What life is like for people using this service:

• People continued to receive safe care. Staff knew how to keep people safe from harm and people told us they were safe. The provider had a system in place to recruitment staff to ensure people would be supported safely. There were enough staff to support people safely. Where people received medicines the provider ensured this was administered as it was prescribed. Staff followed infection control guidance, they received appropriate training and had access to personal protective equipment. Accidents and incidents were noted and trends monitored to reduce accidents.

• People continued to receive effective care. Staff had the skills and knowledge to support people how they wanted. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. People received enough to eat and drink to ensure they had a healthy diet. People could access health care when needed.

• People continued to receive care from staff who were kind and caring. People were supported and encouraged by staff to make decisions as to how their needs were met. Staff were caring, compassionate and kind. Staff understood the importance of respecting people’s privacy dignity and independence.

• People continued to receive responsive care. Assessments and support plans were in place identifying what was important to people and how people would be supported. The support people received was centred around them and they were involved in any decisions made. People socialised how they wanted. The provider had a complaint process which people were aware of to share any concerns.

• The service continued to be well managed. The environment was welcoming, warm and relaxing. The registered manager was approachable people knew them well. Spot checks and audits were taking place to ensure the quality of the service was maintained.

More information is in the Detailed Findings below.

Rating at last inspection:

• Rated Good (Report published 14/09/2016).

About the service:

• Kiniths House is a small care home providing personal care and accommodation for up to ten people who have a learning disability or sensory impairment. At this inspection ten people lived within the service.

Why we inspected:

• This was a planned inspection based on the rating at the last inspection. The service remained Good overall.

Follow up:

We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Our inspection took place on 9 August 2016 and was unannounced.

The provider is registered to accommodate and deliver personal care to ten people who lived with a learning disability or an associated need. Ten people lived at the home at the time of our inspection. We started our inspection early in the morning. We did this to enable us to meet and speak with as many of the people we could in case they all went out later.

At our last inspection on 8 September 2015 the provider was not meeting all of the regulations that we assessed as we found that there was inadequate quality monitoring of the service as there was a lack of evidence to determine that regular audits and checks had been undertaken. This inspection we found that quality monitoring and checking processes had been implemented by the registered manager and provider.

The manager was registered with us and was present during our inspection as was the provider. 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.

We found improvements regarding the medicine management systems that confirmed that people had received their medicine safely and as it had been prescribed by their doctor. Staffing levels had improved to ensure that people were safe and received the care and support that they needed in the way that they preferred. People told us that they were safe living at the home. Although we found that some environmental safety issues that needed to be addressed the registered manager was working to resolve these. There were systems in place that staff knew they should follow if at any time they felt that people may be at risk of abuse.

New staff were given induction training to ensure that they had the knowledge of how to support people safely and appropriately when they started work. Staff had received all of the other training they needed to do their job safely. Staff had received training and understood the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguarding (DoLS) and ensured that people were not unlawfully restricted. People were offered meal choices to ensure that their preferences and dietary needs were met. People received input from a range of health care professionals to meet their healthcare needs.

People were supported by staff who were kind and friendly. Relatives were welcomed by staff who were polite and helpful. Care plans highlighted people’s needs and preferences and people and their relatives were involved in reviews.

A complaints procedure was available for people to use and people told us that they would be happy to use it if they had the need. People and their relatives were encouraged to make their views known on the quality of the service.

The provider had a leadership processes in place that people and their relatives understood. Staff were directed and supported to work in a way that ensured a good, safe quality service.

Our inspection took place on 8 September 2015 and was carried out by one inspector. The provider is registered to accommodate and deliver personal care to ten people who lived with a learning disability or associated need. Ten people lived at the home at the time of our inspection. We started our inspection early in the morning so that we could meet and speak with the people who lived there and staff in case they were out of the home later.

At our last inspection on 5 July 2013 the provider was meeting all of the regulations that we assessed.

The manager was registered with us as is required by law. 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.

We found that medicine management systems needed some improvement so that people would consistently receive their medicine safely and as it had been prescribed by their doctor.

There were systems in place to protect people from the risk of abuse. Staff confirmed the reporting processes they should follow if they had any concerns about abuse.

Staffing levels at the time of our inspection meant that people may not always receive the care and support they needed.

Mental capacity assessments were not used and staff understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguarding (DoLS) varied due to a lack of training.

Processes were in place to induct new staff to ensure that they had some knowledge when they first started work. Staff received supervision sessions and had the opportunity to attend staff meetings which provided support and development.

Staff felt adequately supported on a day to day basis in their job roles and received most of the training they needed to do their job safely.

People felt that the staff were nice and kind. Relatives felt that staff showed an interest in people and showed them respect.

People received input from a range of health care professionals. However, care planning was lacking in some instances as it did not always highlight people’s health care needs.

People were offered meals that they liked and felt that the meals met their needs.

A complaints procedure was available for people to use and people told us that they would be happy to use it if they had the need.

There was little quality monitoring of the service. The provider had not always ensured that they informed us of incidents that they should have to comply with the law and there was a lack of evidence to determine that regular audits and checks had been undertaken.

You can see what action we told the provider to take at the back of the report.

We met nine of the 10 people living there, and spoke with the manager, owner, a senior and two care staff. Some people were unable to express their views verbally, so we spent time observing how staff supported them.

People had been supported to provide their consent to their care. One person told us, "Staff explains everything to me so I understand, and if I don’t agree they accept that. I have agreed to some things because it is safer for me, these were explained”.

We saw people's needs had been assessed and appropriate plans of care put in place to meet their needs. Staff knew how to support people and reduce risks to their health and safety.

We saw that people's welfare and safety was protected when they moved between different services such as going into hospital. This meant that if a person went to hospital they would have information about people's immediate medical needs.

We saw people had their medication when they wanted it and that staff had the guidance and training they needed to do this safely.

Staff had received specialist training to safely support the people living there. Staff were very positive about the support and guidance they received, one staff said, "We get lots of support and guidance, it is a great place to work".

We spoke with five people who told us they were supported in making choices about the things that were important to them. Two people we spoke told us about their voluntary work placements in the community, which they enjoyed.

Staff knew how to support people to meet their needs and referred people to other health professionals. Staff followed advice from other professionals to ensure people's health and well being.

People told us they had a choice of foods and we saw that staff encouraged people to eat a healthy and balanced diet.

Staff knew how to safeguard people from harm and felt confident that if they had to report any abuse, action would be taken to protect people.

We saw there were enough staff to meet people’s care needs and promote their social opportunities.

There were systems in place to make sure that any risks to people's safety and welfare could be identified and improvements could be made.

People had access to a complaints procedure and told us their concerns had been listened to.

We saw that care plans and other care records were up to date, detailed and reflected people’s support needs. One person told us "Staff talks to me about what I want and they put this in my care plan. I know it's in there because they do things the way I want". This ensured that people knew what was written about them.

We saw that the home is a safe and homely environment for people to live in, with plenty of space for people to move around from one activity to another. People told us they liked living at the home. They said that the staff were very nice and that they could choose what they wanted to do every day.

Eight people were living at the home at the time of our visit. We talked with four of the people who were at home on the day of our visit and two staff on duty. People told us how long they had lived there and about their various interests and activities.

We saw that everyone was individually dressed and their clothes were appropriate for the activities they were undertaking that day. Some people were going out to work later in the day and some people were creating festive decorations for the lounge. We saw that there were lots of videos and board games in the lounge for people to watch and play.

All the people we spoke with knew who their key worker was and said that they regularly have a private conversation with that person about their needs and future plans. People told us about the varied activities, trips and holidays they enjoyed. One person said, “I am going to Minehead for a holiday next year – I didn’t go this year”.

We saw that care records were detailed, updated regularly, and signed by staff and people who live at the home. We saw that staff asked for people's opinions and took them into account when planning their care. We heard from staff how everyone's unique skills and abilities were taken into account when the care plans were reviewed.

We saw and heard good interactions between staff and people who live at the home. Staff addressed people by name and we heard staff talking with people individually about their families and personal interests. The conversations we heard between staff and people who use services demonstrated staff's knowledge and understanding of different people’s needs and their lifestyles and family connections.