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Inspection carried out on 10 April 2019

During a routine inspection

About the service:

Kittens Lane is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Kittens Lane accommodates up to 10 people with a learning disability and complex needs in two self-contained bungalows. During our comprehensive unannounced inspection on 10 April 2019, there were 10 people living there.

This care service supported people in line with the values that underpin the Registering the Right Support and other best practice guidelines. 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.

People’s experience of using this service:

Staff understood their responsibilities to protect people from abuse, harm and discrimination.

Staff continued to be recruited safely and received on-going support and training to be competent in their roles.

People were protected from harm by effective systems in place to monitor medicine management, staffing, infection control and the upkeep of the premises.

People’s nutritional and hydration needs were met.

The service worked well with other organisations to ensure people had joined up care. Community professionals made positive comments about the service provided to people.

People’s independence was encouraged, their privacy respected, and their dignity maintained.

The way staff interacted with people had a positive effect on their well-being. People using the service appeared comfortable in the presence of staff.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People’s care records were detailed and up to date. They were reviewed with the person and their relatives where possible. They reflected people’s needs with their end of life wishes documented.

People had a variety of activities which they enjoyed on a regular basis and had opportunities to maintain positive links with their community.

People and relatives' views were sought, and opportunities taken to improve the service.

Formal supervision meetings were carried out with staff. They told us they were supported and clear about what was expected of them.

There was a complaints procedure in place and people’s concerns were addressed.

The service had systems to continuously monitor, assess and improve the service provided.

Rating at last inspection:

We inspected Kittens Lane on 21 October 2016 and published our report on 5 December 2016. We rated the service overall good. Safe, effective, caring and responsive were rated good and well led was rated requires improvement.

Why we inspected:

We inspected this service in line with our inspection schedule for services currently rated as good.

Follow up:

We will continue to monitor this service and plan to inspect in line with our re-inspection schedule for those services rated good.

For more details, please see the full report which is on the CQC website at

Inspection carried out on 21 October 2016

During a routine inspection

The inspection took place on 21 October 2016 and was unannounced.

Kittens Lane provides a home and support with personal care for a maximum of ten people with a learning disability and complex needs. It is divided into two self-contained bungalows, one for six people and one for four. At the time of our inspection, ten people lived there.

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.

At our last inspection of this service in October 2014, we found that some improvements were needed to aspects of the safety, responsiveness and leadership within the service. Systems for monitoring the quality and safety of the service had not worked well to identify what needed to improve. Staff did not have access to essential records about people's assessed needs and risks to people's safety. Systems for managing medicines were not as safe as they should be. At this inspection, we found improvements had been made.

Medicines management had improved to ensure people received their medicines as the prescriber intended and in a safe way. They were properly accounted for, stored safely and recorded accurately. Checks were in place to ensure that any concerns were identified and could be followed up promptly.

There were enough staff to support people safely and robust recruitment processes contributed to protecting people from the risk of harm or abuse from staff who were not suitable to work in care. Staff understood their responsibilities to report if they had any concerns that people were at risk of harm or abuse and how to go about this. They also understood the risks to which people were exposed and followed guidance in people's care records to promote people's safety.

Staff were competent and skilled and had a good understanding of people's individual needs and preferences. Staff had developed warm and caring relationships with people living in the home. They treated people with respect for their dignity and privacy and were working explore how they could help to increase people's participation in their care.

Staff understood the importance of seeking people's consent to deliver care. They were also aware of their obligations to properly consider people's best interests if there were any concerns they could not give informed consent to specific aspects of their care. This contributed to promoting people's rights. Staff also ensured they sought guidance from professionals and acted upon the advice they were given to promote people's physical and mental wellbeing. Staff recognised when people's needs changed and responded flexibly to these changes.

Improvements had been made in aspects of leadership within the service, for example in the systems for auditing quality and safety. The provider's representatives had identified the need to further improve and organise record keeping practices standards, particularly within the main office. There was an action plan in place for improvements which also took into account the potential to increase the presence of the registered manager within the home. Some staff and relatives had commented that this was an issue for them presenting concerns about the manager's approachability and awareness of what was happening on a day to day basis within the service.

Inspection carried out on 16 and 17 October 2014

During a routine inspection

We inspected Kittens Lane on 16 and 17 October 2014. This was an unannounced inspection and was completed over two days by one inspector.

Kittens Lane provides a home and care for up to 10 people with a learning disability and complex needs. It is divided into two self-contained bungalows, one for six people and one for four.

There is 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 and associated Regulations about how the service is run.

People were protected from abuse. Staffing levels met people’s needs and staff were able to respond to people promptly. Recruitment processes were robust, so contributing to safeguarding people. However, there were some aspects of the service people received which were not safe. Risks to people’s safety associated with activities were not consistently identified, assessed and managed. Some medicines were not properly checked to ensure they were managed safely.

The premises were maintained safely, including emergency systems used in the event of a fire. We have made a recommendation about the home’s guidance for evacuating people safely.

Staff were well trained and understood how to support people with their personal and health care. People had access to healthcare professionals and staff sought medical advice promptly on behalf of people if they became unwell. Staff understood the requirements of the Mental Capacity Act (2005) and the importance of people being supported to make informed choices. The manager was aware of the Deprivation of Liberty Safeguards. This meant they were working within the law to support people who might lack capacity to make their own decisions.

Staff were caring and compassionate and treated people with respect. They offered people comfort and reassurance.

People’s independence was encouraged as far as practicable and we saw that they were supported to access activities within the community. However, staff did not have access to individual plans of care showing people’s needs were regularly assessed and reviewed or which reflected their individual preferences.

Quality monitoring systems were insufficiently robust. Systems had not identified issues with maintenance of records, the way risks were assessed and managed, or that the provider’s guidance for supporting staff was not being adhered to. Half of the eight staff spoken with felt well supported but the remainder and some relatives were concerned about staff morale and how this might affect care in the long term. We have made a recommendation about motivating staff and team building.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

During a check to make sure that the improvements required had been made

We inspected Kittens Lane on 5 August 2013. At that time we found that there were some shortfalls in the way medicines were managed. Although they were stored securely and there was guidance for staff, the dates by which they needed to be used were not being properly monitored. This meant that the provider could not be sure these medicines remained effective and safe in use.

Since that inspection, the arrangements for monitoring the effectiveness of medicines, including lotions and creams, have been strengthened. The manager sent us the clear guidance that had been put in place about expiry dates and the length of time items could remain open before they were disposed of due to the risk of contamination or loss of effectiveness. We were also supplied with copies of weekly checks undertaken to ensure that the relevant checks were made.

The monthly visits made to the service, to assess quality and compliance on behalf of the provider had been strengthened. The person carrying out these visits also confirmed to us that they were booked on training for the management of medicines, so that they had improved underpinning knowledge of monitoring medicines and could identify any slippage from expected standards. We therefore concluded that improvements had been made and that people were protected from unsafe management of medicines. This was because arrangements for identifying when these needed to be disposed of and replaced had improved.

Inspection carried out on 5 August 2013

During a routine inspection

The people using this service had complex needs and so were not able to tell us verbally what they thought. We were not able to use a formal system for observing people's interactions and well-being. This was because our presence proved distracting and people were busy moving around the home engaging in activities. In order to gather information about people's experiences, we contacted relatives who could tell us about the service on behalf of some of the people living there. We also observed informally some interactions between people and staff on duty.

Staff were knowledgeable about the needs of people they supported. They told us how they tried to support people to make decisions and choices about their care. People's relatives told us they felt they were consulted and kept informed so that they could help support decision making if this was needed. They were satisfied with the standard of care that people received. One relative said, "I'm more than happy with the care..." They felt that staff were caring and responsive to people's needs.

We found that the way medicines were managed was generally satisfactory but that the arrangements for disposal and obtaining replacements when they may have become contaminated or ineffective were not always sufficiently robust.

Staff had access to regular training so that they remained competent to work with people safely. Staffing levels were flexible according to people's needs, appointments and activities.

People would need support in order to make a complaint. Staff were aware of the importance of listening to their relatives. Relatives were confident that any concerns they had would be dealt with effectively.