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Inspection carried out on 23 April 2018

During a routine inspection

This inspection took place on 23 April 2018. We gave the registered manager short notice that we would be coming because people who use the service are often out during the day. We needed to be sure the registered manager, staff and people who used the service would be available to speak with us.

Kingdom House is a ‘care home’. People in care homes receive accommodation and nursing or 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.

The service was last inspected in December 2016 and was rated Requires Improvement. Kingdom house is a home for people with learning disabilities, those on the autistic spectrum, physical and sensory impairments, mental health issues and complex needs. The service can accommodate eight people. Seven people were living there at the time of our inspection.

The care service has 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. Registering the Right Support CQC policy

There was a registered manager in place for the service. A registered manager is a person who has registered with 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 told us they felt safe living in the home. Relatives agreed that their family members were in a safe environment. We saw people were happy and trusted the staff. There were systems and processes in place to minimise risks to people. These included a robust medicines management system and making sure staff knew how to recognise and report abuse.

There were adequate numbers of staff available to meet people's needs in a timely manner. Recruitment checks were completed prior to staff being employed which helped make sure staff employed were of good character.

People enjoyed the food provided and were supported to receive adequate food and drink to remain healthy.

Staff were receiving regular training, supervision and appraisal so they were skilled and competent to carry out their role.

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 knew the people they were supporting and provided a personalised service. Support plans were in place detailing how people wished to be supported and people were involved in making decisions about their care. Staff respected the right to confidentiality for people who used the service. How they made sure people's confidentiality was kept was described in the 'Service user guide.'

We observed staff displayed caring and meaningful interactions with people and treated people with respect. We observed people's dignity and privacy was actively promoted by the staff, supporting them in a situation where some people could not speak up for themselves.

A varied range of activities were made available and we saw staff were proactive in engaging people with individual activities of their preferred choice.

Systems were in place to deal promptly and appropriately with any complaints or concerns raised about the service. The registered manager and registered provider treated complaints as an opportunity to learn and improve.

The home was well led by an experienced registered manager and management team. The registered provider had systems in place to monitor the quality of the service, seek people's views and make on-going improvements.

Further information is in the detailed findings below

Inspection carried out on 15 December 2016

During a routine inspection

This was an announced inspection which took place on 15 December 2016. We gave the service 48 hours’ notice of the inspection because the location provides a re-ablement and respite service for people who may often be out during the day; we needed to be sure that the manager, staff and people who used the service would be available to speak with us. The service was last inspected in November 2015 when we found it was meeting all the outcomes we inspected.

Kingdom house is a re-ablement and respite facility designed for adults with learning disabilities, those on the autistic spectrum, physical and sensory impairments, mental health issues and complex needs. The service can accommodate eight people. Seven people were living there at the time of our inspection.

The service did not have a registered manager in place 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 manager had left in April 2016.However the acting manager had made an application to be registered with the Care Quality Commission and was awaiting the outcome of the application.

During this inspection we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Our check of medicine records identified that medicines were not always safely managed and recorded. Medicines were not securely stored in a fridge and fridge temperatures were not being checked on a daily basis as per manufacturers guidance. Medicine bottles in use had no recorded date of opening. There was also a bag of medicines stored in the medicines cupboard that stated” use before the end of December.” However there was not accounted for or recorded in the daily MAR sheets.This meant that people accessing the service may not be protected against the risks associated with the effective management of medicines.

Suitable arrangements for the service and maintenance of fire extinguishers had not been completed, electrical items we checked showed that only two electrical items had a record of a portable appliance test and these indicated that they needed retesting by November 2016. Water temperature records we looked at showed that the temperatures exceeded the required safe limit on six occasions, two occasions being the showers used for personal care and bathing were not within the acceptable range. However no immediate and appropriate action was taken to address these concerns. This potentially placed people at risk of scalding.

There were systems in place to monitor and improve the quality of the service provided. Regular checks and audits were undertaken by the acting manager and the senior team to make sure full and safe procedures were adhered to. However findings from the checks and audits were not always acted upon.

The support plans were centred on people’s individual needs and contained information about their preferences, backgrounds and interests. People were treated with dignity and respect throughout our inspection. Staff were aware of people’s differing cultural and religious needs.

There were enough skilled and experienced staff and there was a programme of training, supervision and appraisal to support staff to meet people’s needs.

Our observations provided evidence that the service was caring. The staff we spoke with had a clear understanding of the differing needs of people staying at the home and we saw they responded to people in a caring, sensitive, patient and understanding professional manner.

People’s physical health needs were monitored and referrals were made when needed to health professionals.

People were

Inspection carried out on 10 November 2015

During an inspection to make sure that the improvements required had been made

Kingdom house is a re-ablement and respite facility designed for adults with learning disabilities, those on the autistic spectrum, physical and sensory impairments, mental health issues and complex needs. The service can accommodate eight people. Four people were living there at the time of our inspection.

This inspection took place on 10 November 2015 and was announced. The provider was given 24 hours’ notice of our inspection because the location was a small home for people who may be out during the day; we needed to be sure that someone would be in.

The service was last inspected in November 2014 and was given an overall rating of ‘good’ with the domain of safe being rated as ‘requires improvement.’ This was due to a breach of regulation 15: Premises and equipment.

There was a registered manager 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.

Outstanding repairs of the premises since our last inspection had been completed. Health and safety audits of the premises were routinely undertaken to ensure the environment was safe for people.

We saw that stock levels of people’s medicines corresponded with their medication records. There was clear information in place about medicines that people took. Guidance for ‘as required’ medicines was not consistently applied as there was a lack of information for some people to help inform staff as to when they may require these. Regular audits were completed which identified and addressed medicines errors.

There were detailed risk assessments in place for each person’s needs which gave guidance about how to promote people’s independence in a safe way. Staff had training in safeguarding and knew how to identify and report abuse. The registered manager had oversight of all incidents and made referrals to appropriate organisations where required.

There was a sufficient amount of staff to meet people’s needs and photos on display to show each person which staff were supporting them. We saw positive and friendly interactions between people at the service and staff. Feedback from relatives and professionals was positive about the staff and how they cared for the people they supported. Staff were knowledgeable about people’s preferences and helped people to maintain activities they enjoyed and access the community.

Health action plans and hospital passports were in place to assist healthcare professionals to meet people’s needs. People were assisted to health care appointments and supported to maintain good health.

Recruitment processes ensured that staff were checked and assessed as being suitable to work at the service. Staff records we checked showed staff had appropriate, necessary documentation in place. Staff received an induction and training designed to equip them with the skills and knowledge required to support people using the service. They received regular supervisions and felt supported by the registered and deputy manager.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The service was working within the principles of the MCA and we did not see that anyone was subject to unlawful restrictions.

There was a comprehensive audit process undertaken at the service, both by the registered manager and the provider in order to continuously monitor the service. Team meetings took place on a regular basis and feedback was captured on an individual basis from people using the service, relatives and stakeholders. Incidents were monitored and had oversight from the manager who made referrals on to other organisations and agencies where required.

Inspection carried out on 5 November 2014

During a routine inspection

The inspection was announced. This was the first inspection of this service which was registered in February 2014 and became operational in July 2014. Kingdom house is a re-ablement and respite facility designed for adults with learning disabilities, those on the autistic spectrum, physical and sensory impairments, mental health issues and complex needs.

The service can accommodate eight people. Two people were living there at the time of our inspection.

There was a registered manager at the service but he did not manage the daily running of the service. This role was undertaken by a manager who was not yet registered. 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 manager told us that the intention was for the current daily manager to become registered with the CQC in the near future and they would be submitting an application. However, the registered manager was still responsible for the service during this transition process.

There were areas of the service that were not safe. Outstanding repairs of the premises meant there was a risk people’s safety. We identified that one person required particular attention to maintaining the safety of their environment but the hazards we saw did not support this. This meant the requirements of the regulations relating to safety and suitability of premises were not being met. The manager informed us he would ensure these were rectified as soon as possible. You can see what action we told the provider to take at the back of the full version of the report.

We saw good practice with medicines where information was clearly recorded about any effects of medicines people took with clear guidance as to when these were required. However, the medicines audit process required improvements to ensure it was sufficiently robust to identify any errors or discrepancies.

There were detailed risk assessments in place which tailored to each person’s needs. These gave clear guidance about how to promote people’s independence in a safe way. Staff had training in safeguarding and knew how to identify and report abuse. The manager had oversight of all incidents and made referrals to appropriate organisations where required.

There was a sufficient amount of staff to meet people’s needs and photos on display to show each person which staff were supporting them. We saw positive and friendly interactions between people at the service and staff. Staff were aware of people’s preferences and how they liked to be supported and this information was reflected in person centred support plans.

Recruitment processes ensured that staff were checked and assessed as being suitable to work at the service

Support plans contained detailed information about people’s healthcare needs. Health action plans and hospital passports were in place and assist healthcare professionals to meet people’s needs. People were assisted to health care appointments so that people were supported to maintain good health.

Staff received a structured induction and training designed to equip them with the skills and knowledge required to support people using the service. The induction incorporated training about the Mental Capacity Act (MCA 2005) and Deprivation of Liberty Safeguards. Regular supervisions took place and staff felt supported in their roles.

People regularly accessed the community and the manager had promoted community links with a local shop. Activities were encouraged and people were supported to participate in these as well as seek new opportunities.

There was a comprehensive audit process undertaken at the service, both by the manager and the provider in order to continuously monitor the service. Team meetings took place on a regular basis and feedback was sought on an individual basis from people using the service and relatives. The manager was intending to implement service user meetings and relatives meetings going forward. Incidents were monitored and had oversight from the manager who made referrals on to other organisations and agencies where required.