We carried out this announced inspection on 19 May 2018. The inspection was announced as this allowed the registered manager to prepare the people they supported at Kingston house to know that an inspector would be visiting their home. With this knowledge they were then prepared and were able to choose if they wished to be involved in the inspection process.

The last inspection took place on 4 April 2017. The service was rated as Requires Improvement at that time. There were concerns around how the management team supported staff and how staff responded to each other in front of the people they supported. Since the inspection the operational manager had left the organisation, and there had been a number of staff personnel changes in the home. Staff told us they felt more supported by the managers of the service, and with the staff changes this had led to the staff team working more positively together. One staff member commented “Some staff left, staff personalities are much better now. I enjoy my shift.” The registered manager commented “Staff are aware this is a person home, arguments are left outside. Staff morale is so much better, staff are much happier.”

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. The service is now rated as Good.

Kingston House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Kingston House is a detached home which provides accommodation for three people. The service has environmental adaptations to enable people who use specialist equipment to move freely around their home. At the time of the inspection three people were living at Kingston House. Kingston House is part of Westlake, an organisation providing support and care for people with a learning disability in the Cornwall and Plymouth area.

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.

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.

On the day of the inspection there was a calm, relaxed and friendly atmosphere in the service. We met with the three people living at Kingston house and spent some time with them and staff. Staff were respectful and caring in their approach. They knew the people they supported well and had an understanding of their needs and preferences. People were treated with kindness, compassion and respect.

Staff ensured people kept in touch with family and friends. Relatives we spoke with told us "They [staff] are brilliant” and “[person’s name] needs are more than well met by brilliant staff.” Relatives told us they were always made welcome and were able to visit at any time.

Staff said they were proud to work at Kingston house and told us “This is our extended family.” We saw a staff member turn to the person they supported and said to them, “We are a team.”

People were protected from abuse and harm because staff understood their safeguarding responsibilities and were able to assess and mitigate any individual risk to a person’s safety.

The service was warm, comfortable and appeared clean with no unpleasant odours. The service was well maintained. Peopl

We inspected Kingston House on 4 April 2017. The inspection was announced. This is because Kingston House is a small service and we wanted to be sure someone would be available to speak with us. The service was last inspected in November 2014 when it was rated Good.

Kingston House is part of Westlake Care who specialise in the care of adults who have a learning disability, autistic spectrum disorder, physical disability and/or a sensory impairment. Westlake Care have two other homes in the south west. Kingston House is registered to support a maximum of three people. At this inspection we found the service remained Good.

The service had a registered manager in place. 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.

Staff relationships were strained and there were sometimes arguments between members of the staff team. Staff told us the language and tone of these arguments could be quite aggressive. On occasion the arguments had taken place in front of people living at Kingston House. This demonstrated a lack of respect and a disregard for the potential impact on people’s well-being. The registered manager was aware of the situation and had informed the provider. A staff meeting had taken place to try and address the issues.

Roles and responsibilities were well-defined and understood by the staff team. The registered manager was supported by a deputy manager. There was a key worker system in place. Key workers are members of staff with responsibility for the care planning for a named individual.

Interactions between staff and people were friendly and supportive. There were enough staff available to help ensure people’s needs were met quickly. Staff spoke with people to inform them of what was happening when supporting them to move around the premises.

Recruitment practices helped ensure staff working in the home were fit and appropriate to work in the care sector. Procedures were not consistently followed and we have made a recommendation about this in the report.

Staff had received training in how to recognise and report abuse and information on how to report concerns within the organisation was on display. Staff told us they were aware how to raise concerns both inside and outside of the organisation.

People were assessed in line with the Deprivation of Liberty Safeguards (DoLS) as set out in the Mental Capacity Act 2005 (MCA). DoLS provide legal protection for vulnerable people who are, or may become deprived of their liberty. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals when appropriate. Records showed people were supported in line with the legislation. 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.

Staff had access to regular training. Training to help staff meet people’s specific needs was available. Staff meetings were an opportunity to contribute to the development of the service and individuals.

People’s support plans included detailed information about their health needs. Care plan reviews were held regularly and information up-dated accordingly. People had access to a range of activities outside of the service and were supported to access the local community on a regular basis.

There were quality assurance systems in place to monitor the standards of the care provided. Audits into various areas of the service took place monthly.

We inspected Kingston House on 4 November 2014, the inspection was unannounced. At the last inspection in December 2013 we did not identify any concerns.

Kingston House is a residential care home for up to three people on the autistic spectrum. The service is part of the Westlake Care group. The service has a registered manager in place. 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 happy and relaxed on the day of the inspection. We saw people interact with staff in a positive and stimulating way. Staff were attentive and available to meet the needs of people. We saw they encouraged people to engage in meaningful activity and spoke with them in a friendly and respectful manner.

Care records were detailed and contained specific information to guide staff who were supporting people. Personal profiles were developed in a format which was more meaningful for people. This meant staff were able to use them as communication tools. Risk assessments were in place for day to day events such as using a vehicle and one off activities. Where activities were done regularly risk assessments were included in people’s care documentation.

Relatives told us Kingston House was a caring environment and staff had a good understanding of people’s needs and preferences. One relative told us, “Kingston House has a very homely atmosphere. The care my son receives is excellent, very person centred and tailored to my son’s needs”. We found staff were knowledgeable about the people they supported and spoke of them with affection.

The service met the requirements of the Mental Capacity Act (2005) and the associated Deprivation of Liberty Safeguards.

People had access to a range of activities. These were arranged according to people’s individual interests and preferences. One relative of a person who lived at Kingston House told us, “People are encouraged to take part in a variety of activities. My son has had opportunities to take part in rock climbing, bastket-ball and even coming down on a zip wire”.

Staff were well supported through a system of induction and training. Staff told us the training was thorough and gave them confidence to carry out their role effectively. The staff team were supportive of each other and worked together to support people.

Relatives knew how to raise concerns and make complaints. They told us concerns raised had been dealt with promptly and satisfactorily. Incidents and accidents were recorded. These records were reviewed regularly by all significant parties in order that trends were recognised.

There was an open and supportive culture at Kingston House. Staff and relatives said the registered manager was approachable and available if they needed to discuss any concerns. One professional who worked in a multi-disciplinary Learning Disability team told us, “All of the interactions I have had with Kingston House have been very positive. They are very open and actively encourage advice and input to provide the best care and support for the people who live at Kingston House”. 

During the inspection we were able to meet all of the people who used the service. People who used the service were unable to verbally communicate with us about their experiences of living in the home. We did however spend time in the home speaking to staff and observing the care and support being provided.

We saw within records and through discussion with staff and relatives that people’s rights and ability to consent had been considered when planning and providing care and support. Records confirmed that the correct procedures were followed to protect people’s rights when they were unable to consent to decisions being made about them.

The support plans we looked at provided staff with clear and up to date information about people’s needs and how they should be met. People were supported to partake in a range of age appropriate activities.

Systems were in place, which ensured that people were protected from the risks of abuse. A relative we spoke to said “I am able to visit the home at any time, the care is brilliant and I have never had cause to be concerned”

We found that the records held in the home about people using the service were mainly well maintained and up to date.

A system was in place to regularly assess and monitor the quality of the service being provided. We saw that the home liaised regularly with relatives and other agencies and responded promptly and appropriately to any issues or concerns raised.

We carried out an inspection of Kingston House on 6 July 2012 and 10 July 2012. During the course of our inspection we talked with two relatives of people who lived at Kingston House. We also spoke with the registered manager, four members of staff, a social worker and one community nurse.

The three people that lived at Kingston House were unable to tell us about their experiences. So to help us to understand their experiences we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allowed us to spend time watching the type of support people received. We observed that overall people had positive experiences living at Kingston House.

Relatives we spoke to told us that staff were “excellent” and that the manager was “outstanding”. Other comments included, “we feel that we have found a wonderful place, it’s perfect, it’s wonderful”, “we have absolute total confidence in them” and “although my X can not speak, it is obvious that he is very happy”.

Staff comments included, “it is a great place to work”, “I absolutely love it here”, “the manager is adorable”, “I miss the place when I am not here” and “you can ring the manager or provider at anytime, they always pick up the phone”. However, staff were critical of formal supervision arrangements at Kingston House. The registered manager told us that she had recognised this and had a plan in place to address it.

During our inspection we looked at seven outcomes of the Health and Social Care Act 2008. We found that the provider was compliant in five areas and non compliant in two areas inspected.

In the two areas of non compliance, we found that people who lived at Kingston House were not protected from the risk of abuse, because not all staff were trained in the safeguarding of vulnerable adults and children. It is important that all staff are trained so that they are able to raise any safeguarding concerns with the relevant department within the local authority and/or police and have a clear understanding of their responsibilities and of the process.

We also found that the provider did not have an effective system to regularly assess and monitor the quality of service that people receive. It is essential for service to have systems in place to measure and improve ongoing service quality.