King Street

King Street is a care home providing accommodation for up to 14 people. People live in shared and individual houses and flats. The service specialises in supporting younger adults with a learning disability and autistic spectrum disorder. At the time of the inspection there were eleven people using the service.

People’s experience of using this service and what we found.

We found the provider had effective systems in place to safeguard people from the risks associated with abuse. There was effective management of risk. Staff were recruited, trained and deployed appropriately and effectively to ensure people’s needs were met. People were protected from the risk and spread of infection and people’s medicines were managed safely.

There were effective systems of governance, monitoring and review in place, with good evidence of provider oversight to ensure the service was working to the provider’s expected standards. There was evidence that feedback from people who used the service and their relatives had been sought and acted upon in positive ways. There was an emphasis on improving the service, and ensuring it was person centred and service user led. There was evidence of staff working in partnership with other agencies. This helped deliver individualised care and supported people’s access to other healthcare and social care services.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

The setting community based and people were able to access their local community, nearby shops and services.

Right care:

Care and support was person-centred and promoted people’s dignity, privacy and human rights. People were supported in the least restrictive way and education and learning was promoted.

Right culture:

The ethos, values, attitudes and behaviours of leaders and care staff ensured people using the service were leading confident, inclusive and empowered lives. One person’s relative said, “[Person] is empowered and given opportunities to do as many different things as possible.”

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

Rating at last inspection

The last rating for this service was good (published November 2018).

Why we inspected

We received information of concern in relation to two other services run by this provider. These included concerns to people’s safety, staff culture and governance. A decision was made for us to inspect and examine those risks at all of the provider’s ASC locations, to see if these concerns were repeated. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has not changed. This is based on the findings at this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe, effective and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for King Street on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Community Solutions is registered to provide accommodation for up to 14 people who require personal care. People live in shared houses and individual houses. All bedrooms have en-suite bathrooms. The service specialises in supporting younger adults with a learning disability and autistic spectrum disorder. The service is based in the centre of Thorne, which is a busy town with plenty of local facilities such as shops, cafes, restaurants, parks and leisure facilities.

The service had a registered manager in post 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 registered provider was working within the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

We spoke to people with limited verbal communication, who showed us through their body language and positive interaction with staff, that they were very happy and safe living there. People were busy, during both the days of our visit, taking part in various chosen activities, such as voluntary work, dancing class, food shopping and walks in the local area.

Staff were knowledgeable about how to safeguard people from abuse and felt confident that people were safe. The support plans we looked at contained risk assessments which considered the safety of people whilst balancing them having an enjoyable and safe life. Risks were monitored and did not place undue restrictions on people.

Records showed that the registered provider's recruitment procedures were robust and systems were in place to check that support workers were of good character and were suitable to care for people who used the service, prior to employment.

Rotas and training records showed us that there were sufficient numbers of suitably qualified staff to support people in line with their needs. People received one to one support when this was needed and staff were skilled in providing person centred support.

There were systems in place to ensure people's medicines were managed safely. Staff were trained and competency assessed to administer medicines.

We saw staff enabled people who used the service to follow their preferred interests and be as independent and active as possible. Procedures were in place to ensure people were protected from the risk of infections.

Consent to care was sought in line with legislation.

Staff were trained to carry out their role and felt they had the necessary skills to do their job. Through our observations we saw staff knew people well and understood their needs. Healthcare professionals were accessed as required.

Care records reflected people's needs and preferences, as well as any risks associated with their care. These provided staff with detailed guidance about how to support people and keep them as safe as possible. Support plans and risk assessments had been reviewed and updated regularly to ensure they were meeting each person's needs. People had consented to their support. Processes were in place to ensure there were no discrimination, including the protected characteristics under the Equality Act.

People were treated with kindness and respect and staff clearly knew people’s needs very well. Staff were observed to be very good at communicating with people and responding to their needs.

The provider had a complaints policy to guide people on how to raise concerns. People who used the service had been encouraged to share their views and were regularly invited to meetings about the service.

We found the provider had robust audit and monitoring systems in place to identify and address shortfalls.

Community Solutions is registered to provide accommodation for up to 13 people who require personal care. People live in shared houses and, flats, and individual houses. All bedrooms have en-suite bathrooms. The service specialises in supporting younger adults with a learning disability and autistic spectrum disorder. The service is based in the centre of Thorne, within walking distance of local facilities including, shops, cafes, restaurants, parks and leisure facilities.

The service had a registered manager in post 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.

Some people we spoke with had limited verbal communication. However, everyone very clearly indicated they felt safe and were happy living in the service, liked the staff and did the activities they liked to do.

Staff we spoke with had a clear understanding of safeguarding people and they were confident their managers and the rest of their team would act appropriately to safeguard people from abuse.

The support plans we looked at included risk assessments, which identified any risks associated with people’s care, and had been devised to help minimise and monitor the risks without placing undue restrictions on people. People’s medicines were well managed.

Everywhere was very clean and well maintained, and there were effective health and safety audits in place.

There were enough staff to keep people safe and to meet people’s individual needs, and the staff told us they received good training and support. Thorough recruitment checks were undertaken before staff started work in the service.

The Mental Capacity Act 2005 (MCA) sets out what must be done to make sure that the human rights of people who may lack mental capacity to make decisions are protected. MCA assessments and ‘best interests’ decisions had been made where there were doubts about a person’s capacity to make a specific decision. DoLS applications had been made appropriately to the local authority.

There was good guidance for staff regarding how people expressed pain or discomfort, so they could respond appropriately and seek input from health care professionals, if necessary. People had access to a good range of health care services and staff actively advocated for people if they felt health care services were not as responsive as they should be.

People were supported to have a good, well balanced diet and people’s individual needs and choices were catered for. They also had good access to a range of health care services, and received good health care support.

Staff retention was good, and staff knew people well and had built good relationships. There was also a good mix of staff.

Staff spoke to people in a caring and positive way, treated people with respect and were mindful of their rights and dignity. There was a nice, relaxed atmosphere and people were relaxed and smiling in the presence of the support staff.

There were very good care and support plans and information for staff about people’s likes and dislikes and we saw that staff were very good at monitoring people’s reactions and responses and responding to people in positive way. People were involved in choices about all aspects of their lives.

We found that staff respected people’s spiritual and cultural needs. Staff were knowledgeable about this aspect of people’s needs and this information was also clearly reflected in people’s care and support plans. The care plans themselves were detailed and thoughtful, and included pictures and photographs to enhance people’s understanding and involvement.

People had full lives, engaging in lots of activities, and this included in the evenings and at weekends. They were encouraged to keep in touch with the people who were important to them, such as their family members. People and their close family members, were encouraged to make their views known about their care. An independent advocate had sometimes helped people with this. An advocate is someone who speaks up on people’s behalf.

The complaints process was clear and people’s comments and complaints were taken very seriously, investigated and responded to in a timely way. People didn’t have any complaints to tell us about and indicated they were happy.

The registered manager was very person centred in their approach. Person centred care is when staff understand what is important to the person and give them the right care and support to do the things they want.

There was a good range of quality and safety audits, undertaken by staff and managers.

People had a chance to say what they thought about the service and the service learned from its mistakes, using comments, complaints and incidents as an opportunity for learning and improvement.

We found that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

There were effective recruitment and selection processes in place and appropriate checks were undertaken before staff began work.

There was an effective complaints system available. One person told us they would speak to staff if they were not happy.