Kimbolton is a residential care home for up to six people with learning disabilities and complex needs. It is situated in Bedford, near to local amenities and the town centre, making it accessible for people to engage in the wider community.

At the last inspection, the service was rated Good.

The inspection was undertaken as part of our routine re-inspection programme, to review the rating from the first comprehensive inspection completed on 4 March 2015.

At this inspection we found the service remained Good.

People felt safe and comfortable with the staff that supported them. Staff understood their responsibilities to protect people from the risk of abuse and had received training to assist them. Risk assessments identified specific risks for each person and gave guidance to staff about how they could assist people in a way which promoted their independence and choice. Staffing numbers were flexible and sufficient enough to ensure staff could safely meet people's needs. The provider had a robust system for employing new staff and ensured pre-employment checks were conducted prior to staff starting work. People were supported with their medication by staff who were trained and assessed as competent to give medicines safely and as prescribed.

People were confident staff had the skills and training to undertake the care being provided. Staff had access to training and professional development and a system was in place to ensure their training was up to date. Staff had received training on mental capacity and demonstrated an understanding and worked within, the principles of the Mental Capacity Act (2005). As a result, people's legal rights were protected and staff ensured people's rights to make decisions were respected. People had access to health professionals when needed and staff advocated on behalf of people to ensure appropriate health care was provided.

The delivery of care was person centred and where appropriate people and their relatives were involved in their care needs. This ensured decisions made met their specific needs. Staff were kind and compassionate and treated people with dignity and respect.

Care plans detailed the individual care and support needs of the person, and ensured that the delivery of care was responsive to people's needs. Where people's needs changed staff were informed so that care plans were adjusted to reflect the change. Records detailed people's preferred methods of communication, favourite activities and personal choices and these preferences were known to the care workers. People and their relatives knew what to do if they had any concerns about their care, and the provider responded positively to any issues or complaints raised.

We found the provider had systems to assess, monitor and improve the quality of the service and obtained feedback on the service provided. Staff were given responsibility and were involved in the day to day running of the service. They felt able to make suggestions about how the service could be improved. The views of people about the service were listened to and appropriate actions were taken to improve the service people received.

We considered all the evidence we had gathered under the outcomes we inspected during our inspection at Kimbolton. We used the information to answer the five questions we always ask.

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive to people's needs?

• Is the service well led?

This is a summary of what we found:

Is the service safe?

We found evidence to suggest that people enjoyed a good quality of life and were kept safe. One person told us, “I like being here.” Our observations confirmed that people felt relaxed and safe in the company of staff and we overheard some positive examples of staff engaging with people on a personal level.

Person centred care plans and individual risk assessments were updated regularly and contained comprehensive, specific detail to guide staff to deliver consistent care and ensure that people were protected from harm.

Staff had received training in the protection of vulnerable adults. Staff that we spoke with knew how to report concerns. We saw evidence that incidents of safeguarding had been appropriately reported to the local authority and the Care Quality Commission.

We observed that there were enough staff on duty to make sure people were cared for safely. We found that the staffing ratio facilitated people to participate in activities of their choice, both within the home and the wider community. It also enabled them to manage people's support needs in a caring and considerate way.

Good recruitment procedures were in place that ensured people were protected from harm. When staff started their employment they received an induction and training. We saw that training continued on a consistent and ongoing basis so that staff had the right skills and knowledge to provide care, treatment and support to people who lived at Kimbolton.

We found that there was a robust system in place to make sure that manager and staff learnt from events, including accidents and incidents, health and safety issues, complaints and concerns. This meant that the risk of harm to people was reduced and that the service was able to evidence its intention to provide proactive care which took account of future improvements.

Is the service effective?

People living in the home had their needs assessed and we observed that staff understood people’s individual care needs. Each person had a range of care plans in place which provided information about how people preferred care and support to meet their daily routines.

There were arrangements in place that ensured staff had the most up to date information about people’s needs. This included daily handovers that ensured people received effective and consistent care and treatment. Staff had the required knowledge to effectively assess, identify and meet people’s nutritional needs.

People were encouraged to maintain their independence and we saw examples of this during the inspection. We observed staff talking with and supporting people during our time in the home, and we found that this was done with the person's privacy and dignity in mind. This demonstrated staff's awareness of people's individual support needs. This was also reflected in the support plans we viewed on the day.

Care plans were pictorial in nature and showed that people needs were assessed prior to admission and reviewed on a regular basis. Through our discussions with staff, we found that they had a good understanding of what people’s care needs were and when they had changed.

Staff worked in partnership with other professionals to make sure people received appropriate care, treatment and support to meet their diverse health and social care needs.

Is the service caring?

The evidence we reviewed confirmed that people and their relatives felt they were well supported by staff. We found that people’s preferences were always well documented, and staff were able to tell us about the people in the home and their individual needs.

During our inspection we saw staff made sure that people’s privacy and dignity was upheld. They closed doors when people received personal care and we found that people could spend private time with relatives and friends as they chose.

We observed that people were happy with the care and support they received. People were offered support at a level which encouraged independence and ensured their individual needs were met. Staff were relaxed, friendly and courteous in their approach to people and interacted confidently with them. Records showed that people were encouraged to express their views about the quality of care in the home and the pictorial care plans showed they were involved in planning their care, making decisions about their support and treatment, and how they spent their time.

Is the service responsive to people's needs?

No-one in the home needed a mental capacity assessment or a best interest decision at this time, although staff were aware of the action that needed to be taken should this arise. Staff had received training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and all the training was current.

We noted that people's wishes were respected by care staff and taken into account when making best interest decisions, gaining consent and planning care and support. Records showed that the service engaged effectively with other professionals in ensuring that all areas of health and well-being were maintained.

The records showed that staff worked well with other health professionals. This meant incidents and accidents in the home were dealt with effectively.

There were well developed procedures in place that made sure complaints were listened to and taken seriously. We saw that the registered manager operated an open and responsive culture where complaints were encouraged, explored and responded to in good time.

Is the service well- led?

There was a registered manager in post. Staff were aware of their roles and responsibilities and were supported by the manager. There was evidence that the registered manager provided strong and inclusive leadership. Staff we spoke with told us that the registered manager had an ‘open door’ approach so that staff could express any concerns or issues they had daily if they needed to.

People living in the home were able to express their views and opinions about how the service was being run because there were meetings and other methods used to gain their views. There was evidence that the registered manager acted on feedback received and made changes to practices that ensured improvements were made.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We were told that contact had been made with the supervisory body for one person, who advised that an application was not required. There had been Deprivation of Liberty applications submitted and decisions made by the supervisory body for four of the other people living at the service. This meant that proper policies and procedures were in place and staff understood when an application should be made, and how to submit one.

We found that the provider monitored the quality of the service provided to people and acted upon the feedback they were given. The quality assurance systems in place were effective as they highlighted and addressed identified shortfalls which enabled improvements to be made. This showed that the service had an effective management structure and was responsive to concerns, making efforts to drive ongoing improvement.

When we visited Kimbolton on 24 September 2013, we used different methods to help us understand the experiences of people using the service. We observed people were offered support at a level that supported their independence and ensured that specific needs were appropriately met. The atmosphere within the home was calm and relaxed and people were observed to be happy and were engaged in activities of their choice. We noted staff were attentive to the needs of the people they were supporting which meant that people's needs were met in a timely manner.

We spoke with two people and were told they were happy living at Kimbolton. We found from the care records that people were supported to engage with external professionals to ensure their care and welfare needs were met appropriately.

Medication was stored safely and we observed from the care records that it was administered on time to people.

We noted that the premises was appropriate in layout for those people who lived at the home. Regular maintenance took place so that it remained safe and free from harm.

Staff received regular training that was relevant to the needs of those people who lived at Kimbolton. They told us that this gave them the right skills to care and support people.

We found records were stored securely and protected both staff and people's confidentiality. Records were updated on a frequent basis which meant that the provider made efforts to monitor service provision on a regular basis.

When we visited Kimbolton on 3 December 2012, we used different methods to help us understand the experiences of people using the service.

We observed that people were offered support at a level which encouraged independence and ensured that individual needs were met. The atmosphere in the home was calm and relaxed and staff were observant to the needs of the people they were supporting. This meant that people were at ease with the staff caring for them.

The staff were polite and respectful in how they approached people and engaged appropriately with them, supporting them in planning their care and making decisions about how they spent their time.

We spoke with three out of five people currently living at the home, who said they were happy living there and that they felt safe and supported. One person said, "I like living here and I like the staff. The home is well organised and structured which is good." A relative told us that, "All the staff are excellent and work together as a team." They also said that, "The staff look for solutions to problems and offer choices. They have promoted independence but also listen and value what you have to say as a family member."

Some of the people that we met during our visit on 25 November 2011, did not use words to communicate, so we spent some time observing the support being provided to them.

We noted that staff were attentive, and understood the needs of the people that they were supporting.

Staff prioritised people's needs over other tasks that they were doing. And we observed people being supported to make their own choices and decisions.

People that we spoke with, told us that they were happy living at the home, that they liked the staff and felt well supported by them.

A relative of someone using the service had recorded in a satisfaction survey that "all the staff I have been in touch with are excellent".

Kimbolton is registered to provide accommodation and support for up to six people with learning disabilities and complex needs. On the day of our visit, there were six people living in the home.

Our inspection took place on 4 and 9 March 2015 and was unannounced. At the last inspection in May 2014, the provider was meeting the regulations we looked at.

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.

People felt safe and were protected from the risk of harm by staff who knew how to recognise and respond to allegations of abuse.

The service had a recruitment process which ensured that suitable staff were employed to look after people safely.

There was enough qualified and experienced staff on duty to meet people’s needs safely.

There were suitable arrangements for the storage and management of medicines.

Staff received appropriate support and training to perform their roles and responsibilities. They were provided with on-going training to update their skills and knowledge.

Staff understood the systems in place to protect people who could not make decisions and followed the legal requirements outlined in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS).

People were provided with a balanced diet and adequate amount of food and drinks of their choice.

People were looked after by staff that were caring, compassionate and promoted their privacy and dignity.

Staff were knowledgeable about how to meet people’s needs and understood how people preferred to be supported.

There were effective systems in place for responding to complaints and people and their relatives were made aware of the complaints processes.

Quality assurance systems were in place and were used to obtain feedback, monitor service performance and manage risks.