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Inspection carried out on 10 December 2019

During a routine inspection

About the service

Kingsley House is a residential care home providing personal care and support for up to 19 younger adults who have autism and a learning disability. At the time of the inspection there were 11 people living at the service with no plans to expand this number.

Kingsley House was formerly a special needs school. It is a large site with a number of buildings which allows people to have their own self contained house or flat as well as communal space and large grounds.

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 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. 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 19 people. Ten people were using the service. 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 meaning people had their own self-contained flats or houses. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

People experienced exceptionally responsive care and support from staff who were dedicated to ensuring people had fulfilling and engaging lives. Some of the people living at Kingsley House had experienced a number of unsuccessful placements before living here.

Without exception relatives and professionals agreed that Kingsley House offered people a high standard of care which was truly personalised and ensured people were afforded a person-centred approach which met their needs and wishes.

Staff were skilled and experienced at understanding people’s complex behaviours, rituals and ways of communicating. They spoke passionately about people’s achievements and progress to be independent. This was key to providing a successful and fulfilling lives for people.

The management team and staff genuinely cared for the people they were supporting. They advocated for them at every opportunity. They were there for them and their families at point of admission, when needing to transfer to hospital or at the end of their lives. They had recently achieved a national accredited training in end of life care. They had been commended for the effort they had put into ensuring one person could receive hospital treatment which was not thought previously possible to achieve.

People were valued and placed at the centre of the service. Staff promoted their privacy and dignity, enabling them to make choices and have as much control and independence as possible. The service used a variety of methods to facilitate this including supporting people with communication, assistive technology, providing information in an accessible format and a consistent staff team who knew people extremely well.

People’s holistic needs were very well met by a staff team who were well-trained and understood the ethos of ensuring person centred care. The provider ensured the staffing ratios remained high so the best possible care and support could be provided. Each person had their own core team of staff which ensured a consistent approach.

People received their medicines in a safe and timely way. Staff worked in the least restrictive way with people and this included ensuring any calming medicines were used only when needed, and once other aven

Inspection carried out on 29 March 2017

During a routine inspection

This inspection took place on 29 March and 6 April 2017. The first day was unannounced and the second day was an agreed date to ensure people and staff were available to talk to.

Kingsley house provides specialist care and support to younger adults who have autism and learning disabilities. It is run by the National Autistic Society (NAS) and is registered to support up to 19 people living in small flats and houses on one site. The service does not provide nursing care. At the time of the inspection there were 10 people living at the service.

The last inspection completed in January 2015 we rated this service as good with requires improvement in effective as we did not feel the environment was age appropriate.

There was a registered manager running 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.

Kingsley House offered people a service which was highly personalised and took into account people’s complex needs due to their autism. Staff were exceptionally skilled at working with people in the least restrictive way to promote their rights and empower them to live fulfilling lives. Staff were proud of their achievements in assisting people to develop their independent living skills and celebrated successes with each other and those who lived at the service. For example, they emailed good news stories about the accomplishments people had achieved.

We found the registered manager and management team to be open honest and transparent. The environment and atmosphere was inclusive and everybody was treated as an individual and was valued.

The manager demonstrated that they continually looked for ways to make improvements so that people who used the service benefited from exceptional care and expertise. Staff were skilled at understanding people’s needs and unique ways of communicating. The provider had employed a speech and language therapist to work alongside the care staff to enable them to develop the best ways of assisting people to communicate. This was by way of symbols, pictures and photos. This type of media was extensively used in everyday working, to help people to make sense of what was happening and what was being asked of them. They also used social stories to help people process information and prepare for events. For example the registered manager prepared a social story for people to help them understand about the inspection process, our visit to the service and what questions we might ask.

The staff team worked in innovative ways to ensure their skills were utilised to the best effect. For example one care worker was a skilled musician and they were given time to share this skill in providing music sessions for people. Another care worker had been assisted to gain trampoline qualifications to enable them to provide this activity for people safely.

People’s safety was considered in every aspect of their care and support. Risks were well documented. Medicines were safely managed. The provider operated safe recruitment processes to ensure only staff who were suitable to work with vulnerable people were employed.

Care and support was really well planned and person centred. Support plans for people were very detailed and ensured staff were providing a consistent approach. Support plans focussed on positive aspects of people. They were reviewed with people and those who were important to them. Where people needed additional support to ensure their own safety and that of others, this was done in a sensitive and caring way. When people showed expressive behaviours, staff looked at why they may be showing this behaviour and looked at what they could do to provide more positive reinforcement and ensure people had the rig

Inspection carried out on 21 and 28 January 2015

During a routine inspection

The inspection took place on 21 and 28 January 2015 and was unannounced. The service had been first registered with the Care Quality Commission on 29 December 2014 and therefore had not been previously inspected.

Kingsley House provides accommodation with personal care for up to 19 people over the age of 18 who have a diagnosis of autism. Kingsley House is located in buildings which were previously run by the provider as Broomhayes, a specialist school for children and young people with autism. The school closed in 2014 and the buildings on the site have been, or are in the process of being, redesigned and refurbished to meet the needs of adults with autism. Whilst the school had been operational, there had been accommodation, called Orchard House, located on the Broomhayes site. This was registered with the Care Quality Commission to provide accommodation and personal care for up to eight people in the further education sector. Orchard House had been deregistered as a location on the 29 December 2014, when Kingsley House had been registered.

People were provided accommodation in a number of separate units within the grounds of Kingsley House, some of which are self-contained. In addition to the residential accommodation, the buildings also accommodate a day centre which people living in Kingsley House use. At the time of the inspection, seven people were living at Kingsley House, all of whom had previously been residential pupils at Broomhayes.

There was a registered manager in post, who had been appointed in summer 2014. 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 décor and design of the home was not entirely appropriate for adults. Although a refurbishment programme was being undertaken, there were still aspects of the home which reflected that it had been a school. For example there was playground equipment in outdoor areas and some parts of the building still had a ‘school-like’ atmosphere.

The service provided to the people living at Kingsley House was delivered by knowledgeable staff who had been trained to support people with autism. Many of the staff had known the people living there for many years, when they had been students at Broomhayes. Staff recognised that they had needed to change the way they worked with people taking into account that they were adults rather than children. Although we heard occasional references to ‘students’, staff quickly corrected their error. We did not see any instances where staff dealt with people inappropriately.

People said they liked living at Kingsley House and found the staff kind. One person had chosen to move to other accommodation close to family, and was being supported to do this by staff accompanying them on visits to their new home.

People were able to do a wide range of activities both in the home and in the community and chose what they wanted to do each day. The service was flexible in supporting people to achieve what they wanted to do by allowing them to ‘bank’ hours when they would be supported by two members of staff. This enabled people to go on longer trips out when they wanted to do something special, such as a shopping trip to Exeter.

People’s needs and risks were assessed and care plans were developed to support them to be as independent as possible. Daily notes reflected the care described in the care plan. Where concerns about a person were identified, staff met and discussed how they could best address them. Changes were then written up in care plans and these were communicated to staff through meetings and hand overs.

Medicines were stored, administered and recording safely. People were supported to have their health needs addressed with other health and social care professionals including their GP and dentist.

People were supported to have a healthy balanced diet which they were involved in shopping for and preparing. Staff were aware of some people’s need to have support to address risks around cooking and eating and undertook appropriate measures to address these.