Kilkhampton Lodge

The service had been developed prior to publication of Registering the Right Support and other best practice guidance. This ensures that 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. Staff values were in line with the underlying principles of the guidance. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to nine people. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design. People had their own self-contained accommodation and most were able to choose whether to spend time in shared areas or on their own. The service was accessed via a long drive and was not visible from the road. There were no outward signs to indicate it was a care home.

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

People were protected from abuse by staff who had received relevant training and were confident about how to report any concerns. During the inspection we saw people approach staff to chat and request support. The number of incidents and use of restraint was low.

Staff were well supported by a system of induction, training and supervision. Most of the staff had worked at the service for over a year and knew people well. New staff worked alongside more experienced staff until they were confident to work alone.

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. Any changes in restrictive practices were highlighted to the relevant authority to help ensure they remained necessary and proportionate.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible to gain new skills and become more independent.

Two people were living in segregated accommodation. This meant they lived entirely separately from others and were unable to access shared lounges and kitchens or leave their accommodation independently. This was done to keep them and others safe. These people were given choice and control in their basic daily routines, for example, deciding when to get up and go to bed. Staff had developed ways to help people to make choices using communication tools and simple sign language. They continued to work with other agencies to develop these techniques.

Care plans detailed people’s needs across a range of areas. Risk assessments guided staff on the actions they should take when people became distressed. There was also information about people’s preferences and background personal histories. This information helped staff to develop an understanding of people’s needs.

People living at Kilkhampton Lodge had very different and wide ranging needs. Care delivery was planned according to each individuals needs and preferences which were understood and respected by staff. Relatives told us they believed their family members received the support they needed. They were highly complimentary about staff and management.

The service was well managed. There were clear roles and responsibilities in place which were well understood by the whole staff team. Regular checks and audits were completed to help identify any areas for improvement. The management team kept up to date with changes in the sector through membership with online organisations and forums.

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 27 July 2018)

Why we inspected

The inspection was brought forward following concerns raised regarding staff deployment and practices around hygiene.

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 this inspection we found improvements had been made in all the areas identified at the previous inspection. This meant the service had met all the outstanding legal requirements from the last inspection and is now rated as Good.

Kilkhampton Lodge provides care and accommodation for up to eight people with complex needs who have a learning disability and/or mental health conditions. At the time of the inspection eight people were living at the service.

People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this 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.

The service requires a registered manager and there was one in post. 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.

People were comfortable and at ease with staff and within their environment. Staff were supportive and caring in their approach. They spent time chatting to people and checking on their well-being. Activities provided were varied and met people’s individual preferences and interests. People were able to go on spontaneous trips out as well as taking part in planned activities.

There was a stable staff team in place and staff retention was very good. Staff told us they were well supported and worked together as a team. Roles and responsibilities were clearly defined and understood by all. Systems for communicating about changes in people’s needs were effective.

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 supported this practice. Where relevant, best interest processes had been followed to help ensure any restrictive practices were necessary, proportionate and the least restrictive option.

Care plans were detailed and informative. Staff recorded information about how people spent their time and their health and emotional well-being on a computerised system. This could be accessed by the senior management team as necessary. Some people had specific aspects of their care and well-being monitored. Records were not always sufficiently detailed and we have made a recommendation about this in the report.

There were effective quality assurance systems in place to monitor the standards of the care provided. Audits were carried out regularly by the registered manager and staff. Relatives and people’s views about how the service was operated were sought out.

Kilkhampton Lodge provides care and accommodation for up to eight people with complex needs who have a learning disability and/or mental health conditions. At the time of the inspection seven people were living at the service.

There was a registered manager in post. 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.

Risk assessments did not always contain the relevant information to help guide staff as to how they could protect people from an identified risk.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The authorisation procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working within the principles of the MCA. Some people were subject to some restrictive practices in order to keep themselves safe. There was no evidence that a best interest process had been followed to help ensure the least restrictive options had been identified. There was no evidence decisions regarding restrictive practices were regularly reviewed. Applications made by the service to authorise deprivations of liberty did not include all the restrictive practices being used to support the person.

People living at Kilkhampton Lodge were supported to take part in activities and pastimes which reflected their individual preferences and interests. There were enough staff available to make sure everyone was supported according to their own needs. Some people liked to take part in evening activities or go away to attend events. Staff were flexible and able to adapt the rota in response to need. One person had been out the evening before the inspection and another was planning a trip to a music festival.

Each person had their own individual flat which comprised of a bedroom, en-suite facilities including a shower, as well as a lounge and kitchen area. One person showed us their flat and told us they liked living there. The flat was decorated to reflect the person’s taste and interest and they displayed a sense of ownership when showing us round. Relatives told us the environment suited their family member’s needs.

Staff completed a thorough recruitment process to help ensure they had the appropriate skills and knowledge to carry out their role. Systems were in place to support staff in their role through regular supervision and appraisals. The staff team told us they were well supported by the management team and could request additional support or advice whenever they needed to.

Staff were trained in a range of subjects which were relevant to the needs of the people they supported. A training matrix identified what each staff member had undertaken and identified when a refresher course was due. Training certificates were also included in staff files to support this. New employees undertook a structured induction programme which prepared them well for their role. Staff told us they were confident supporting people at all times.

There were systems in place to ensure people who used the service were protected from the risk of harm and abuse and the staff we spoke with were knowledgeable of the action to take if they had concerns in this area.

Accidents and incidents were being recorded and analysed to identify any trends. Quality assurance systems were in place to gather people’s views about the service. Regular audits were carried out to help ensure the service was running effectively and safely and policies and procedures reflected current legislation and good practice guidance.

People knew how to complain and we saw people had the opportunity to discuss how they felt about the service. Each person had a key-worker who checked regularly if people were happy with the service they received. One person had made a complaint and this had been documented and action taken to try and address the issues raised.

Relatives and staff told us the service was well-managed. They told us they felt they were listened to and any ideas or suggestions were acted upon. Relatives said they were kept up to date with any developments and encouraged to raise any concerns or ask questions of the registered manager at any time.

We identified breaches of the regulations. You can see what action we have asked the provider to take at the back of the full report.

Kilkhampton Lodge provides care and accommodation for up to eight people with complex needs who have a learning disability and/or mental health conditions. At the time of the inspection seven people were living at the service.

There was a registered manager in post. 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.

People living at Kilkhampton Lodge were supported to lead fulfilled lives which reflected their individual preferences and interests. There were enough staff available to make sure everyone was supported according to their own needs.

Each person had their own individual flat which comprised of a bedroom, en suite facilities including a shower, as well as a lounge and kitchen area. Some people were supported to develop life skills which would help them when moving to independent living. Other people were engaged in their choice of individual routines and activities. Relatives told us they believed their family members had choice and control in their lives and were supported safely and with respect. Comments included, “It is an excellent place for people to live if they need the level of support (person’s name) needs” and “They (people living at the service) do so much and there are plenty of staff to support them”.

Staff members were available to support peoples’ needs and engage in activities. Staffing levels were flexible so they could respond to people who at times required additional support. Staff on duty supported people respectfully. People told us that staff supported them to maintain their independence and we saw evidence of this within the care documentation we viewed. For example supporting people to develop life skills including cooking and supporting people to maintain links with the local community.

Staff completed a thorough recruitment process to ensure they had the appropriate skills and knowledge to carry out their role. Systems were in place to support staff in their role through supervision and appraisals. The staff team were well supported by the registered manager through daily communication.

Staff were trained in a range of subjects which were relevant to the needs of the people they supported. A training matrix identified what each staff member had undertaken and identified when a refresher course was due. Training certificates were also included in staff files to support this. New employees undertook a structured induction programme which prepared them well for their role.

There were systems in place to ensure people who used the service were protected from the risk of harm and abuse and the staff we spoke with were knowledgeable of the action to take if they had concerns in this area.

Where people did not have the capacity to make certain decisions, the service acted in accordance with legal requirements under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. Staff had a good understanding of the principles of the legislation and training was updated regularly. A staff member told us, “Some people have to have authorisations in place for their own protection but is always monitored and reviewed”.

Care plans were informative and contained clear guidance for staff. They included information about people’s levels of risk and how it might be managed also, routines, personal preferences and any situations which might cause anxiety or stress. They clearly described how staff could support people in these circumstances. In addition records included assessments and support plans from other health professionals. People had been involved in their care planning and reviews which were in easy read versions to aid communication.

Accidents and incidents were being recorded and analysed to identify any trends. Quality assurance systems were in place as well as gaining people’s views about the service. Regular audits were carried out to help ensure the service was running effectively and safely and policies and procedures reflected current legislation and good practice guidance.

People knew how to complain and we saw people had the opportunity to discuss how they felt about the service. Each person had a key-worker who checked regularly if people were happy with the service they received. One relative told us, “I have never felt the need to complain but I think the manager would listen and take what I said on board”.

Kilkhampton Lodge was well-led and relatives and staff told us they were kept informed about any changes in the service. They told us they felt their comments were listened to and acted upon. The service had an open and positive culture with a clear focus on enabling and supporting people to maximise their quality of life.

Before people received any care or treatment they were asked for their consent and staff acted in accordance with their wishes. Throughout our visit we saw staff involving people in their care and allowing them time to consent to care through the use of individual cues, such as looking for a person's facial expressions, body language and spoken word.

We spent time talking to people who lived at Kilkhampton Lodge and observing the interactions between them and staff. Comments included: 'It's really good here. I have my own flat and can make my own drinks and sandwiches' and 'We make our flats our own. I like living here.'

Medicines were kept safely. We saw that there were locked medicine cupboards within the staff office. The cupboards were securely attached to the wall to ensure the security of the medication.

Staff confirmed that people's needs were met in a timely manner and felt that there were sufficient staffing numbers.

We saw that a range of audits were carried out by the management team. These were conducted on an ongoing basis to monitor the quality and safety of the service provided.

During our visit we met with four of the five people who were living in the home. One person was out all day with a staff member. We met with five staff members, the registered provider and the registered manager.

One person told us, 'This place is great, homely. I want to be treated fairly.' Two people told us about their activities outside the home and how staff had supported them in these activities. Another person told us they had no issue with the care or service provided.

Health care professionals who spoke with us said that this service had done 'excellent' work with the person they supported. One said that they gave the person space, did not impose surveillance in an intrusive way and managed to support the person through a period of disturbed behaviour.

We saw care records that were detailed and appropriate to each individual. Risks had been assessed and guidance for staff about how people should be supported was written in detail. Incident reports had been shared promptly with people's care co-ordinators so they were aware of the person's distress and able to assess the home's ability to deal with it.