Kingshill is a residential care home that provides short term accommodation and 24 hour care, support and enablement services for a maximum of 15 people who suffer or have suffered from a mental illness. The home is situated in the Standish area of Wigan. At the time of our inspection 14 people were living at the home.

At the last inspection in August 2015, the service was rated good. This inspection took place on the 6 July 2017 and was unannounced. At this inspection we found the service remained good overall. For the last five years the service had consistently met the standards we inspected against.

The management team promoted a culture of inclusion, and people living at the home were encouraged to achieve their goals and improve their skills of daily living. People’s goals and plans were reviewed regularly with input from an occupational therapist. Support was provided to people in a way that helped them achieve the best results they could.

Staff we spoke with were aware of how to recognise signs of abuse, and systems were in place to guide them in reporting these. They were knowledgeable about how to manage people’s individual risks, and were able to respond to people’s needs. People told us they were supported in a safe way and worked with staff to have their medicines when they needed them.

People told us staff knew how to support them and understood how to meet their needs. Staff had up to date knowledge and training to support people. 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 place supported this practice. People had food and drink they enjoyed and had choices available to them. Staff actively encouraged and supported people to maintain a healthy lifestyle. People said they had access to health professionals when they needed to. Relatives were confident their family member was supported to maintain their well-being and had access to the health professionals as they needed.

People said they were happy living at the home and supported by patient and kind staff. Relatives told us they were happy with the service their family member received. They told us staff were patient and knew people’s preferences and respected them. People living at the home were able to see their friends and relatives as they wanted. We saw staff treated people with dignity and respect and had a good knowledge of people’s rights.

The management team sought people’s views and acted upon them. People and their relatives knew how to raise complaints and felt confident that they would be listened to and action taken when needed.

The registered manager promoted an inclusive approach to providing care for people living at the home. For example, people and their relatives were encouraged to attend regular meetings, and to complete questionnaires to share their views about the quality of the service. The management team had actioned suggestions made by people, their families and staff where possible, and took a proactive approach to making improvements. The provider had systems in place to monitor the quality of care and treatment people living at the home received. The registered manager had identified where improvements were needed and had a plan in place to ensure these were made in a timely way.

Kingshill is a residential care home that provides accommodation in the form of 24 hour care for people who suffer, or have suffered from a mental illness. Some people live at the home permanently, whilst others are supported to move into their own accommodation after an approximate two year period of receiving support from the service. The home is situated in the Standish area of Wigan.

We carried out our inspection of Kingshill on 05 August 2015. At the previous inspection on 30 December 2013, we found the service was meeting each of the standards assessed.

There was a registered manager in post. 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.

We spoke with four people who lived at the home who all told us they felt safe as a result of the support they received. One person said; “I do feel safe living here. I like all the staff. I would feel confident speaking with them if I didn’t feel safe”.

People’s medicines were looked after properly by staff that had been given training to help them with this. Regular checks were done to make sure they were competent.

We looked at how the service managed risk. We found individual risks had been completed for each person and recorded in their support plan. There were detailed management strategies to provide staff with guidance on how to safely manage risks and also ensure people’s independence, rights and lifestyle choices were respected.

People were protected against the risks of abuse because the home had a robust recruitment procedure in place. Appropriate checks were carried out before staff began work at the home to ensure they were fit to work with vulnerable adults. During the inspection we looked at six staff personnel files. Each file contained job application forms, a minimum of two references and evidence of either a CRB or DBS (Criminal Records Bureau or Disclosure Barring Service) check being undertaken. Several people living in the home had been actively involved in the recruitment of new staff.

We looked at how the service ensured there were sufficient numbers of staff to meet people’s needs and keep them safe. We looked at the staff rotas. We found the home had sufficient skilled staff to meet people's needs. Staff spoken with told us any shortfalls, due to sickness or leave, were covered by existing staff which ensured people were looked after by staff who knew them. They also said staffing numbers were kept under review and adjusted to respond to people’s choices, routines and needs.

All staff were given training and support they needed to help them look after people properly. We observed staff being kind, friendly and respectful of people's choices and opinions. The atmosphere in the home was relaxed and the staff spoken with had a good knowledge of the people they supported. People were able to ‘come and go’ when they wanted and had good access to the local community.

People living at the home were supported with all aspects of daily living, in order for them to develop the living skills to become independent in their own accommodation. This included support with budgeting, food preparation, laundry and cleaning their bedroom.

The Mental Capacity Act 2005 (MCA 2005) sets out what must be done to make sure the human rights of people who may lack mental capacity to make decisions are protected. The Deprivation of Liberty Safeguards (DoLS) provides a legal framework to protect people who need to be deprived of their liberty to ensure they receive the care and treatment they need, where there is no less restrictive way of achieving this. From our discussions with managers and staff and from looking at records we found all staff had received training about the MCA and DoLS. The manager and staff spoken with expressed a good understanding of the processes relating to DoLS.

People living in the home were involved in the planning of the menus and went shopping with staff to local shops and supermarkets. People, who were able to, were given support by staff to prepare their own meals. There was no set meal for lunch time and people living in the home were able to choose either to dine in or out of the house at a time convenient to them.

From looking at records, and from discussions with people who used the service, it was clear there were opportunities for involvement in many interesting activities both inside and outside the home. People were involved in discussions and decisions about the activities they would prefer which would help make sure activities were tailored to each individual. Activities were arranged for groups of people or on a one to one basis. Each person’s support contained a ‘weekly planner’ and set out the different types of things they liked to do during the weeks and at weekends.

The staff we spoke with spoke positively about the management and leadership of the home. One member of staff said; “I feel that the service is extremely well managed. The manager has achieved a lot in a short period of time”.

The complaints procedure in place. The procedure was available in an easy read format that could be understood by everyone who lived at the home. We looked at the complaints log and saw complaints had been responded to appropriately, with a response given to the individual complainant.

There were effective systems in place to regularly assess and monitor the quality of the service. They included audits of the medication systems, supports plans, money, fire safety, infection control and environment. There was evidence these systems identified any shortfalls and that improvements had been made.

We spoke with five people who lived at Kingshill and they told us they had been provided with lots of information about the staff and services provided before they moved in. Comments included; "staff talked to me and gave me information about the home before I came here" and "staff are good to me, they have helped me to understand myself". They also told us they were asked for their agreement and consent in all aspects of daily life and were happy that they were given choices. People said staff always discussed things with them and made sure they were happy with the care and treatment they were given.

Care and support plans were clear and staff told us they worked with people to make sure they enjoyed a valued and inclusive life. They said they were committed to an individual, person centred philosophy of service delivery with the main aim being to support people to manage their own condition and gain or regain the skills and confidence to achieve their own goals.

Staff were well trained and supported and demonstrated, through discussions and observations, their total commitment to maximise the daily lives of the people who lived at Kinsghill.

The home held regular residents meetings and used various quality assurance systems to make sure it was run in the best interests of the people who lived there.

We spoke with eight people who lived at Kinsghill and one relative. They told us that people were provided with clear information about the home before they made a decision to live there. They said that they had been provided with a care plan and brochure about the home so they knew all about the services provided. People said they were treated with dignity and were assisted to achieve their goals.

People said that they liked the home very much and felt settled. Comments included “I love it here, I don’t ever want to leave”, "I feel very happy here, staff are lovely”. “Staff are very kind and caring”, “I can do what I want and staff are here to help me”, “The manager is kind and listens to me, so do all the staff. It is my home and I love it”. “The staff are great, they help me to achieve the things I want in life and help me to be creative. They empower me to show my brilliance”,” They make us feel good about ourselves,” They really care” and “I trust the staff to care for the people living here. Staff are very professional in all that they do.”

People who talked to us were happy to be living and working at Kingshill and we saw that the service promoted their wellbeing and safety.

We were told:

“I love this place I think it’s the best place I’ve ever been in.”

“I like the building and it’s handy for the bus stop.”

“I’ve never had a complaint I’m happy just as it is.”

“They treat me with respect it’s awfully nice here.”

When asked about improvements needed we were told:

“There’s nothing really, they have socials and we get invited, there’s good family contact and low turn over of staff.”

And:

“The “Star” is great. (Recovery Star support package) It’s rewarding to think about and find things you want to achieve. I write poetry and Making Space has published them. I’m encouraged by staff to improve myself.”

We found the service at Kingshill compliant with the essential standards of quality and safety assessed. We found the manager to be well organised, diligent, and competent and so the service was well run.

It was clear that through his leadership skills the changes in emphasis towards enabling and promoting independence had been fully embraced by people living at Kingshill and implemented by those working in the service.

We found the people living at Kingshill were supported to be successful and to have a good standard of life.