Kathleen House

People’s experience of using this service:

People looked comfortable and relaxed with staff and their relatives told us they were safe. Staff told us how they should keep people safe and minimise risks to their safety.

People were supported by staff we saw were caring and expressed interest in people who lived at Kathleen House. People received effective person-centred care and support based on their individual needs and preferences. Staff were knowledgeable about people; their needs and preferences and we saw they had a good relationship with the people.

People were supported by care staff who had a range of skills and knowledge to meet their needs. Staff understood, felt confident and well supported in their role, and they said they were supported through formal staff supervision. People's health was supported as staff worked with other health care providers to ensure people’s health needs were met.

People were supported to have maximum choice and control of their lives and staff understood that they should support them in the least restrictive way possible; the policies and systems in the service supported this practice.

People's care plans reflected people’s needs and preferences and staff and the registered manager could explain any recent changes to people’s care. Where there was changes staff knew how they should provide care to ensure people were safe, their needs were met, and preferences respected.

People’s representatives knew how to complain. Relatives and staff knew how to identify and respond if people were unhappy with the service. People we saw could communicate how they felt to staff, this assisted by staff understanding their individual communication needs. Relatives told us when they had raised concerns these had been addressed appropriately.

People, relatives and staff gave a positive picture as to the quality of care people received and said the registered manager was approachable. We saw staff listened to people and relatives said staff also listened to what they said and involved them by asking their opinions on their loved ones care.

Quality monitoring systems were in place although recording of the outcomes of audit findings could be better recorded so it was accessible in one service development tool. The provider was able to demonstrate they were responding to findings from the quality monitoring system so it was effective.

Rating at last inspection: The rating for the service at our last inspection was ‘requires improvement’ (Published on 22 June 2017).

Why we inspected: This was a planned comprehensive inspection that was due based on our scheduling targets.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-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

The service currently provides a respite service to approximately 60 people that live in the community. People visit the home for a short stay, enabling relatives and carers to have a break from their caring role. People who use the service have a range of needs which include learning disabilities, physical disabilities, autistic spectrum disorder and dementia.

There was a registered manager in post and she was present during 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 and associated Regulations about how the service is run.

At our last inspection in March 2016 we found the provider was meeting the regulations of the Health and Social Care Act 2008. However we found improvements were needed in the following areas. Recruitment procedures were not robust, and records had not been updated where people’s needs had changed and where restrictions were in place for people to keep them safe. Staff were not following recommendations made by healthcare professionals, and plans were not in place for staff to complete refresher training. We also found that people’s dignity was not always promoted. The registered manager had not informed us about notifiable incidents and audits were not effective. At this inspection we found that improvements had been made in most of these areas although some further improvements were still required in others.

Staff did not always follow the procedures in place to ensure risks to people were reduced. People were supported by staff that had undergone recruitment checks to ensure they were safe to work. Staff understood how to report concerns on abuse to keep people safe. Medicines were given in a safe way.

Staff had access to training and supervision to support them in their role. Staff understood the importance of seeking consent in line with the Mental Capacity Act 2005. People were supported to have enough to eat and drink and had been supported to access healthcare support when required.

People were supported by staff who were kind and treated people with dignity. People and their representatives were supported to be involved in their care. People were supported to maintain relationships with people important to them. People had support from advocacy services where required.

People felt supported by staff who knew them well and were given opportunity to take part in activities that were meaningful to them. People and their representatives knew how to make a complaint if needed.

Some records required updating following changes to people’s needs. Some records needed to be completed so there was consistent guidance for staff when supporting people with their medicines and when using equipment. Staff felt supported by the management team. Audits were now completed consistently by the management team to monitor the service provided. Systems were in place to enable people and their representatives to provide feedback on their experiences of the service.

At our last inspection in August 2014 the provider was not meeting one regulation that we assessed relating to consent to care and treatment. We told the provider to take action. Following that inspection the provider sent us an action plan which highlighted the action they would take to improve. Our inspection findings confirmed that improvements had been made and were on-going to ensure that people that lacked capacity had assessments undertaken in relation to their capacity to make decisions about their care.

There was a registered manager in post and she was present during 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 and associated Regulations about how the service is run.

Systems for updating care records and risk assessments were not effective to ensure risks were managed appropriately, and to ensure staff had the guidance about how to provide support to people.

Relatives told us they thought their family member was safe.

The recruitment procedures in place were not robust to ensure all required information was obtained before people commenced employment.

Staff were knowledgeable about how to protect people from harm. People received their medicines when they needed them.

When people were unable to consent we found that mental capacity assessments had not been completed for all of these people. However the registered manager was in the process of completing these. We saw that people’s consent was sought before staff provided support. The provider had considered when people were being restricted and Deprivation of Liberty Safeguarding (DoLs) applications were being submitted.

Staff knew people well and interacted with them in a kind and compassionate manner.

People had opportunities to engage in activities they enjoyed.

Not all of the people who used the service had a personalised plan of care detailing their needs and preferences to guide staff on how they wanted to be supported.

Feedback was being sought from relatives about the service provided to their family member.

Quality assurance systems were not always effective and had not identified the shortfalls we found during this inspection.

The registered manager had failed to meet the requirements of their registration with the Care Quality Commission as we found a number of incidents that had occurred within the service that had not been reported as required. However these have now been sent to us following the inspection.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

There were effective recruitment and selection procedures in place at the service. Staff records showed that all staff were trained in the needs of people who used the service.

Accidents and incidents were investigated and reported appropriately.

Written consent to care was not seen in any of the plans of care we looked at. We found that the service had not complied with the Mental Capacity Act 2005 in relation to obtaining the agreement to people's plan of care and support where people lacked the capacity to make decisions for themselves. We saw no evidence that people were being unlawfully deprived of their liberty.

Is the service effective?

Care plans were regularly reviewed. We saw that care plans were based on each person's needs. They were comprehensive and well written. Many care plans included evidence-based management plans for specific medical conditions. However, there was no evidence of consent being recorded for care given.

The care plans contained evidence of effective working with specialist health professionals. Specific medical conditions and their potential emergencies were planned for by these professionals.

Is the service caring?

People were supported by caring staff. All plans of care were written to reflect each person's needs. We spoke with two people who used the service and they said they were happy with the service given. One relative said, "(Relative) is very happy there. I am very satisfied." Another said, "(Relative) seems happy there. She goes out every day." However, one relative of a person who used the service said, "They don't give me regular updates, they only call me in an emergency."

Is the service responsive?

People's needs had been assessed before care started. Complaints were dealt with well and people knew how to make complaints. The provider also audited many aspects of the service and used these audits to improve care.

Is the service well-led?

There was a system for recording formal and informal complaints. The provider carried out regular surveys of people using the service in order to learn their views. There were effective and safe recruitment procedures in place.

Prior to this inspection we had received some concerns from an anonymous source. We looked into these issues as part of this visit. We did not find any evidence to support these concerns and therefore they were not substantiated.

One person we spoke to said, "The staff team are nice and when I need support I get it".

We found that medicines were being managed appropriately for people who lived in the home permanently and audited to ensure people were receiving their medicines safely. We were unable to clarify the improvements made to the respite support as there was no one in the home on respite during the inspection.

We found that improvements to the records had not been completely actioned as the completion date for some of the actions had not yet been reached.

People we spoke with told us they liked living at this home. One person said, 'I am happy here.' The visitors we spoke with told us, 'Our relative enjoys coming here for respite.'

Staff supported people to ensure their healthcare needs were met. We observed that staff interacted well with people.

People received sufficient food and drink that met their needs and preferences.

We found that improvements were required to ensure people received their medication as prescribed.

We found that procedures were in place to ensure that only suitable staff were employed to work at the home.

Systems were in place to enable people and their representatives to raise any concerns and these were responded to.

We found that people's care records were not up to date, detailed and fit for purpose.

We saw care workers spending time with people and giving them individual attention. We saw positive relationships between care workers and people living at the home. We saw that some community based and in-house activities were offered to suit people's individual needs and choices. People told us that they enjoyed these.

We found that people's needs had been assessed by a wide range of health professionals including speech and language therapists, physiotherapists, specialist doctors, opticians and dentists. This meant that people's health care needs were being monitored and met.

We heard that people's views were sought and they were listened to. There were systems in place to monitor how the home was run, to ensure people received a quality service.