About the service:

Kirtling House is a residential care home without nursing that provides support to up to eight people with mental health needs. The service aims to support people to reach their potential, moving towards independent living and social inclusion. At the time of our inspection there were seven people living at the home.

People’s experience of using this service:

People told us they were well supported by the staff and managers.

Staff were friendly and caring and treated people with respect. There was an open, inclusive culture and ethos within the service, which empowered people and promoted positive outcomes. The managers and staff engaged well with people using the service, their relatives, and external stakeholders.

Staff demonstrated a good knowledge of people’s individual needs and preferences regarding their support. People were empowered to be involved in making decisions about their care and support and how the service was run. Any concerns were listened to and followed up appropriately.

There were systems and processes in place to protect people from harm. Staff were trained in how to recognise and respond to abuse and understood their responsibility to report any concerns to the management team.

People’s medicines were stored and well managed to ensure their safe and proper use. People were supported to manage their own medicines within a framework of individual risk assessment.

Safe recruitment practices were followed and appropriate checks had been undertaken, which made sure only suitable staff were employed to care for people in the home. There were sufficient numbers of experienced staff to meet people’s needs.

Staff were supported to provide appropriate care to people because they were trained, supervised and appraised. There was an induction, training and development programme, which supported staff to gain relevant knowledge and skills.

People were supported to have 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.

People’s needs were assessed and care and support plans were person-centred and reviewed.

People were supported to maintain their mental and physical health and the service had good relationships with external professionals.

There were flexible approaches to supporting people to budget, shop, and to eat and drink well.

The service was responsive to people’s needs and staff listened to what they said. People were confident that any concerns or complaints they raised would be dealt with.

There were a range of systems in place to assess and monitor the quality and safety of the service and to ensure people were receiving appropriate support.

The service had been without a registered manager for over a year which has meant that the rating for the well led key question cannot be rated better than requires improvement.

More information is in the full report.

Rating at last inspection:

Kirtling House were rated Good at their last inspection (Report published 13 October 2016).

Why we inspected:

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

Follow up:

We will follow up on this inspection as per our re-inspection programme, and through ongoing monitoring of information received about the service.

This inspection took place on 1 and 2 September 2016 and was unannounced. We last inspected the service in February 2014. At that inspection we found the service was compliant with the essential standards we inspected.

Kirtling House is a care home without nursing that provides support to up to eight people with mental health needs. On their website the service states their aim is to support people to reach their potential, moving towards independent living and social inclusion. At the time of our inspection there were seven people living at the home.

The service had a registered manager who registered with the Care Quality Commission (CQC) on 4 April 2016. 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. The registered manager was present and assisted us during this inspection.

Staff were professional and skilful when working with people. Staff knew how individuals liked things done and people were treated with care and kindness. Staff were aware of people's abilities and encouraged them to be as independent as possible.

People received support that was designed to help them meet their personal goals. Support was person centred and incorporated their personal preferences and needs. People said staff knew what they were working on and what they were able to do for themselves. People confirmed staff helped them to work towards their individual goals for recovery and increasing independence.

People received appropriate health care support. People's health and well-being was assessed and measures put in place to ensure people's needs were met in an individualised way. Medicines were stored and administered safely.

People were protected from the risks of abuse and from risks associated with their support provision. They were protected by recruitment processes and people could be confident that staff were checked for suitability before being allowed to work with them.

There were sufficient numbers of staff on each shift to make sure people's needs were met. People benefitted from staff who received training to ensure they could carry out their work safely and effectively

People's rights to make their own decisions were protected. The manager and staff had a good understanding of people's rights to make their own decisions and ensured that decisions were not made on behalf of people unlawfully.

People knew how to raise concerns and felt they were listened to and taken seriously if they did. Staff were clear on what actions they should take should anyone raise concerns with them.

People benefitted from staying at a service that had an open and friendly culture. People felt staff were happy working at the service. People's wellbeing was protected and all interactions observed between staff and people at the service were caring, friendly and respectful. People's rights to confidentiality were upheld and staff treated them with respect and dignity.

Risks related to the premises were assessed and monitored. Checks were in place and action was usually taken to address any identified risks. However, on occasions we found some actions, although identified as needed, were not always monitored to ensure they had been completed. We have made a recommendation about the management of issues and remedial work identified during routine audits, servicing visits and risk assessments of the premises.

During our inspection we spoke with four people living at the home. We also spoke with the acting manager, the acting deputy manager and a recovery worker and looked at two people's care records.

People told us they were happy living at the home. One person told us, “They [staff] are brilliant…really supportive”. People told us that they were involved in making decisions about their care and treatment. One person said, “They [staff] respect my decisions".

We saw that the home had information from referring agencies and that this was incorporated into people’s care and support plans which were detailed and provided information about key risks. Staff we spoke with were able to tell us about people’s support needs and we observed positive interactions between staff and people who used the service.

The home supported people to take their medication and where possible, staff encouraged people to develop independence in managing their own medication.

The home was adequately staffed, however the service was reviewing its arrangements for determining staffing levels to ensure that these provided the best possible service to people who lived at the home.

Systems were in place to monitor the quality of the service and to seek the views of people about the support they received.

In this report the name of a registered manager (James Gillespie) appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. His name appears because he was still a registered manager on our register at the time. At the time of our inspection the provider had an acting manager in post whilst recruitment to the role of registered manager was undertaken.

People had good access to and knowledge of their care plans which they made regular contributions to. They told us this made them feel that care and support were led by them and not just provided for them. They said that care and support were provided in ways that were empowering.

Regular meetings were held where staff and people were together discussing the same subject. People said these meetings gave them a sense of belonging. They told us that they were very happy with the service.

We saw that people experienced safe and effective care based on detailed care plans and risk assessments that met individual needs.

People using the service were protected from abuse as they were supported by a staff team who had appropriate knowledge and training on safeguarding adults. People told us if they had any concerns they would report them to the manager of senior person on duty.

Staff received ongoing training and supervision which provided them with the skills and knowledge to meet the needs of the people they were supporting.

The Provider had effective systems in place to monitor and assess the quality of the service.

When we visited we spoke with two people using the service. Both were positive about their experiences. One person told us they understood their care programme and had been fully involved in its design. They said that that people were treated with respect and supported to be involved in the running of the home. We were also told that people were encouraged to make their own decisions about how to spend their time and how to develop independence. People told us that residents meetings were effective in giving people a say in the running of the home.

We also heard that people were encouraged to design their own care plans, including developing recovery strategies.

People told us that they found staff had time to talk to them, and that key-worker support was effective. They said they were supported to consider their physical health needs, including diet and exercise, as well as their emotional needs.