King Edward House

King Edward House is a ‘care home’ for up to 5 people with learning disabilities. At the time of the inspection the people living at the service were also older people. People in care homes receive accommodation and personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

There were 5 people living at the service at the time of our inspection. The service was set in a large house with a private garden which was based in a residential area. The accommodation was spread over 2 floors which one bedroom on the ground floor. There were two lounges and a kitchen dining room with a comfortable seating area.

At the last inspection, on 4 May 2016, the service had an overall rating of ‘Good’. This inspection report is written in a shorter format because our overall rating of the service has not changed.

At this inspection we found the service remained ‘Good’.

People continued to be protected from abuse. Staff understood how to identify and report concerns. Medicines were managed safely, and people received their medicines when they needed them. Risks were assessed and there were actions in place to minimise risk and keep people safe.

There continued to be sufficient numbers of staff who had the skills and knowledge they needed to support people living at the service. Staff were appropriately supervised and supported. New staff had been recruited safely and pre-employment checks had been carried out.

Peoples’ care met their needs. Care plans continued to accurately reflect people’s needs and included information on their religious and cultural needs. We observed that staff followed the guidance in people’s care plans. 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 support this practice. Staff were aware of people’s decisions and respected their choices.

Staff continued to support people to maintain their health and wellbeing. People confirmed that they had access to healthcare services. People were supported to eat safely and had a choice over what they ate.

People were treated with respect, kindness and compassion. Their privacy was respected, and they were supported to lead dignified lives. People were supported to maintain their independence. There were systems in place to seek feedback from people to improve the service. People were encouraged to express their views and were listened to.

The service was clean and the setting pleasant and welcoming. The building had been adapted to meet people’s individual needs. People had chosen the decoration for their room and the shared areas. Staff were aware of infection control and the appropriate actions had been taken to protect people.

The service was well-led. People knew the registered manager well. Staff told us that they were happy at the service and were proud to work there. The service was regularly checked to identify where improvements were needed, and actions were taken.

Incidents were recorded, investigated and acted upon. Lessons learnt were shared and trends were analysed. The service worked in partnership with other agencies. The registered manager was well informed about best practice and shared this learning thought the service.

Further information is in the detailed findings below.

The service provides long-term care and support for up to six people with learning disabilities. People who used the service had low to moderate care needs; they made daily choices about their routines and received support from staff when they needed it. At the time of our inspection there were six people using the service, five of whom had made King Edward House their home for thirty years. The accommodation was homely, personalised and looked comfortable.

A registered manager was not employed 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 2008 and associated Regulations about how the service is run. However, the provider had appointed a manager who had applied to register with the CQC.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. No one living at the service was subject to any restrictions that required a DoLS application, but the manager understood when an application should be made. People made their own decisions about their care or day to day medical treatment. The manager ensured they followed the principals of the Mental Capacity Act 2005 when assisting people with making decisions about non-routine medical issues. Decisions were arrived at lawfully, in people’s best interest and were fully recorded.

People were kept safe by staff who understood their responsibilities to protect people living with learning disabilities. Each person had a key worker who assisted them to learn about safety issues such as how to evacuate the building in an emergency and to speak to if they felt unsafe. People understood how to respond to emergencies like the fire alarm sounding. Staff had received training about protecting people from abuse. The management team had access to and understood the safeguarding policies of the local authority and followed the safeguarding processes.

The manager and care staff used their experience and knowledge of caring for people with learning disabilities effectively. Staff assessed people as individuals so that they understood how to plan people’s care to maintain their safety, health and wellbeing. People had communication and health action plans to assist external health and social care professionals understand people’s needs. For example, if they were admitted to hospital.

Risks were assessed within the service, both to individual people and the wider risk from the environment. Staff understood the steps to be taken to minimise risk when they were identified. The provider’s policies and management plans were implemented by staff to protect people from harm.

There were policies and procedures in place for the safe administration of medicines. Staff followed these policies and had been trained to administer medicines safely. Where people could retain the information, they had been supported to understand what their medicines were for and when they needed to take them. This was reinforced by staff who administered medicines.

People had access to GPs and their health and wellbeing was supported by prompt referrals and access to medical care if they became unwell. Good quality records were kept to assist people to monitor and maintain their health. Staff had been trained to assist people to manage the daily health challenges they faced from conditions such as poor swallowing reflexes. People had been supported to understand their health conditions and had been given information to help them manage their own health and wellbeing.

We observed and people described a service that was welcoming and friendly. Staff provided friendly compassionate care and support. People were encouraged to get involved in how their care was planned and delivered. Staff were deployed to enable people to participate in community life, both within the service and in the wider community.

Staff upheld people’s right to choose who was involved in their care and people’s right to do things for themselves was respected. We observed people being consulted about their care and staff being flexible to requests made by people to change routines and activities at short notice.

The manager involved people in planning their care by assessing their needs when they first moved in and then by asking people if they were happy with the care they received. Staff knew people well and people had been asked about who they were and about their life experiences. Records about people’s early lives were comprehensive. This helped staff deliver care to people as individuals.

Incidents and accidents were recorded and checked by the manager to see what steps could be taken to prevent these happening again. Staff had received training about the safe management of people with behaviours that may harm themselves or others.

Managers ensured that they had planned for foreseeable emergencies, so that should they happen people’s care needs would continue to be met. The premises and equipment in the service were well maintained to promote safety.

Recruitment policies were in place. Safe recruitment practices had been followed before staff started working at the service. The manager recruited staff with relevant experience and the right attitude to work well with people who had learning disabilities. New staff and existing staff were given extensive induction and on-going training, which included information specific to learning disability services.

Staff received supervisions and training to assist them to deliver a good quality service and to further develop their skills. The manager ensured that they employed enough staff to meet people’s assessed needs.

Staff understood the challenges people faced and supported people to maintain their health by ensuring people had enough to eat and drink. People were supported to make healthy lifestyle choices around eating and drinking.

There were no barriers to people asking for what they wanted, or speaking to the manager and staff if they wanted to raise an issue. People were being asked frequently if they were unhappy about anything in the service. This included meetings with care managers from social services. If people wanted to complain there was a policy that would ensure they were listened to.

The manager and staff demonstrated a desire to deliver a good quality service to people by constantly listening and improving how the service was delivered. People and staff felt that the service was well led. They told us that managers were approachable and listened to their views. The manager of the service and other senior managers provided good leadership. The provider visited the service regularly, was well known by people and assisted the manager in developing business plans to improve the service.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, their relatives, the staff supporting them 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 was safe because the manager had a good understanding of the risks and needs of the people using the service and had put appropriate measures in place. Risk assessments had been completed to make sure staff knew how best to support people to minimise potential risks to their wellbeing. People were treated with respect and dignity by the staff. Safeguarding procedures were robust and staff understood how to safeguard the people they supported. People told us that they felt safe. One person said, 'The staff make sure I am safe ". The provider had appropriate systems in place to monitor and assess the quality of service.

Is the service effective?

The service was effective because people's health and care needs were assessed with them and/or their representatives. Specialists including psychologists and speech and language therapists had been involved in people's care and to give staff training and advice. Staff had received the training they needed and there was an ongoing training programme to make sure staff had the skills they needed to support people appropriately.

Is the service caring?

The service was caring. Staff spent time with people and assisted them to do what they wanted. Staff had got to know the people using the service well and had developed ways to communicate with them. When people needed support this was given respectfully and in a relaxed way. Staff occupied people with activities and encouraged people to learn new skills.

Is the service responsive?

The service was responsive. People were given choices and staff were responsive to their needs. Sometimes people needed support with their behaviour and there were plans and systems in place to respond to this. The service had a development plan that addressed all areas of improvement needed and they had been responsive to concerns that had been raised.

Is the service well-led?

The service was well-led. The service had a manager who was experienced in working with people with learning disabilities and although they had responsibilities as head of care in another service within the organisation, there was a senior member of staff on duty at all times. They told us 'The manager is very supportive and I can contact them if I have a query or if I need support. They are just down the road'.

There were systems in place to provide on-going monitoring of the home. This included checks for the environment, health and safety, fire safety and staff training needs. The staff confirmed that they had individual supervision and staff meetings. This enabled them to share ideas and concerns.

We found that people could choose what they wanted to eat and drink. One Person told us 'I like the meals they are always nice.' Another person told us 'I like washing up afterwards' We observed that the people who used the service were encouraged to engage in household tasks and were encouraged to maintain their independence wherever possible.

We looked at the care records of three people who used the service. We saw that each person had a set of care records that were individual to their needs and were person centred.

We looked at staffing and recruitment records and spoke with staff. We saw that the manager had carried out relevant checks for new staff when they joined the service to ensure that they were suitable for the role.

We looked at how the service monitored quality. We saw that there were systems in place at a local and corporate level to ensure the quality of the service that people received was maintained effectively.

People who used the service said or showed us they felt free to raise concerns and that they felt safe. One person told us 'I feel safe here and I can always speak to workers if I feel worried about anything." We spoke to one care worker who told us' I always treat people with respect, I always talk to people about their care and try to help them with decision making." We observed care staff treated people with respect and communicated with people in an appropriate and polite way. For example, we observed care staff assisting a people to make choices about what they wanted to watch on television and whether they preferred a hot or cold drinks.

People who used the service said told us they were satisfied with the care and support they were given and that they were encouraged by staff to be independent. One person said 'I get help to get up in the morning and I am happy living here and everyone treats me well.' Another person gave a thumbs up sign when asked about the support they received.