What life is like for people using this service:

• The service provided exceptionally person-centred support to people and enabled them to live as full a life as possible through understanding, encouragement, positive behaviour support, and working effectively with guidelines from healthcare professionals. Changes in people’s needs were responded to immediately and staff went beyond the call of duty to ensure people had additional support. People were made to feel cared for and treated as valued individuals.

• The service supported people coming from different areas, for example from acute hospital services, to work through and manage their symptoms, become more independent and in some cases, go on to live independently. This was supported by a thorough preassessment process. The service worked closely with involved healthcare professionals to ensure people received holistic care which took into account all areas of their lives. This enhanced people’s health and wellbeing.

• Staff had access to a wide range of training which in turn supported them to meet people’s needs effectively. They sought advice from a wide range of healthcare professionals, and took initiative to support people according to their needs at the time. This included working with people to manage their symptoms with minimal negative impact wherever possible. Staff knew people extremely well, and what approaches were effective with them, which added to the effectiveness of the service.

• People were supported by a positive, proactive staff team who were accountable for their actions and knew what was expected of them. The ethos and values of the service was evident throughout the home. Staff supported people with a wide range of activities, hobbies and interests, and were there to listen to people when they needed. People had privacy and their own space, which staff respected.

• There was exceptionally good leadership in place, and the registered manager worked closely with staff and was always visible, regularly talking with people living in the home and participating in supporting people. There were highly effective systems in place to gain feedback and ensure the service was running well. The registered manager sought and shared knowledge and ideas, which contributed to improving the service and ensuring up do date best practice was followed. People and staff feel respected, valued, highly supported and listened to.

• People were truly placed at the centre of the service and were consulted on every level. Respect for privacy and dignity, and supporting people to feel truly, ‘at home’, was at the heart of the provider's culture and values.

Rating at last inspection: Good, with Outstanding in responsive (published 11 May 2016)

About the service:

Klair House is registered to accommodate twelve people with a mental health condition and has two self-contained units, in addition to the main house. These units are intended as ‘transitional’ accommodation for people preparing to move on into independent living in the community. At the time of our inspection Klair House was fully occupied.

Why we inspected:

This was a planned inspection based on the rating at the last inspection. The service has increased its’ rating to Outstanding.

Follow up:

Going forward we will continue to monitor this service and plan to inspect in line with our reinspection schedule for those services rated Outstanding.

We considered our inspection findings to answer questions we always ask: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led? This is a summary of what we found. The summary is based on our observations during the inspection, speaking with two people who used the service, the manager and two support workers. We looked in depth at three care plans and people's daily records.

Is the service safe?

Both of the people we spoke with told us that they felt safe living in Klair House. We saw evidence that there were effective arrangements for reporting safety incidents. The manager showed us how incidents were audited and action plans put in place to help reduce the risk of further occurrences.

People told us without exception that they felt there were sufficient staff on duty to meet their needs. We observed staff attend to their duties in a confident and competent manner. We noted that there were effective handovers between staff about the people they were caring for. This helped to ensure continuity of care and support which promoted the safety and well-being of the person.

The Care Quality Commission (CQC) monitors the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. While no applications had needed to be submitted, policies and procedures were in place in case an application was necessary. The manager and senior support worker had undertaken significant training in relation to the Mental Capacity Act (2005) and DoLS. The training file for the service showed that all staff had received appropriate training in relation to mental capacity and their roles and responsibilities in safeguarding vulnerable adults.

There were procedures in place to gain people's views and people felt that any concerns they raised were acknowledged and acted upon.

The manager showed us the audit schedule for the service. This tested the reliability of systems, processes and operating procedures. It included the layout, cleanliness and maintenance of the premises and facilities, staff recruitment checks and health and safety.

The provider had effective arrangements in place to manage foreseeable emergencies. These included disruption to staffing or facilities.

Is the service effective?

Both of the people we spoke with told us that they were very happy with the care and support they received. One person said, “I am really happy living in Klair House. The food is wonderful. I was involved in the planning of my care and what was needed to help make me feel better. I couldn’t be happier”. Another person said, “I am very satisfied living here, everything here is good”.

People’s needs were assessed and care and support was planned and delivered in order to meet these needs. Care plans were person-centred and undertaken with the person involved. We saw evidence that the care and support given, was effective in meeting people’s needs. The people who used the service did so, partly, to be in an environment that promoted their independence and helped them towards their goal of living independently in the community. There were numerous workshops for people to attend to help them achieve life skills such as finance and saving, food hygiene, managing their medicines and route planning to enable them to take public transport.

Each person who used the service had their capacity to consent assessed in line with the Mental Capacity Act (2005). All of the people had capacity and there were mechanisms in place to seek, record and review consent decisions. The decisions about the provision of care and support to a person were made without unlawful discrimination.

All of the staff were appropriately trained and competent to carry out their roles safely and effectively in line with best practice. The facilities, equipment and activities had a positive impact on people’s outcomes. Some of the people enjoyed gardening and we were shown the garden including the potting and planting that people had done. Other people enjoyed fitness, and this was accommodated in a building outside, including cardiovascular equipment as well as table tennis and lighter sports. The people we spoke with said that activities were aimed at individual preferences and helped to make them feel positive and ‘well’ in themselves.

People’s records were shared with other health and social care agencies, with their consent. This helped to maintain multi-disciplinary working so all of the person’s needs were being met.

Is the service caring?

Both of the people we spoke with told us that the staff were kind and always treated them with dignity and respect. One person said, “The staff are great and so is the manager. Nothing is ever too much trouble”.

People told us that they felt well supported and well-cared for. They said that if they felt troubled or worried then the staff would respond with compassion and spend time speaking with them.

Staff respected people’s individual preferences, habits, culture, faith and background. We noted that confidentiality was respected at all times during our inspection.

We observed staff using a range of communication aids to ensure effective communication with people. This was done in an appropriate and respectful manner.

The people who used the service told us that they understood their care and felt confident to ask about anything they were unsure about. One person explained that before living in Klair House they had neglected themselves and their medical condition. They told us that the support workers had been extremely caring when they explained the different treatment options and helped the person develop a plan of care to address how their needs could be met.

During our inspection we observed staff behaving in a friendly and positive manner towards people’s relatives who visited the home. The staff were available to discuss any issues that the relatives might have had.

Is the service responsive?

Before people went to live in Klair House the manager met with them to ensure that the service could respond to, and meet their expectations and needs. Both of the people we spoke with told us how they had been involved in this process.

People’s care plans responded to and reflected their physical and mental health needs as well as their social and spiritual needs.

Appropriate risk assessments were in place to help ensure the person’s safety in relation to their needs. The manager engaged with other health and social care professionals to help ensure that people’s medical and/or nursing care needs were met.

The care and support delivered to people reflected their goals and aspirations. These included activities to promote good health and wellbeing and support that would promote self-care, people’s independence and activities of daily life.

People knew how to complain and who to speak with if they were unhappy. No one we spoke with had any complaints. Both of the support workers told us that they encouraged people to provide feedback about their care. We noted that people were asked on a daily basis if everything was alright or could be made better. The manager told us that any ‘informal or verbal’ complaints were logged on to the computer and actioned as appropriate.

Is the service well-led?

Klair House aimed to deliver high quality care and promote good outcomes for people. The staff we spoke with could tell us about the strategy and the outcomes for people. They told us that the manager shared information with them and the environment promoted learning from each other. Both people said that they felt very well supported by the manager and that their views and comments were often sought and taken into consideration.

The staff we spoke with understood their roles and responsibilities and knew when they needed to ‘escalate’ an issue or problem to the manager or the senior support worker.

The purpose of this inspection was to follow up on concerns identified during our previous inspection carried out in July 2013.

Following an action plan submitted by the provider, we returned to Klair House to check that improvements in relation to medication stock checking and the accuracy of care planning had been made.

We found that they had.

We observed staff interacting with the people they were caring for and saw that staff knew the people they were caring for well. For example, they talked with the people about the activities planned for the day. Staff and people living at the service got on well together and we noted a happy, relaxed atmosphere.

We spoke with five people living at Klair House and they all expressed satisfaction with the service. One person told us “Everybody is very nice here, I think the home is a good as it gets!” They further commented “I am able to please myself.” Another person told us that they got on “well” with the staff and it was their preference to stay within the home. A third person commented “I couldn’t be happier, I get all the support I need” and “the staff know me very well.”

We reviewed the medication practices within the home and found concerns with regard to stock management and monitoring.

We found that people were cared for, or supported by, suitably qualified, skilled and experienced staff.

During our reviews of people's care records, we found concerns in relation to the appropriateness and accuracy of the information which was held about people.

We spoke with four people living at Klair House and they all expressed satisfaction with the service. One person told us “I used to be a very timid person but since being at the home I have found my confidence” they further commented that “I’m so happy here and don’t feel any improvements could be made”. Another person told us the “Staff are very helpful and encourage me to achieve my aims”. A third person commented “It’s a lovely place, I love living here and I get on well with all the staff”.

People told us that they knew who to contact if they had a compliant and that they felt the support provided met their needs.

We found that Klair House had in place effective procedures to ensure the home remained clean and that staff received appropriate support in order to carry out their roles.

People we spoke with told us that they liked living in Klair House.

One person told us that they liked their 'unit' and were doing very well. They also said that they were hoping to be able to move on and have their own flat soon.

One person said they were usually out a lot but they had, "Decided to come home early today".

People told us that they were looked after well in Klair House and that they liked the staff. People we spoke with told us that they knew what to do and who to talk to if they weren't happy or had a problem.

People also told us they felt safe and happy living in Klair House.

This inspection was carried out on 13 and 14 October and was unannounced.

Klair House Limited owns two adjacent locations (Klair House and Callum House) that provide care, support and accommodation for people with mental health conditions and/or learning difficulties. Klair House is registered to accommodate twelve people with a mental health condition and has two self-contained units, in addition to the main house.These units are intended as “transitional” accommodation for people preparing to move on into independent living in the community. At the time of our inspection Klair House was fully occupied.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

People were safe and lived in a safe environment because the premises were well maintained and any safety issues were rectified promptly. The management and staff ensured that identified risks to people’s safety were recorded on an individual basis and all supporting staff had very good knowledge of how to support people safely and effectively.

Staff were supported by way of training that was specific and relevant for meeting people’s needs appropriately. Staff also received regular supervisions and appraisals to deliver care effectively. On occasions, people using the service also attended certain training sessions at the same time as the staff. There were consistently enough staff to support people and ensure their needs were met and appropriate recruitment checks were carried out before staff began working in the home. New members of staff completed a comprehensive induction and all staff were very well supported by the manager and the organisation as a whole.

Medication was managed and administered safely in the home and people received their medication as prescribed. Some people administered their own medication and there were effective systems in place to ensure people were able to do this safely.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). Nobody living in Klair House was currently subject to DoLS.

All the staff in the service were very caring and frequently went above and beyond the call of duty to provide outstanding care. People using the service decided what meals they wanted on the menus and people living in the self-catering apartments were encouraged and supported to do their own food shopping, as well as prepare and cook their own meals. Friends and relatives visited regularly, were always welcome and sometimes joined their family members for meals. People were consistently treated with dignity and respect and were able to be as independent as possible. People lived very full and active lives and undertook pastimes, hobbies, education or employment of their choice.

A number of people told us that the service was outstanding in the way it was individually tailored and regularly reviewed, to ensure it remained responsive to people’s needs. The staff and management worked very closely with a wide network of healthcare professionals and prompt guidance was sought, with timely referrals made when any needs or concerns were identified. Staff always followed the instructions and guidance provided by these professionals, to ensure people’s ongoing health and wellbeing.

Comprehensive assessments were completed with people prior to their admission, to ensure their placement at the service would be appropriate for them and would meet their needs. People were fully involved in planning all aspects of their care and received care and support that was individual to their needs. Assessments of risk detailed what action was required or had been carried out to remove or minimise these risks for people.

People were able to voice their concerns or make a complaint if needed and had been made aware of the service’s complaints procedure. People were listened to, received appropriate responses and action was taken, as needed.

People were genuinely at the heart of this well run service and people’s needs were being met consistently and appropriately. The manager was very approachable and always open to discussion. Communication between the manager, other directors of the service and staff was also frequent and effective.

There were a number of effective systems in place in order to ensure the quality of the service provided was regularly monitored and maintained. Audits were also carried out regularly by the manager, directors, staff and people using the service, in order to identify and address any areas that needed improvement.