This inspection took place on 8 and 12 September 2016 and was unannounced. We last inspected the home on 17 June 2014 when we found the provider was meeting all the areas that we looked at.

Kemble House is a care home registered to provide accommodation, personal care and support for up to 15 adults with autistic spectrum and complex needs. The home is operated and run by Brookdale Healthcare Limited. At the time of our inspection, 14 people were living in the home.

The home is purpose built and has 15 bedrooms with ensuite facilities split across three floors. The ground floor has dining and lounge areas, and kitchen and a laundry room. The first floor has a kitchen, lounge area and laundry room.

The service had a manager who was promoted from their previous role as deputy manager. They had applied for registration with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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 using the service told us they felt safe at the service. The service had robust safeguarding policies and staff had a good understanding of the safeguarding procedure and the role of external agencies. Staff were able to demonstrate their role in raising concerns and protecting people from harm and abuse.

The service had systems to identify and manage risks. Risk assessments were detailed and individualised, and care records were well maintained. Care plans and risk assessments supported the safe management of people's medicines. The service kept accurate records of medicines administered by staff and medicines collection.

The service had sufficient numbers of staff employed to ensure that people’s individual needs were met. The service followed safe recruitment practices. Staff files had records of application forms, interview notes, criminal record checks and reference checks. Staff told us they were well supported by the manager. However, there were gaps in staff supervision and appraisal. Staff told us they attended induction training and additional training, and records confirmed this.

People using the service and their relatives told us staff were friendly and caring. People were supported and encouraged people to maintain a healthy and balanced diet. People told us they were happy with the food.

The service operated within the legal framework of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). People told us staff asked their consent before supporting them. The manager and staff demonstrated a good understanding of the procedures under MCA and DoLS.

The care plans were personalised and people’s life histories, individual needs and likes and dislikes were recorded. People and their relatives were involved in planning their care. People were asked about their views at residents’ meetings. People were encouraged and supported to carry out activities in and outside of the service. People told us they were asked for their feedback and the service was introducing new ways of seeking feedback from the relatives. People and their relatives told us they felt comfortable in making complaints and they were addressed in a timely manner.

The manager worked with health and social care professionals to ensure the service supported people to maintain healthy lifestyle. The service had records of regular monitoring checks of various aspects of the service. The service maintained efficient systems and processes to assess, monitor and improve the quality and safety of care delivery.

We considered our inspection findings to answer questions we always ask; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

At the time of the inspection there were fourteen people living at the home. People living on the first floor tended to be more independent with people needing more staff support living on the ground floor. We spoke with seven residents (from both floors). People told us “It’s nice and homely here,” and “I definitely feel safe here.” Staff had undertaken safeguarding training and understood their role in safeguarding the people they supported. Accidents and incidents were recorded appropriately, and the home environment was safe and clean.

Staff received appropriate training and supervision to ensure that they worked with people safely and in line with best practice.

Is the service effective?

People told us that their care and support needs were met effectively and they were happy with the home environment. Comments included “I have a nice room and it’s en suite,” and “I always get my medicines on time.” Their health and social care needs were assessed with them, and they were involved in writing their care plans. Care plans were reviewed regularly to ensure that staff met people’s needs consistently.

Staff received appropriate support and supervision to enable them to deliver care to people to an appropriate standard.

Is the service caring?

People we spoke with told us that staff were caring and treated them with respect. Comments included “The staff and residents are nice,” “The staff are good here,” and “I get on with my key worker.”

We observed staff showing patience and empathy when supporting people. People’s preferences, interests, aspirations and diverse needs had been recorded to ensure that care and support were provided in accordance with their wishes.

Is the service responsive?

Some of the people living at the home advised that they were being supported to develop daily living skills with an aim to moving on to more independent accommodation. We saw that staff had identified people’s cultural and religious needs, and people were supported to attend places of worship and have cultural foods.

There was evidence of suitable arrangements in place for obtaining, and acting in accordance with people’s consent in relation to the care provided to them. People told us “I’m involved in a lot of activities,” and “I get enough support to do what I need to do.” One person with a fear of heights told us that staff supported them with this issue. Another person told us that one of their goals was to visit Australia, and staff were supporting them with developing their skills in overnight stays away from the home.

Is the service well-led?

People living at the home spoke positively about the home’s management. They told us “I like Kemble House - it’s nice here,” and “We have meetings – we had one recently.” Staff spoke highly of the support of the manager and deputy and said that they had an ‘open door policy.’

Staff were clear about their roles and responsibilities and showed a good understanding of the needs of individual people they supported. We reviewed several audits that took place since the previous inspection, indicating that the service was proactive at finding areas for improvement and addressing these.

On the day we visited the home we spoke with four people who use the service, who lived on the first floor. They told us they liked living in the home and described a wide range of activities they took part in including voluntary work and attending college courses. One person said, “it is our own house so staff encourage us to be independent,” which was typical of the comments we received from people.

Staff were described by people who use the service as “caring and diligent”, “very calm”, “very consistent” and “the right mixture of understanding and encouraging.” The service provided person-centred care based on a clear assessment of individual needs. Staff understood the needs of the people they cared for and supported and we saw staff interacting with people in a caring and compassionate way and responding to their needs.

The service was clean and hygienic and there were effective systems in place to reduce the risk of infection. Staff recruited to work in the service underwent checks on their suitability before they began work.

Systems were in place to assess and monitor the quality of service that people received and ensure care and support was provided appropriately and in a safe environment and the service was well-led. Records kept by the service were accurate and securely stored.

People who use the service told us they were happy with the care and treatment they received. For example, one person said, “if you have an issue staff are always there, even in the night." Another person told us “when I worry about things staff try and talk to me.” People took part in a range of activities including attending courses at a local college. One person said, “staff are good at prompting and offering opportunities.” People who use the service described staff as “very supportive”, “hard-working” and “dedicated.” Care and support were provided in accordance with people’s wishes.

Medicines were stored securely and administered safely to people who use the service. Staff received appropriate training and support to enable them to deliver the care to people that they needed. Complaints about the service were managed effectively and resolved where possible.

We spent most part of our visit talking with people who use the service. People told us they could talk to staff about their needs. They said they had a weekly one-to-one meeting with their key workers. A key worker is a member of care staff who has a special interest in and a responsibility for monitoring the care provided to a person using the service. People told us they were treated with respect and dignity. Their views can be summarised by the following comments:

"The home is great".

"Staff listen to me".

"I decide what I buy and eat".

People told us they were satisfied with their care and treatment. They said they were busy in the home doing their own activities such as using computers, accessing the Internet, listening to music or preparing their meals. They said they could travel independently or with staff. People using the service told us they felt safe living at the home. They said they had keys to their bedrooms and they could access all communal areas. The following were some of the comments people made:

"I do my own shopping on a weekly basis".

"I do feel very safe living here".

"The home is good. I am happy".

People told us they liked living at the home. They said they felt safe and they were happy with the staff and the other people using the service. We were informed by people that they could choose what, when and where to eat; and they could decide when to sleep or when to get up from bed. People told us "staff were good" and "they listened" to them. From people's files and discussion with them it was evident that people using the service maintained contact with their families and friends.

People told us they could speak to the manager or staff if they had concerns. They said they had weekly one-to-one meetings with their key workers and talked about their care. People told us they attended "residents' meetings" and discussed issues common to them. We were informed that people used suggestion boxes provided by the service or emails to make comments regarding their experiences of the service.