About the service:

191 Kneller Road provides accommodation and personal care for up to six adults with a learning disability and/ or autistic spectrum disorder.

People’s experience of using this service:

• The people living at the home were unable to communicate verbally with us to provide detailed feedback. We therefore used observation of interaction and engagement between people and staff in order to understand how comfortable and at ease people were. People were able to tell us they felt safe and happy in short phrases. Their interaction with staff throughout the inspection demonstrated that they felt at ease, were able to indicate their needs through various interactions and the use of sign language and pictorial images and enjoyed freedom of movement and activity in and around the home.

•The outcomes for people using the service reflected the principles and values of Registering the Right Support and other best practice guidance. These values include the promotion of choice, independence and inclusion, so people with learning disabilities and autism can live as ordinary a life as any citizen. At 191 Kneller Road people's support focused on them having maximum choice and control in their day to day lives, and the premises were designed to promote independence.

• People could access a range of interesting things to do. They were supported to enjoy a range of activities which enhanced their lives, both individually and in groups. This included support to enjoy swimming, clubs and going out in the community doing things they liked.

• People were supported to keep in touch with relatives and friends who were important to them.

• People had access to the healthcare they required. Staff had been provided with clear guidance so people would receive the support they needed if they required emergency health care.

• Staff understood people’s safety needs well and supported people so their individual risks were reduced. People were supported to have their medicines safely, by staff who were competent to do this.

• The environment at the home was clean, well maintained and regularly checked. The risk of accidental harm or infections was reduced as staff used the resources and equipment provided to help ensure this.

• There were sufficient staff to care for people. Staff received effective training and support to develop the skills they needed to care for people.

• People’s care needs were assessed and detailed support plans put in place based on their individual needs and to promote their well-being. These were reviewed regularly and kept up to date.

• People, their relatives, staff and other involved healthcare professionals were encouraged to make any suggestions for improving the care provided and the service further.

• There was an open and transparent and person-centred culture with good leadership evident. The provider, registered manager and the staff team were committed to providing high quality person centred care and support. They reflected on the support provided and considered improvements to enhance this.

• We found the service met the characteristics of a “Good” rating in all areas.

More information is available in the full report.

Rating at last inspection:

At our last inspection, the service was rated Good. Our last report was published on 8 September 2016.

Why we inspected:

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner.

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

191 Kneller Road provides accommodation and personal care for up to five adults with a learning disability and/ or autistic spectrum disorder. At the time of our inspection five people were living in the home. The inspection took place on 8 August 2016 and was unannounced. At the previous inspection, held in October 2013 we found that the service was meeting the required standards.

The home was presented as an ordinary detached house over two floors with access to the first floor via stairs. People had single rooms. Communal space consisted of a lounge area and dining room. There was a private garden at the rear of the property.

There was a registered manager in post, and they were at the home at the time of our inspection. 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 home was well decorated and adapted to meet people’s needs. The home had a homely feel and reflected the interests and lives of the people who lived there.

The people living at the home were unable to communicate verbally with us to provide feedback. We therefore used observation of interaction and engagement between people and staff in order to understand how comfortable and at ease people were. People were able to demonstrate their needs through various interactions with staff and enjoyed freedom of movement and activity in and around the home.

There were sufficient numbers of staff to meet the needs and preferences of the people that lived there. Staff understood their duty should they suspect abuse was taking place, including the agencies that needed to be notified, such as the local authority safeguarding team or the police. Risks of harm to people had been identified and clear plans and guidelines were in place to minimise these risks, without restricting people’s freedom. Staff ensured that people were involved in these decisions by speaking with people and making sure care plans were personalised and easy to read.

People were offered choices, supported to feel involved and staff knew how to communicate effectively with each individual according to their needs. People were relaxed and comfortable in the company of staff. Staff supported people in a way which was kind, caring, and respectful.

Staff helped people to keep healthy and well, they supported people to attend appointments with GP’s and other healthcare professionals when they needed to. Medicines were stored safely, and people received their medicines as prescribed. People were involved in their food and drink choices and meals were prepared taking account of people’s health, cultural and religious needs.

Where people did not have the capacity to understand or consent to a decision the provider had followed the requirements of the Mental Capacity Act (2005). An appropriate assessment of people’s ability to make decisions for themselves had been completed. Where people’s liberty may have been restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were protected.

The provider regularly sought people’s and staff’s views about how the care and support they received could be improved. There were systems in place to monitor the safety and quality of the service that people experienced.

Our inspection of 8 August 2013 found that while some people were enjoying their chosen activities not everyone was being supported to partake in their choice of planned activities. An incident at the home involving disrespectful comments directed towards someone living at the home meant that some people could not enjoy the full benefits of life at Kneller Road.

We wrote to the provider and asked them to send us a report of the changes they would make to comply with the standards they were not meeting. The provider sent us an action plan telling us what action they would take to become compliant.

We returned in December 2013 as part of a follow up inspection to ensure that the necessary changes had been made. We found that improvements had been made and the provider was meeting the requirements.

Activity plans had been modified and reviewed since our previous inspection. The seven day plans we looked at indicated how people spent their time. We noted that some people enjoyed aromatherapy, pedicures and nail treatments while others enjoyed listening to music and visiting the pub, going for walks and visits to local parks. People were involved in domestic activities within the home and would visit supermarkets for personal shopping with support from staff.

We looked at the daily activity records of five people and randomly selected dates to cross check how people were using their time. Some people were watching television while others watched films.

As part of our inspection we tried to speak with people living at the home. We were unable to speak with people using the service because people using the service had a number of complex needs meaning that it was difficult for people to tell us about their experiences.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

We asked staff why people were not participating in activities listed in their plans. Three staff told us there was not enough staff to address people's individual activities. One staff said "We have to have a driver to take people out; not all staff drive". Another staff told us "We are short of staff and are trying to recruit".

We asked about medication. Staff explained that medications were obtained via a local dispensing chemist and blister packs were used to administer medication.

The provider may wish to note, we spoke with five staff and three staff told us that the service was understaffed. The manager explained they were recruiting for permanent staff, "We've had vacancies but it has been quite challenging recruiting the right type of staff".

We read the complaints policy and recent surveys sent to relatives and people's advocates. We read comments by relatives, which indicated that people's families were happy with the care people received. People’s personal records including staff and medical records were available, accurate and fit for purpose.

In February 2012 we inspected this service and found that documents relating to people's care and support, including incidents and accident forms, health, safety and fire monitoring documents were not being fully completed. We made a further unannounced visit to the home on 3rd October and found that care records were still not being effectively completed. We also saw maintenance work related to fire prevention and safety which was not being effectively addressed. There was a lack of audit and monitoring evidence available for us to view at the time of the inspection. We returned on the 5th December and spoke with two people who use the service, however their responses did not relate to the standards we were inspecting. We spoke with staff and saw that a number of improvements had been made since our earlier inspection, and following action the provider had taken.

In February 2012 we inspected the service and found that staff records and people’s personal care and support notes, along with other records used by the home were not being maintained, regularly updated, or reviewed. We made a second visit in October 2012 and found that although some documents and records had been reviewed, staff and people’s care and support records had still not been reviewed. While auditing of some systems across some parts of the home had begun there was insufficient evidence that the quality of the service was regularly assessed and monitored, and that risks were being fully addressed.

We also found that people were at risk from unsafe and unsuitable premises and were not being protected from risks and hazards in the environment.

We spoke with three people living at Kneller Road; one person told us that they liked their key worker and their meals. We spoke with five staff who described how they supported people, and explained how people’s needs were assessed and how care was provided.

The people who use the service were unable to communicate with us.

We saw that people were free to spend their time as they wanted, in the company of others or on their own. We saw that people spent time out of the service, with staff or with their advocate.

However, we have identified concerns in the records of the service, as these do not demonstrate that issues are managed, similarly, there is insufficient evidence to show us that people’s money is always managed properly. These findings also demonstrate that the quality monitoring systems of the service and organisation are not effective in identifying concerns.

The people who use the service were unable to communicate with us. However, we saw that people were relaxed and spending their time as they wished. We saw people listening to music, spending time in the garden, and others being visited by relatives.

Relatives we spoke to said that they were very happy with the service and they feel it met the needs of their relative.

We saw that some staff were abrupt in their communication with people who use the service and we passed this information onto the manager to address.

The service looks after the monies of some people who use the service. When we looked at these we found that there was an issue where the processes of looking after and spending people’s monies was vague, and correct authorisation could not be evidenced. We have referred this to the local authority to investigate under their safeguarding procedures.