Kemble House

Kemble House is a care home that provides accommodation and care services for a maximum of 15 people with autistic spectrum conditions and complex needs. At the time of the inspection, the service accommodated 13 people.

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.

People’s experience of using this service:

People told us they liked living at the service and most people said they felt safe there. Two people mentioned that had they felt uncomfortable about the occasional behaviour of people who had recently moved out.

Most people told us staff were kind and caring and people, families and health and social care professionals confirmed this.

The service was not always meeting the underpinning principles of Right support, right care, right culture due to issues highlighted in the Right support section below.

Right support: Despite the service being larger than best practice guidelines, the service provided care that was personalised, and the service was working to maximise people’s choices. People were involved in a range of community activities of their choice, but people told us they would like the opportunity to go out to additional community activities.

Long-standing staff understood people’s needs. New staff were in the process of getting to understand the needs of the individual people living at the house. But we were made aware from some relatives and health professionals that the service was not always able to understand the challenges of supporting people with dual mental health needs and a learning disability or autism. The registered manager was working with the staff team to develop their skills, knowledge and experience.

Right care: Care documentation was up to date, person-centred and promoted people’s dignity, privacy and human rights. Care documents outlined people’s needs, preferences and routines. Risk assessments were in place to address known risks. The management team were working with family members and health professionals, to understand how best to support people living at the home, and showed commitment to further improve this partnership working. Appropriate documentation was in place where people’s liberty was restricted.

Right culture: The registered manager promoted good quality care, and was supporting staff to further develop and improve their skills through supervision, training and effective team communication. People and relatives told us that the registered manager communicated with them when issues arose. Following the inspection, the service introduced regular meetings with family members, had asked for their views through a survey, and was planning to undertake a survey of the views of health professionals.

Safe recruitment took place at the service, and people were safeguarded against the risks of abuse and harm by the systems and by the staff. There were enough staff to meet people’s needs.

Medicines were managed safely, and there were infection control processes in place.

The provider and registered manager had systems in place to monitor the quality of the service through audits and checks. However, we became aware of some issues through feedback with relatives and health professionals, as part of the inspection that the registered manager and provider should have known.

The building utilities and fire equipment were safely maintained, but we saw that there was outstanding maintenance to the building required. At the time of writing this report we were shown a plan to address these building improvements.

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 inspection at which a rating for the service was given, was good (published 20 June 2019).

Why we inspected:

This was a planned inspection based on the previous rating. This report only covers our findings in relation to the Key Questions Safe, Effective, Caring and Well-Led.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up:

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

At the time of inspection, the service accommodated seven people. The service had been developed and designed in line with 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. For example, the building is located near community facilities, such as shops and colleges and people were supported to be part of the local community.

We found the following examples of good practice.

The home had responded to peoples’ choices and individual needs during the pandemic to help them carry out activities outside the home safely. For example, ensuring lateral flow testing each day before they leave the home and providing packs of masks and sanitiser to take with them.

When the provider admitted people to the home, they recognised and responded to peoples’ individual needs whilst following the current guidelines. People were tested before being admitted then a period of isolation in their room before a further test at the end of the isolation period. Staff carried out regular welfare and mental health checks throughout the isolation period.

The home consisted of two floors. If there was an outbreak on a floor, the home could be run as two separate homes with staff assigned to each floor to ensure infections did not spread. A separate entrance could be used for the staff on the second floor to ensure minimal contact with the staff on the ground floor.

The staff were aware of who to contact should they have an outbreak of Covid 19 and the protocols to follow.

The provider was following the current government national guidance regarding home visiting. People had their named visitors and essential care giver. Information on the home procedures and the use of PPE was available.

The home had set up a testing station in a building attached to the main home. Visitors were tested in this area before being able to undertake a visit. Visits took part in the staff room which was the room closest to the entrance designated for visitors to minimise any transmission. There was a separate entrance at the side of the building that led to the test area. Visitors were required to use this entrance.

The home had alternative methods to support social contact for visitors who were not named. For example, video calling.

The home had sufficient supplies of Personal Protective Equipment (PPE). There were PPE stations throughout the premises. Staff had received training in infection prevention and control and how to don and doff PPE.

The provider had a system in place to ensure staff had the necessary vaccinations and had completed the necessary Covid 19 testing prior to working at the home.

The layout of the service and communal areas supported social distancing. The premises looked clean and hygienic throughout. There were cleaning stations in place and adequate ventilation.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

Kemble House is a care home that provides accommodation and care services for a maximum of 15 people with autistic spectrum conditions and complex needs.

At the time of the inspection, the service accommodated 15 people. However, the service had been developed and designed in line with 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. For example, the building is located near community facilities and people were supported to be part of the local community.

The last inspection was carried out in September 2016. The overall rating of the service was Good. However, in 2018 we received notifications highlighting concerns with fire safety, medicines management, health and safety, and infection control. At this inspection we saw that improvements had been made to meet the relevant requirements.

People’s experience of using this service:

We have made a recommendation about LGBT+ inclusive practices ((LGBT+ describes the lesbian, gay, bisexual, and transgender community).

At this inspection, we saw that methods of monitoring the quality of the service had been improved. Regular checks and improvements had been carried out in relevant areas. Whilst we were reassured with the current progress, the improvements had come about because of the combined input from the host local authority. Therefore, whilst we have judged the service to be ‘good’ overall, the provider will need monitoring to demonstrate a continuous track record of sustaining improvement without support from external agencies.

People were protected from abuse and avoidable harm. Staff understood different types of abuse, which meant they could spot the signs of abuse and report accurately to relevant authorities. The service had also made improvements in several areas, including fire safety, medicines management and infection control. There were also effective systems and processes in place to minimise risks to people. Each person's care plan had several risk assessments and measures to reduce risk.

People’s care, treatment and support promoted a good quality of life. They were supported by trained and skilled staff. People’s assessments had taken account of their choices. Staff understood these choices. Staff supported people to access the healthcare services they needed. There were arrangements to ensure that people’s nutritional needs were met. People’s dietary requirements, likes and dislikes were assessed and known to staff.

People were supported and treated with dignity and respect. They were involved as partners in their care. People confirmed that staff were kind and caring. People told us they had been fully consulted about their care. They were supported to maintain their independence. Their care records contained information about their choices and independence.

The service planned personalised care that met people’s needs, preferences and interests. People’s records set out their preferences and addressed their individual needs and risks. There was a programme of activities organised by the service. People attended a variety of activities and outings, which they enjoyed. Each person’s preferred method of communication was highlighted in their care plans, which showed people’s communication needs had been considered.

Rating at last inspection:

At our last inspection, the service was rated "Good". Our last report was published on 23 August 2016.

Why we inspected:

This was a scheduled inspection based on the previous rating. The inspection was also prompted in part by notifications of serious concerns regarding the quality of care at the home.

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.

Kemble House is a care home registered to provide accommodation, personal care and support for up to 15 adults with autistic spectrum and complex needs. The home is operated and run by Brookdale Healthcare Limited. At the time of our inspection, 14 people were living in the home.

The home is purpose built and has 15 bedrooms with ensuite facilities split across three floors. The ground floor has dining and lounge areas, and kitchen and a laundry room. The first floor has a kitchen, lounge area and laundry room.

The service had a manager who was promoted from their previous role as deputy manager. They had applied for registration with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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.

People using the service told us they felt safe at the service. The service had robust safeguarding policies and staff had a good understanding of the safeguarding procedure and the role of external agencies. Staff were able to demonstrate their role in raising concerns and protecting people from harm and abuse.

The service had systems to identify and manage risks. Risk assessments were detailed and individualised, and care records were well maintained. Care plans and risk assessments supported the safe management of people's medicines. The service kept accurate records of medicines administered by staff and medicines collection.

The service had sufficient numbers of staff employed to ensure that people’s individual needs were met. The service followed safe recruitment practices. Staff files had records of application forms, interview notes, criminal record checks and reference checks. Staff told us they were well supported by the manager. However, there were gaps in staff supervision and appraisal. Staff told us they attended induction training and additional training, and records confirmed this.

People using the service and their relatives told us staff were friendly and caring. People were supported and encouraged people to maintain a healthy and balanced diet. People told us they were happy with the food.

The service operated within the legal framework of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). People told us staff asked their consent before supporting them. The manager and staff demonstrated a good understanding of the procedures under MCA and DoLS.

The care plans were personalised and people’s life histories, individual needs and likes and dislikes were recorded. People and their relatives were involved in planning their care. People were asked about their views at residents’ meetings. People were encouraged and supported to carry out activities in and outside of the service. People told us they were asked for their feedback and the service was introducing new ways of seeking feedback from the relatives. People and their relatives told us they felt comfortable in making complaints and they were addressed in a timely manner.

The manager worked with health and social care professionals to ensure the service supported people to maintain healthy lifestyle. The service had records of regular monitoring checks of various aspects of the service. The service maintained efficient systems and processes to assess, monitor and improve the quality and safety of care delivery.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, 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?

At the time of the inspection there were fourteen people living at the home. People living on the first floor tended to be more independent with people needing more staff support living on the ground floor. We spoke with seven residents (from both floors). People told us 'It's nice and homely here,' and 'I definitely feel safe here.' Staff had undertaken safeguarding training and understood their role in safeguarding the people they supported. Accidents and incidents were recorded appropriately, and the home environment was safe and clean.

Staff received appropriate training and supervision to ensure that they worked with people safely and in line with best practice.

Is the service effective?

People told us that their care and support needs were met effectively and they were happy with the home environment. Comments included 'I have a nice room and it's en suite,' and 'I always get my medicines on time.' Their health and social care needs were assessed with them, and they were involved in writing their care plans. Care plans were reviewed regularly to ensure that staff met people's needs consistently.

Staff received appropriate support and supervision to enable them to deliver care to people to an appropriate standard.

Is the service caring?

People we spoke with told us that staff were caring and treated them with respect. Comments included 'The staff and residents are nice,' 'The staff are good here,' and 'I get on with my key worker.'

We observed staff showing patience and empathy when supporting people. People's preferences, interests, aspirations and diverse needs had been recorded to ensure that care and support were provided in accordance with their wishes.

Is the service responsive?

Some of the people living at the home advised that they were being supported to develop daily living skills with an aim to moving on to more independent accommodation. We saw that staff had identified people's cultural and religious needs, and people were supported to attend places of worship and have cultural foods.

There was evidence of suitable arrangements in place for obtaining, and acting in accordance with people's consent in relation to the care provided to them. People told us 'I'm involved in a lot of activities,' and 'I get enough support to do what I need to do.' One person with a fear of heights told us that staff supported them with this issue. Another person told us that one of their goals was to visit Australia, and staff were supporting them with developing their skills in overnight stays away from the home.

Is the service well-led?

People living at the home spoke positively about the home's management. They told us 'I like Kemble House - it's nice here,' and 'We have meetings ' we had one recently.' Staff spoke highly of the support of the manager and deputy and said that they had an 'open door policy.'

Staff were clear about their roles and responsibilities and showed a good understanding of the needs of individual people they supported. We reviewed several audits that took place since the previous inspection, indicating that the service was proactive at finding areas for improvement and addressing these.

Staff were described by people who use the service as 'caring and diligent', 'very calm', 'very consistent' and 'the right mixture of understanding and encouraging.' The service provided person-centred care based on a clear assessment of individual needs. Staff understood the needs of the people they cared for and supported and we saw staff interacting with people in a caring and compassionate way and responding to their needs.

The service was clean and hygienic and there were effective systems in place to reduce the risk of infection. Staff recruited to work in the service underwent checks on their suitability before they began work.

Systems were in place to assess and monitor the quality of service that people received and ensure care and support was provided appropriately and in a safe environment and the service was well-led. Records kept by the service were accurate and securely stored.

Medicines were stored securely and administered safely to people who use the service. Staff received appropriate training and support to enable them to deliver the care to people that they needed. Complaints about the service were managed effectively and resolved where possible.