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Inspection carried out on 23 September 2017

During a routine inspection

The inspection took place on 23 September 2017 and was unannounced. Klein is a residential care home for up to two people. It specialises in the care of people who have a learning disability and associated conditions. At the time of this inspection there was one person living there.

The service had a registered manager. 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 the last inspection on the 4 and 5 September 2015, the service was rated Good. At this inspection we found the service remained Good.

Why the service is rated good:

People said; “Yes I feel safe here because I have staff for company all the time.” A relative said; “Very safe. It’s the safest environment possible. Fantastic team. I can’t praise them enough.” Staff said; “We keep people safe because they have the staffing they need to keep them safe.”

People remained safe at the service. There were sufficient staff to meet people's needs and support them with trips out and activities. Risk assessments were completed to enable people to retain their independence. People received their medicines safely.

People continued to receive care from staff who had the skills and knowledge required to effectively support them. Staff were well trained and competent. 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. People's healthcare needs were monitored by the staff and people had access to a variety of healthcare professionals.

The staff were very caring and people had built strong relationships with the staff. We observed staff being patient and kind. People's privacy was respected. People or their representatives, were involved in decisions about the care and support people received. One person said; “They (their relatives) come to my review meetings.”

The service remained responsive to people's individual needs and provided personalised care and support. People were able to make choices about their day to day lives. Complaints were fully investigated and responded to. A relative said; “We raised two minor concerns. They were dealt with straight away.”

The service continued to be well led. People and staff told us the registered manager was approachable. The registered manager and provider sought people's views to make sure people were at the heart of any changes within the home. The registered manager and provider had monitoring systems which enabled them to identify good practices and areas of improvement.

Inspection carried out on 4 & 5 September 2015

During a routine inspection

The inspection took place on 4 & 5 September 2015 and was unannounced. Klein provides care and accommodation for up to two people with learning disabilities who each have their own self-contained living accommodation within the home. On the day of our visit two people were living in the service. Modus Care (Plymouth) Limited owns Klein and has three other local services.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. The registered manager is also the registered provider. Registered providers 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.

We met and spoke to people during our visits. We observed people and staff were relaxed in each other’s company and there was a calm atmosphere. Some of the people who lived in the service were not able to fully verbalise their views. People responded positively when asked if they liked living in Klein. All staff agreed that they felt people were safe living in the service. Staff knew people well and had the knowledge to be able to support people effectively.

Staff had undertaken training on safeguarding adults from abuse, they displayed good knowledge about how to report any concerns and described what action they would take to protect people against harm. Staff felt confident any allegations or concerns would be fully investigated.

People’s medicines were managed safely. People received their medicines as prescribed and received them on time. Staff were appropriately trained and records showed what each medicine was prescribed for. People were supported to maintain good health through regular access to health and social care professionals, such as dieticians and social workers.

When people were asked about the care and support they received, those able, responded positively while others responded with a smile indicating they were happy with the staff support. Care records were comprehensive and personalised to meet each person’s needs. Staff fully understood people’s individual complex behavioural needs and responded quickly when a person became anxious. People were involved as much as possible with their care and records documented how people liked to be supported. People were offered choice and their preferences were respected.

People living in the service could be at high risk due to their individual needs and additional support was offered when needed. People’s risks were well managed and documented. People lived active lives and were supported to try a range of activities. Activities were discussed and planned with people’s interests in mind.

People enjoyed the meals provided and they had access to snacks and drinks at all times. People were involved in planning of menus, food shopping and preparing meals.

People did not have full capacity to make all decisions for themselves, therefore staff made sure people had their legal rights protected and worked with others in their best interest. People’s safety and liberty were promoted.

Staff said the registered manager was very supportive and approachable and worked in the home regularly. Staff talked positively about their roles.

People were protected by safe recruitment procedures. There were sufficient numbers of staff on duty to support people safely and ensure everyone had opportunities to take part in activities. Staff received an induction programme. Staff had completed appropriate training and had the right skills and knowledge to meet people’s needs.

People had access to healthcare professionals to make sure they received appropriate care and treatment to meet their health care needs such as community nurses and GPs. Staff acted on the information given to them by professionals to ensure people received the care they needed.

There were effective quality assurance systems in place. Any significant events were appropriately recorded, analysed and discussed at staff meetings. Evaluations of incidents were used to help make improvements and ensure positive progress was made in the delivery of care and support provided by the service. People met with staff on a one to one basis and were able to raise concerns. Feedback was sought from people living in the home, relatives, professionals and staff.

Inspection carried out on 13, 18 June 2013

During a routine inspection

We made two visits to the home to enable staff to give people the choice of meeting us on either occasion. However due to people�s complex needs they choose not to meet us and we were unable to observe staff as they provided care and support. Therefore we spent time looking at records, speaking to staff and speaking to a professional involved in peoples care. We were able to hear staff talk to people via the telephone or through the flat door. This helped us gain a better understanding about people's support needs and experiences of the service.

One visiting professional said, �X has really settled here and the staff have worked hard to make that happen.�

We obtained from discussions with the staff and listening to staff talk with people that people were treated respectfully and their choices and independence promoted . The interactions and relationships we overheard were positive and this helped to create a safe and homely environment for the people using the service.

People were involved in the planning of their care and had access to their personal information. Care plans were detailed and reviewed with regular updates included. The staff had a good understanding of issues relating to abuse and systems were in place to ensure that any incidents of abuse were recognised, reported and acted upon to keep people safe.

Sufficient staffing levels were in place and staff received a range of training opportunities to ensure they could meet people's individual needs.