About the service:

Klearwater Adult Services Limited is a residential care home that accommodates up to three people in one adapted building. The service specialises in supporting people with learning disabilities. There were three people using the service at the time of this inspection.

People’s experience of using this service:

People were safe at the service. Staff were trained to safeguard people from abuse and understood how to minimise identified risks to people’s safety. The provider carried out health and safety checks of the premises and equipment to make sure they were safe. The premises was clean and tidy and provided a range of comfortable spaces for people to spend time in. Staff followed good practice when providing personal care and when preparing and handling food which reduced hygiene risks.

There were enough staff to support people. The provider made sure staff were suitable and fit to support people and provided them with relevant training to help them meet people’s needs. Staff were supported to continuously improve their working practices.

People told us their needs were being met by staff who sought their views and respected their choices for how they wished their care to be provided. Staff supported people in a dignified way which maintained their privacy and independence. 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 helped people stay healthy and well. They supported people to eat and drink enough to meet their needs and to take their prescribed medicines. Extra help was sought for people if they needed this, for example when they became unwell. Staff worked well with other healthcare professionals to ensure a joined-up approach to the care people received.

People were satisfied with the quality of care and support they received. They knew how to make a complaint if needed. The provider investigated accidents, incidents and complaints and kept people involved and informed of the outcome. Learning from investigations was shared with staff to help them improve the quality and safety of the support they provided.

The registered manager was open and honest and encouraged people and staff to have their say about how the service could improve. They used this feedback along with other checks, to monitor, review and improve the quality and safety of the support provided. The provider worked proactively with other agencies and acted on recommendations to improve the quality and safety of the service for people.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection:

At the last inspection the service was rated ‘Good’ (29/11/2016). The service continues to meet the characteristics of a good service.

Why we inspected:

This inspection was planned based on the previous rating of ‘Good’.

Follow up:

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned in line with our inspection schedule or in response to concerns.

We visited Klearwater Adult Services Limited on 29 September 2016. The inspection was announced.

The service provides residential care for up to three adults with learning disabilities. At the time of our inspection there were two people using the service.

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.

Relatives of people using the service and staff told us people were safe. Staff had completed safeguarding training and knew how to recognise abuse and report safeguarding incidents. They were aware of how they could escalate concerns. Handovers took place between shifts to ensure staff had the most up to date information about people using the service. The service was a safe place for people, visitors and staff as the building and equipment used was well maintained. People’s needs were assessed and supported with relevant risk assessments. There were sufficient numbers of staff to meet people’s needs and safe recruitment procedures were followed. People received their medicines as prescribed and at the right time. Medicines were stored and managed appropriately.

Staff had the skills, knowledge and experience to deliver safe and appropriate care and treatment. Staff received regular training and support through supervision meetings with the manager. Mental capacity assessments were completed when necessary to establish each person’s capacity to make specific decisions. People had a healthy diet and were supported with their healthcare needs.

Relatives commented positively about relationships between people using the service and staff. Relatives lived locally and there were no restrictions on visits. People and their relatives were involved in their care and support. People using the service were supported by a keyworker. People’s choices and preferences were taken into account. Staff treated people with dignity and respected their privacy.

People received personalised care that was responsive to their needs. Care plans used person centred terminology and focused on meeting each person’s needs. People using the service benefited from a range of activities that enhanced their quality of life and reduced the risks social isolation. There were systems in place to listen to and obtain feedback from people and their relatives. Relatives were confident that they could raise concerns with staff or the manager.

Staff spoke positively about the manager and were confident they could raise any concerns or issues. Staff meetings were held on a regular basis. The service had a system of checks, reviews and audits to assess, monitor and improve the quality of service they provided.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Two people used the service at the time of this inspection. We had contact with both people and spoke with one person and a relative. We also spoke with a support worker and the registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

Records viewed included those of both people, staff rosters and staff training, policies and procedures and minutes of meetings.

Below is a summary of what we found. The summary describes what people using the service, those acting on their behalf and staff told us and what we observed.

Is the service safe?

Records showed people experienced safe and appropriate care. Their needs had been assessed and their support planned and delivered in accordance with individualised support and risk-management plans. For example, positive behaviour support plans had been produced for the safe management of behaviours that challenge services.

We saw staff had cooperated with other agencies and professionals involved in people’s care and support. They shared information in a confidential manner, ensuring people's support was safe and appropriate.

We found sufficient numbers of suitably qualified, skilled and experienced staff on duty to ensure people’s safety, health and wellbeing. Systems were in place for responding to and analysing incidents, accidents, complaints and safeguarding alerts.

The provider and registered manager understood their responsibilities under the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). At the time of our inspection no one was subject to a DoLS authorisation or application.

Procedures were in place for dealing with emergencies and staff suitably trained to ensure people’s safety and welfare.

Is the service effective?

People’s needs had been assessed and care and risk management plans had been produced and were mostly current. A person we spoke with felt staff understood and met their needs. We saw that people experienced effective, safe and appropriate care that met their needs and respected their rights.

People had been involved in some decisions related to their health and support needs. Where unable to actively contribute to these decisions, staff had worked in collaboration with other professionals to assess and meet their needs. A relative told us they had been included in this process during review meetings.

Care plans were detailed and covered all of their health, personal and social support needs. Staff ensured the plans were reviewed regularly and in response to changes in needs or behaviours.

Information from staff and records showed sufficient staff were available to support people in accessing community resources and facilities.

Is the service caring?

A person living in the home stated, “I like living here, I like all the staff." They also told us they had choice in their daily life and routines and staff knew and respected their preferences.

When speaking with staff it was clear they genuinely cared for the people they supported.

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

Is the service responsive?

One person told us staff supported them to have an active social life and engage in their hobbies and interests. They enjoyed a recent holiday and was looking forward to going back to college at the start of the new term. They enjoyed regular visits from a relative who went with them on visits to another member of their family.

Practice observations and records showed staff understood and responded to the wishes of a person with limited verbal communication, enabling choice in their life.

The service worked well with other agencies and services, ensuring people received care and support in a coherent way.

Is the service well-led?

The service had an experienced, suitably qualified registered manager. A staff member said the team received clear direction and support from the registered manager who visited the service most days. We found the registered manager promoted and facilitated effective team-work, setting standards for quality care and support to people and monitored practice.

We saw staff were clear about their roles and responsibilities and had a good understanding of the home’s ethos. Systems enabled staff to provide feedback to managers, so their knowledge and experience was taken into account in the operation of the service. This helped ensure people received a good quality service at all times.

We spoke to one person who uses the service. They told us they had a care plan and they had discussed their care and support needs with their key worker. Staff treated them very well and their privacy and dignity was respected. They showed us around the home and said they liked living there. They liked the food provided at the home. They said they went shopping with staff and got to choose what food they want to eat.

People were not being protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

We found that there was no effective or accessible complaints procedure in place for people using the service to make complaints.

We spoke to one person who uses the service. They told us that they visited the service before they moved in to see if they would like to live there.

They told us they had a care plan and they had discussed their care and support needs with their key worker.

They told us that they and the other person who uses the service attended meetings with staff and talked about what they thought about the service.

They told us that they liked the staff, staff treated them very well and their privacy and dignity was respected.

They told us they went to college, had regular visits from relatives, helped to plan and cook meals and went out regularly into the local community.

They told us that they liked living at the service; they had a nice bedroom and didn’t want to move away.

They told us that they felt safe.

They told us they knew how to make a complaint if they needed to and staff would do something about it.