Kirk House

Kirk House is a care home registered to provide personal care to young adults who live with a physical/sensory disability, learning disability and/or autism. Kirk House is a purpose built home over two floors which can accommodate eleven people. At the time of the inspection there were nine people living at the service. People had access to their own private rooms. The building was being upgraded to enable everyone to have access to a private lounge, bedroom and bathroom.

The service had been developed and designed before the principles and values that underpin Registering the Right Support had been published. This guidance aims to ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. The service was a large home, bigger than most domestic style properties. This is larger than current best practice guidance. People using the service received planned and co-ordinated bespoke person-centred support that was appropriate and inclusive for them.

People's experience of using this service:

People received personalised care that was exceptionally responsive to their needs. Some people had never lived in a shared care setting and a relative told us, "This was an extraordinary achievement for [family member]." There was strong sense of leadership in the service that was open and inclusive. People raised funds for local charities that supported people living in isolation.

The registered persons had focused on achieving exceptional outcomes for people and their staff. Relatives, professionals and our observations confirmed staff provided exceptional care. A relative summed this up by saying, "We remain delighted at the level of care my [relative] receives at Kirk House."

We found robust systems, processes and practices were followed and sustained effectively to safeguard people from situations in which they may experience harm. Risks to people's safety had been thoroughly assessed, monitored and managed so they were supported to stay safe while their freedom was respected. People were supported creatively to live healthier lives by having on-going support to access suitable healthcare services.

Care staff understood the importance of promoting equality and diversity by supporting people to make choices about their lives. People who used the service were treated with compassion and kindness and their privacy and dignity respected.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and live data recording systems in the service supported this practice. People and their representatives had been involved in agreeing their care plans and participated in reviews of the care and support provided to them. One person and family members confirmed staff always asked for consent when carrying out care and support tasks. Confidential information was kept private.

Safe recruitment practices were followed. People were supported by a small team of staff that fully understood their needs. Medicine records reviewed confirmed people received these safely. People lived in an environment that was clean and free from the risk of the spread of infection.

Staff received a thorough induction process and had completed all the training required to support people safely. Staff received regular supervision and annual appraisals and were able to reflect on the care and support they delivered. Staff were able to access further training and development opportunities in addition to their mandatory training. Staff were given the support and opportunities to progress within the organisation. People and relatives benefited from a robust data management recording framework that helped care staff to understand their responsibilities so that risks and regulatory requirements were met.

The provider had flexible ways of encouraging regular feedback from people who used the service, relatives, care staff and professionals. Views were gathered through annual surveys, telephone conversations, regular face to face meetings, house (residents) meetings and at staff team meetings. One complaint had been received in the last 12 months and this was responded to appropriately. People were introduced to lay advocates if necessary.

Comprehensive quality checks were available in real time as the provider had a bespoke live data recording system which could review all records and incidents instantly. This made sure people benefited from the service being able to quickly put problems right and to innovate so that people could consistently receive safe care.

Excellent team work was promoted and care staff were supported to speak out if they had any concerns about people not being treated in the right way. Staff were clear about the vision and values of the service.

The registered persons worked in partnership with other agencies and stakeholders like Skills for Care to support the development of joined-up care. More information is available in the full report.

Rating at last inspection:

Good (report published 14 December 2016)

Why we inspected:

This was a planned inspection based on the rating at the last inspection when we rated the service as good overall. At this inspection there had been further improvements which resulted in the service being rated outstanding overall.

Follow up:

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

Kirk House is registered to provide accommodation and personal care for up to 11 people who have a learning disability or autistic spectrum disorder.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act, 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. This is usually to protect them. The management and staff understood their responsibility and made appropriate referrals for assessment. Some people living at the service had their freedom lawfully restricted under a DoLS authorisation.

Relatives told us that their loved ones were cared for by kind, caring and compassionate staff. Staff undertook appropriate risk assessments for all aspects of a person’s care to keep them safe from harm inside and outside of the service. Care plans were developed to support people’s individual needs. Staff knew what action to take and who to report to if they were concerned about the safety and welfare of the people in their care. People received their prescribed medicines safely from staff that were competent to do so. The registered provider ensured that there were always sufficient numbers of staff on duty to keep people safe.

People were supported to have a nutritious and balanced diet and hot and cold drinks and snacks were available throughout the day. People had their healthcare needs identified and were able to access healthcare professionals such as their GP and dentist. Staff knew how to access specialist professional help when needed.

People were at the centre of the caring process and staff acknowledged them as unique individuals. Relatives told us that staff were kind and caring and we saw examples of good care practice. People were always treated with dignity and respect. People were cared for by staff that were supported to undertake training to improve their knowledge and skills to perform their roles and responsibilities.

People lived busy and active lives and were encouraged to take part in hobbies and interests of their choice. Some people were supported in education, voluntary work and all enjoyed being part of a strong social network. Relatives commented that their loved ones were well looked after and their wellbeing had improved since moving into the service.

People were supported to make decisions about their care and treatment and maintain their independence. People had access to information in an easy read format about how to make a complaint.

The registered provider had robust systems in place to monitor the quality of the service and make improvements. Staff had access to professional development, supervision and feedback on their performance. People, their relatives and staff found the registered manager approachable.

We considered our inspection's findings to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? This is a summary of what we found:

Is the service caring?

All of the people who used the service had complex needs for support. They used a combination of words, sounds and gestures to communicate. People said and showed us by their relaxed manner that they considered staff to be caring and attentive. We observed staff speaking to people in a courteous and polite way.

Is the service responsive?

We saw that people's individual needs for support had been assessed and met. Staff knew about each person's individual support needs, choices and preferred routines. People received the support they needed to do personal and household tasks. In addition, they were being supported to participate in social and occupational activities and to access the community. The accommodation was homely and people had been assisted to personalise their bedrooms so that they were comfortable and reflected their interests.

Is the service safe?

Staff understood their roles and responsibilities to ensure that people were protected from the risk of abuse. People were protected against the use of unlawful or excessive control or restraint because the provider had made suitable arrangements. These measures helped to keep people safe from abuse and to promote their welfare. There were safe and reliable systems for ordering, storing, administering and disposing of medication.

Is the service effective?

The provider had employed enough staff and had ensured there were sufficient staff on duty to enable people to receive the individual attention they needed. People's needs for support had been kept under review so that their changing requirements could be met. The service had arranged for people to receive all the healthcare they needed. Staff had kept in touch with parents so that they could continue to contribute to the support their sons and daughters received.

Is the service well led?

People who used the service and their parents had been consulted about how well the provision was meeting their needs and expectations. There was a clear line of management. This meant that important decisions about organising people's support were made by managers while staff who provided support could use their own judgement to provide a flexible service. Quality checks had been completed to ensure that important measures such as the management of medication, food hygiene and infection control were in place. Most of the necessary fire safety checks had been completed. However, one of them was overdue and the shortfall had not been identified. There was an effective system for responding to incidents and accidents so that lessons could be learnt to reduce the likelihood of them happening again.

We observed care and saw staff were responsive to people and interacted with them positively. People told us the staff were caring and looked after them well.

People told us the food was good and we saw people were involved in planning and cooking.

When we spoke with staff they told us they had received training to enable them to provide safe and appropriate care to people. Staff were able to tell us about safeguarding people and what they would do if they saw incidences of concern. We saw processes around safeguarding were clear and available to staff.

We looked at staffing arrangements and found there were sufficient staff to meet the needs of people according to their assessed needs. We observed staffing levels fluctuated during the day time period. The provider told us this was to meet people's needs.