Knoll House provides accommodation for up to seven people. The home specialises in ¿varying ¿levels of care and support for people who have autism. ¿

This inspection took place on 24 February and 2 March 2017 and was unannounced.¿

A manager was responsible for the home. They were not yet registered but at the time of the ¿inspection they were undergoing the registration process with us. 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 spoke with one person about their service and had more limited communication with four ¿other people. We also used our observations and discussions with people's relatives and staff to ¿help form our judgements.¿

People were safe at the home. One person said, “Staff are nice to me.” There were adequate ¿numbers of suitable staff to support them. Risk assessments were carried out to enable people to ¿retain their independence and receive care with minimum risk to themselves or others. People ¿received their medicines safely.¿

People received effective care because staff had the skills and knowledge required to effectively ¿support them. People’s healthcare needs were monitored by the staff and people saw healthcare ¿professionals according to their individual needs. ¿

Staff provided a caring service to people. People’s independence was encouraged and ¿supported. Staff were kind and patient and people felt comfortable and relaxed with them. One ¿relative said, “We are extremely happy with the care staff provide”,¿

People, and those close to them, were involved in planning and reviewing their care and support. ¿There was a close relationship and good communication with people's relatives. Relatives felt ¿their views were listened to and acted on.¿

The service remained responsive to people’s individual needs. Care and support was ¿personalised to each person which ensured they were able to make choices about their day to ¿day lives. People chose a variety of activities and trips out of the home. One relative said, “[Name] ¿has a little job now which he loves. It’s great for him.” Complaints were fully investigated and ¿responded to.¿

The manager and provider had monitoring systems in place which enabled them to identify good ¿practices and areas of improvement. The manager and provider sought people’s views to make ¿sure people were at the heart of any changes within the home.

We have made a recommendation about involving people in decisions about their care.¿

Knoll House had seven people living in the home at the time of our inspection. People who lived in Knoll House required varying levels of care and support including support with communication. Three people told us they liked and enjoyed living in the home. One person told us “I am very happy”. They also told us they were involved in decisions and attended meetings that were held about their care. They also knew why they took medication and how staff supported them with it.

We spoke with a relative visiting the home on the day of our inspection. They told us “I am very pleased with the service. I have never considered moving my relative anywhere else. They have improved in speech, communication and their level of independence since living here”.

Staff had access to detailed information about people living in the home which enabled them to support people appropriately. Staff also understood how to protect people’s rights when decisions were made about their care and treatment.

The home had plans in place to ensure people were kept safe if there was an emergency and they needed to be evacuated quickly.

People’s medicines were managed so they were administered safely at the correct times. Appropriate arrangements were in place if people refused their medicines which ensured the relevant health care professionals were informed.

Staff received training appropriate to their role to ensure they could meet people’s needs. However, training of some communication methods could be improved to ensure people’s full ability was being maximised.

This review was carried out to follow up on concerns raised at the previous inspection in March 2012. We also carried out a full review of all outcomes detailed in this report.

We used a number of different methods including observations of staff interaction with people to help us understand the experiences of people who lived in the home. People had complex needs which meant they were not fully able to talk to us about their experiences. Three out of seven people who lived in the home were able to tell us that they enjoyed living in Knoll House.

During our visit we observed interactions between staff and people who lived in the home to be respectful and considerate. We saw people were comfortable with staff. We observed staff had a good knowledge of how to interact with people.

Three people told us they felt well supported by staff.

We spoke with one relative after our visit who told us they were “extremely satisfied with the care provided”. They told us that since their relative had lived in the home their verbal communication had increased. They told us they received a call from their relative once a week. They said they spoke to the same support worker each time who would update them on any aspects of their relative’s care. They felt well informed and were included in their relative’s care meeting. This means that decisions were made about people’s care with involvement with other people that know them well.

We found concerns during our visit in relation to staff not receiving regular mandatory training.

People who lived in the home had communication difficulties. Some people were able to confirm that they were happy living at the home. We observed how staff interacted with people and all the interactions we saw were kind and respectful.

We saw that staff ensured people were given the opportunity to make choices. Some people were able to say what they would like and staff respected people’s views. Other people were not able to express their choices verbally so staff needed to interpret their responses to choices offered or use different methods to communicate such as pictures or symbols. We noted there had been recent issues with staff not using people’s communication aids consistently. This had impacted on some of the people who lived in the home.

People took part in a range of activities. A range of day services were provided on site which included art and craft and woodwork. People also attended courses at local colleges. People chose how to spend their time during the evenings and at weekends. People visited their families, went out to social clubs and for days out or spent time at home. Staff helped people to plan and organise holidays.

People who lived in the home appeared well cared for and staff were available when they needed them. During our visit we saw staff interacted with people who lived in the home. Staff were seen to be kind and respectful. Most staff knew people well and had a good relationship with the people they supported.

People who lived in the home did have the opportunity to express their views on the quality of care and support they received at their person centred review meetings. Each person, together with people close to them such as family members, was also asked to complete a questionnaire each year. These were also completed by health care professionals who supported the home and the staff team. The results were analysed and an action plan developed where any improvements were identified.

This inspection took place on 18 and 20 January 2016 and the first day was unannounced. We arranged the second day because the registered manager managed two homes and we wanted to be sure they were in.

There is 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 told us they were kept safe and free from harm. There were appropriate numbers of staff employed to meet people’s needs and provide a flexible service.

Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

There were suitable recruitment procedures and required checks were undertaken before staff began work. Staffing levels and skill mix were planned, implemented and reviewed to keep people safe at all times. Any staff shortages were responded to quickly.

Systems, processes and standard operating procedures around medicines were reliable and appropriate to keep people safe. Monitoring the safety of these systems was thorough.

Assessments were undertaken to assess any risks to the person using the service and to the staff supporting them. This included environmental risks and any risks due to the health and support needs of the person. The risk assessments we read included information about action to be taken to minimise the chance of harm occurring.

Staff knew the people they were supporting and provided a personalised service. Care plans were in place detailing how people wished to be supported and families were involved in making decisions about their care.

People were supported to eat and drink. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs. Staff told us the registered manager was accessible and approachable. Feedback on the quality of the service was obtained from people, relatives and staff and used to improve the service.