and care planning processes. Their support needs, likes and lifestyle preferences had been carefully considered and were reflected within the care and support plans available.

Staff meetings took place on a regular basis. Minutes were taken and any actions required were recorded and acted on. People’s feedback was sought and used to improve the care.

People knew how to make a complaint and complaints were managed in accordance with the provider’s complaints policy.

The manager and provider regularly assessed and monitored the quality of care to ensure standards were met and maintained. The ma

Our inspection team was made up of an inspector, during this visit we were able to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking the staff supporting people who used the service and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The service is safe.

Care records and risk assessments had been following our visit on 10 July 2014. Staff and people who used the service had signed their care records. This meant that the home had responded appropriately to our last inspection report and demonstrated that they had up to date records that staff had read and understood to meet people who lived in the home’s needs.

Is the service effective?

The service is effective.

People’s health and care needs were assessed with them, and they were involved in updating their plans of care and reviews. People’s needs were taken into account with the implementation of a new paper based consent forms that had been developed. This consent to care form was in a user friendly format for people to understand.

Is the service caring?

The service is caring.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

The service is responsive.

We visited the home on 10 July 2014 and found the home to be non-compliant with records. The home responded and sent us an action plan in response to our visit and within the agreed timescales. This clearly set out how the provider would ensure on-going compliance and the timescales for completion.

Is the service well-led?

The service is well led.

Records had been maintained adequately and brought up to date. All care records had been dated and signed by staff and people who used the service to show they had been agreed. We also saw risk assessments that had been undertaken plus the management strategy to minimise identified risk which were dated and signed by staff and people.

We found that people’s personal records were stored in locked cupboards in staff or management offices. This ensured that people’s confidential personal information was protected.

Our inspection team was made up of an inspector, during this visit we were able to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking the staff supporting people who used the service and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People are treated with respect and dignity by the staff. Systems were in place to make sure that the manager and staff team learn from events such as accidents and incidents. This reduces the risks to people and helps the service to continually improve.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. We found that three applications had been submitted to the local authority. The local authority had not replied as at the time we visited.

Policies and procedures are in place to make sure that unsafe practice is identified and people are protected.

Care records and risk assessments had not been updated since 2011 and staff and people who used the service had not signed some care records. This meant the provider could not demonstrate that they had up to date records that staff had read and understood these to meet people who lived in the home’s needs. A compliance action has been set for this and the provider must tell us how they plan to improve.

Is the service effective?

People’s health and care needs were assessed with them, and they were involved in writing their plans of care. People’s needs were taken into account with signage and the layout of the service enabling people to move around freely and safely. The premises had been sensitively adapted to meet the needs of people with physical impairments.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people.

People who used the service were not able to complete an annual survey because of communication difficulties but their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People completed a range of activities in and outside the service regularly. We observed this when we visited as members of staff supported people to the seaside for a picnic as planned on the day.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service has a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

We spoke with two people who used the service about their experience of living in the home. They told us that they liked their home. They commented, "I like it here” and “I am happy here”.

There were effective systems in place to reduce the risk and spread of infection.

Appropriate arrangements were in place for obtaining medicine and medicines were prescribed and given to people appropriately. Medicines were administered and kept safely.

There were effective recruitment and selection processes in place.

There were enough qualified, skilled and experienced staff to meet people's needs.

People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on.

People were made aware of the complaints system. This was provided in a format that met their needs and people had their comments and complaints listened to and acted upon without the fear that they would be discriminated against for making a complaint.

We spoke with three people who lived at the home, and we observed the care and interactions of others living at the home who were less able to speak with us.

On the day of our visit people were being escorted to attend various activities and others remained at the home. The atmosphere was calm and relaxed and people living at the home were pleased to show us their bedrooms and tell us about their interests. We saw that staff were assisting people living at the home to pursue their interests and to take part in the general running of the home. One person and a staff member were making lunch, another was working on a jigsaw puzzle. One of the people living at the home had decided to stay in bed for the morning and staff were taking drinks and snacks to her periodically. People had been supported by staff to tidy their rooms and to use the vacuum cleaner.

One person was pleased to show us around the home, and to show us her photographs and certificates of the goals she had acheived.

People living at the home and their relatives had been asked their views through the quality assurance process and comments were very positive. They included “Very well run, my (relative) is well cared for and very happy”, “Kingsdown House has a friendly environment and there is generally good team work” and “My (relative) is happy there”.

Staff we spoke with said they liked working at the home and felt they had the support they needed to carry out their roles. Staff had developed close friendships with the people living there.