We carried out an unannounced comprehensive inspection at Kilkhampton Lodge on 3 July 2018. The previous inspection took place on 22 June 2017. At that time we found risk assessments did not consistently guide staff on how they could protect people from identified risks. Some people were subject to restrictive practices. The best interest process had not been followed to help ensure the least restrictive options had been identified. Decisions regarding restrictive practices were not regularly reviewed.

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.

We carried out a comprehensive inspection of Kilkhampton Lodge on 22 June 2017. This was an announced inspection. We told the registered manager two days before our inspection visit that we would be coming. This was because we wanted to make sure people would be at the service to speak with us. The service was last inspected in February 2016. The service was meeting regulations at that time.

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 ana

We carried out a comprehensive inspection of Kilkhampton Lodge on 8 February 2016. This was an announced inspection. We told the provider two days before our inspection visit that we would be coming. This was because we wanted to make sure people would be at the service to speak with us. The service was last inspected in September 2013. The service was meeting regulations at that time.

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 s

On the day of our visit we were told that there were six people living at Kilkhampton Lodge. We spoke to three people living at the home, spent time observing the care people were receiving, spoke to six members of staff, which included the deputy manager and looked at two people’s care files in detail.

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.

This inspection was carried out because the Commission received concerning information alleging inappropriate use of restraint. We did not find evidence of this at the time of this visit.

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.

We visited Kilkhampton Lodge between 11:30am and 6pm on Wednesday 30 May 2012. We spoke with four of the seven people who lived there. Two of them showed us their private flats. Each person had a flat with their own front door within the building, a fully fitted kitchen, living room, bedroom and shower or bathroom. People said they were pleased to have chosen their furniture, and they had many of their own belongings.

One person showed us that they had the ingredients for their supper, and told us they would be cooking it, with staff support, in their own flat.

All the people we spoke with told us about the varied activities they enjoyed which included football, household shopping, and working at a garage. People said that staff were respectful and supportive. One person said that their family were also happy with the service. A staff member told us they were “impressed with this organisation. Loads of activities are enabled.”

We looked at systems for looking after people’s medication and money, and found these were done with care, and in accordance with the individual’s best interests.

We found that staff were well trained and supported to provide care for people with complex needs. Staff were pleased with the opportunities available for supporting people with individual activities inside and out of the home. Several people individually told us that the team had been very supportive and they worked together very well.

Management had made regular checks to ensure the service was delivered consistently and in accordance with the regulations.