Kimbolton

About the service

Kimbolton is a residential care home which can support up to 6 people. At time of the inspection 5 autistic people or people living with a learning disability were being supported with personal care. People have their own personalised bedrooms and bathrooms and access to shared communal areas such as a kitchen, lounges and a garden.

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

Right Support:

Reasonable adjustments were made so that people could be fully involved in discussions about their support. Staff communicated with people in their identified and preferred methods.

People benefitted from an interactive and stimulating home environment and were supported not to feel isolated.

Staff supported people to be independent if this was their choice. The management team were continuing to support staff to improve in this area.

People were being supported to pursue their interests and achieve their aspirations and goals. However, these were not always recorded or monitored effectively.

Staff gave people care and support in a clean environment which met their physical needs and people were able to personalise their bedrooms.

The service worked with people to plan for when they experienced periods of distress so that their freedoms were restricted only if there was no alternative.

Staff supported people safely with their medicines.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Care:

Staff had the training and knowledge to support people effectively. The management team were improving the way staff members knowledge and competency was being checked.

People’s support plans did not always fully reflect their range of needs and promote their wellbeing and enjoyment of life.

Staff supported people to assess any risks they might face in a safe way and supported people to take positive risks.

Staff promoted people’s equality and diversity and knew them well as individuals. People received kind and compassionate care which fully promoted their privacy and dignity.

Staff were prompting people to try new things which may enhance their wellbeing and enjoyment of life.

Right Culture:

Audits completed at the service by management had not always picked up on areas that could have been improved.

People and those important to them were involved in planning their support.

People received consistent support from a staff team who knew them well. Staff worked hard to achieve good quality care and good outcomes for people.

People received good quality care and support and were supported to lead inclusive and empowered lives for the most part.

Staff were responsive to people’s needs and worked well together to achieve good outcomes for people. Feedback from people and relatives about the service was positive.

The registered manager and staff team were passionate about continually improving the service and supporting people to achieve their goals and aspirations.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 09 August 2019).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

Kimbolton is a residential care home which can accommodate up to six people. At the time of this inspection six adults were using the service who had a range of care needs including learning disabilities, autistic spectrum disorders and physical disabilities. One person was away on holiday. Some adaptations had been made to the building to promote accessibility for people with a physical disability.

Overall, the service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence.

People’s experience of using this service:

People told us they felt safe living at the service and with the staff. The provider checked to make sure staff were safe to work at the service, but the checks being made did not always fully meet the legal requirements.

Staff asked people for their consent to support and care on a day to day basis. However, the service did not consistently apply the principles and values of Registering the Right Support and other best practice guidance. The outcomes for people did not fully reflect the principles and values of Registering the Right Support because the provider had not gained their consent or followed the ‘best interest’ decision process - for people who lacked capacity to manage their own money, regarding their contributions to a shared car arrangement.

The provider checked to make sure people received good quality, safe care and support. However, the auditing systems in place needed strengthening to ensure all legal requirements were met and to drive continuous improvement.

People’s privacy and dignity was respected and promoted. Staff knew how to protect people and keep them safe. They had the right skills and training to meet people’s needs, including making sure they had their medicines when they needed them.

The building was safe, clean and comfortable for people to use. There was space for people to have privacy in their own rooms and communal space, including a garden.

Staff supported people to stay healthy. They helped people to access healthcare services when they needed to and ensured they had enough to eat and drink.

People were given opportunities to participate in activities, both in and out of the service. People could go on holiday too if they wanted to.

There was a new registered manager who promoted a positive culture that was person centred and open. People were given the opportunity to make suggestions and provide feedback about the service provided to them.

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

Rating at last inspection and update:

The last rating for this service was Good (published 25 March 2017). At this inspection we have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of the full report. We have identified breaches in relation to how people’s finances are managed and the checks the provider makes in order assess the quality and safety of the service.

The overall rating for the service has therefore changed from Good to Requires Improvement. This is based on the findings at this inspection. This is the first time the service has been rated requires improvement.

Please see the action we have told the provider to take at the end of this report.

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection, the service was rated Good.

The inspection was undertaken as part of our routine re-inspection programme, to review the rating from the first comprehensive inspection completed on 4 March 2015.

At this inspection we found the service remained Good.

People felt safe and comfortable with the staff that supported them. Staff understood their responsibilities to protect people from the risk of abuse and had received training to assist them. Risk assessments identified specific risks for each person and gave guidance to staff about how they could assist people in a way which promoted their independence and choice. Staffing numbers were flexible and sufficient enough to ensure staff could safely meet people's needs. The provider had a robust system for employing new staff and ensured pre-employment checks were conducted prior to staff starting work. People were supported with their medication by staff who were trained and assessed as competent to give medicines safely and as prescribed.

People were confident staff had the skills and training to undertake the care being provided. Staff had access to training and professional development and a system was in place to ensure their training was up to date. Staff had received training on mental capacity and demonstrated an understanding and worked within, the principles of the Mental Capacity Act (2005). As a result, people's legal rights were protected and staff ensured people's rights to make decisions were respected. People had access to health professionals when needed and staff advocated on behalf of people to ensure appropriate health care was provided.

The delivery of care was person centred and where appropriate people and their relatives were involved in their care needs. This ensured decisions made met their specific needs. Staff were kind and compassionate and treated people with dignity and respect.

Care plans detailed the individual care and support needs of the person, and ensured that the delivery of care was responsive to people's needs. Where people's needs changed staff were informed so that care plans were adjusted to reflect the change. Records detailed people's preferred methods of communication, favourite activities and personal choices and these preferences were known to the care workers. People and their relatives knew what to do if they had any concerns about their care, and the provider responded positively to any issues or complaints raised.

We found the provider had systems to assess, monitor and improve the quality of the service and obtained feedback on the service provided. Staff were given responsibility and were involved in the day to day running of the service. They felt able to make suggestions about how the service could be improved. The views of people about the service were listened to and appropriate actions were taken to improve the service people received.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive to people's needs?

' Is the service well led?

This is a summary of what we found:

Is the service safe?

We found evidence to suggest that people enjoyed a good quality of life and were kept safe. One person told us, 'I like being here.' Our observations confirmed that people felt relaxed and safe in the company of staff and we overheard some positive examples of staff engaging with people on a personal level.

Person centred care plans and individual risk assessments were updated regularly and contained comprehensive, specific detail to guide staff to deliver consistent care and ensure that people were protected from harm.

Staff had received training in the protection of vulnerable adults. Staff that we spoke with knew how to report concerns. We saw evidence that incidents of safeguarding had been appropriately reported to the local authority and the Care Quality Commission.

We observed that there were enough staff on duty to make sure people were cared for safely. We found that the staffing ratio facilitated people to participate in activities of their choice, both within the home and the wider community. It also enabled them to manage people's support needs in a caring and considerate way.

Good recruitment procedures were in place that ensured people were protected from harm. When staff started their employment they received an induction and training. We saw that training continued on a consistent and ongoing basis so that staff had the right skills and knowledge to provide care, treatment and support to people who lived at Kimbolton.

We found that there was a robust system in place to make sure that manager and staff learnt from events, including accidents and incidents, health and safety issues, complaints and concerns. This meant that the risk of harm to people was reduced and that the service was able to evidence its intention to provide proactive care which took account of future improvements.

Is the service effective?

People living in the home had their needs assessed and we observed that staff understood people's individual care needs. Each person had a range of care plans in place which provided information about how people preferred care and support to meet their daily routines.

There were arrangements in place that ensured staff had the most up to date information about people's needs. This included daily handovers that ensured people received effective and consistent care and treatment. Staff had the required knowledge to effectively assess, identify and meet people's nutritional needs.

People were encouraged to maintain their independence and we saw examples of this during the inspection. We observed staff talking with and supporting people during our time in the home, and we found that this was done with the person's privacy and dignity in mind. This demonstrated staff's awareness of people's individual support needs. This was also reflected in the support plans we viewed on the day.

Care plans were pictorial in nature and showed that people needs were assessed prior to admission and reviewed on a regular basis. Through our discussions with staff, we found that they had a good understanding of what people's care needs were and when they had changed.

Staff worked in partnership with other professionals to make sure people received appropriate care, treatment and support to meet their diverse health and social care needs.

Is the service caring?

The evidence we reviewed confirmed that people and their relatives felt they were well supported by staff. We found that people's preferences were always well documented, and staff were able to tell us about the people in the home and their individual needs.

During our inspection we saw staff made sure that people's privacy and dignity was upheld. They closed doors when people received personal care and we found that people could spend private time with relatives and friends as they chose.

We observed that people were happy with the care and support they received. People were offered support at a level which encouraged independence and ensured their individual needs were met. Staff were relaxed, friendly and courteous in their approach to people and interacted confidently with them. Records showed that people were encouraged to express their views about the quality of care in the home and the pictorial care plans showed they were involved in planning their care, making decisions about their support and treatment, and how they spent their time.

Is the service responsive to people's needs?

No-one in the home needed a mental capacity assessment or a best interest decision at this time, although staff were aware of the action that needed to be taken should this arise. Staff had received training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and all the training was current.

We noted that people's wishes were respected by care staff and taken into account when making best interest decisions, gaining consent and planning care and support. Records showed that the service engaged effectively with other professionals in ensuring that all areas of health and well-being were maintained.

The records showed that staff worked well with other health professionals. This meant incidents and accidents in the home were dealt with effectively.

There were well developed procedures in place that made sure complaints were listened to and taken seriously. We saw that the registered manager operated an open and responsive culture where complaints were encouraged, explored and responded to in good time.

Is the service well- led?

There was a registered manager in post. Staff were aware of their roles and responsibilities and were supported by the manager. There was evidence that the registered manager provided strong and inclusive leadership. Staff we spoke with told us that the registered manager had an 'open door' approach so that staff could express any concerns or issues they had daily if they needed to.

People living in the home were able to express their views and opinions about how the service was being run because there were meetings and other methods used to gain their views. There was evidence that the registered manager acted on feedback received and made changes to practices that ensured improvements were made.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We were told that contact had been made with the supervisory body for one person, who advised that an application was not required. There had been Deprivation of Liberty applications submitted and decisions made by the supervisory body for four of the other people living at the service. This meant that proper policies and procedures were in place and staff understood when an application should be made, and how to submit one.

We found that the provider monitored the quality of the service provided to people and acted upon the feedback they were given. The quality assurance systems in place were effective as they highlighted and addressed identified shortfalls which enabled improvements to be made. This showed that the service had an effective management structure and was responsive to concerns, making efforts to drive ongoing improvement.

We spoke with two people and were told they were happy living at Kimbolton. We found from the care records that people were supported to engage with external professionals to ensure their care and welfare needs were met appropriately.

Medication was stored safely and we observed from the care records that it was administered on time to people.

We noted that the premises was appropriate in layout for those people who lived at the home. Regular maintenance took place so that it remained safe and free from harm.

Staff received regular training that was relevant to the needs of those people who lived at Kimbolton. They told us that this gave them the right skills to care and support people.

We found records were stored securely and protected both staff and people's confidentiality. Records were updated on a frequent basis which meant that the provider made efforts to monitor service provision on a regular basis.

We observed that people were offered support at a level which encouraged independence and ensured that individual needs were met. The atmosphere in the home was calm and relaxed and staff were observant to the needs of the people they were supporting. This meant that people were at ease with the staff caring for them.

The staff were polite and respectful in how they approached people and engaged appropriately with them, supporting them in planning their care and making decisions about how they spent their time.

We spoke with three out of five people currently living at the home, who said they were happy living there and that they felt safe and supported. One person said, "I like living here and I like the staff. The home is well organised and structured which is good." A relative told us that, "All the staff are excellent and work together as a team." They also said that, "The staff look for solutions to problems and offer choices. They have promoted independence but also listen and value what you have to say as a family member."