Kemble House

Updated 20 October 2022

The inspection:

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2008.

Inspection team:

The inspection was carried out by one inspector, and an Expert-by-Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type:

Kemble 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.

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post.

Notice of inspection:

The inspection was unannounced.

Inspection activity started on 10 August 2022 and ended on 20 September 2022. We visited the location’s service on 10 August 2022.

What we did before the inspection:

We reviewed information we had received about the service since the last inspection. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. However, we used our own intelligence gathered over the last 18 months to inform the inspection visit.

During the inspection:

We spoke with five people who lived there, a member of the care staff, the newly employed deputy manager and the registered manager.

We reviewed a range of records. This included three people’s care records, three staff recruitment files and building maintenance documentation, including fire-fighting equipment and fire drills. We reviewed how accidents and incidents were recorded and acted on. We checked stocks against records for medicines, and reviewed ‘as needed’ PRN medicine protocols.

We sought clarification from the management team, including two virtual meetings with the registered manager and the regional manager. We reviewed additional documentation including training, provider compliance audits and supervision records. We also received confirmation of planned works to the building.

We also received feedback from four family members and four health and social care professionals.

Updated 20 October 2022

About the service:

Kemble House is a care home that provides accommodation and care services for a maximum of 15 people with autistic spectrum conditions and complex needs. At the time of the inspection, the service accommodated 13 people.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

People’s experience of using this service:

People told us they liked living at the service and most people said they felt safe there. Two people mentioned that had they felt uncomfortable about the occasional behaviour of people who had recently moved out.

Most people told us staff were kind and caring and people, families and health and social care professionals confirmed this.

The service was not always meeting the underpinning principles of Right support, right care, right culture due to issues highlighted in the Right support section below.

Right support: Despite the service being larger than best practice guidelines, the service provided care that was personalised, and the service was working to maximise people’s choices. People were involved in a range of community activities of their choice, but people told us they would like the opportunity to go out to additional community activities.

Long-standing staff understood people’s needs. New staff were in the process of getting to understand the needs of the individual people living at the house. But we were made aware from some relatives and health professionals that the service was not always able to understand the challenges of supporting people with dual mental health needs and a learning disability or autism. The registered manager was working with the staff team to develop their skills, knowledge and experience.

Right care: Care documentation was up to date, person-centred and promoted people’s dignity, privacy and human rights. Care documents outlined people’s needs, preferences and routines. Risk assessments were in place to address known risks. The management team were working with family members and health professionals, to understand how best to support people living at the home, and showed commitment to further improve this partnership working. Appropriate documentation was in place where people’s liberty was restricted.

Right culture: The registered manager promoted good quality care, and was supporting staff to further develop and improve their skills through supervision, training and effective team communication. People and relatives told us that the registered manager communicated with them when issues arose. Following the inspection, the service introduced regular meetings with family members, had asked for their views through a survey, and was planning to undertake a survey of the views of health professionals.

Safe recruitment took place at the service, and people were safeguarded against the risks of abuse and harm by the systems and by the staff. There were enough staff to meet people’s needs.

Medicines were managed safely, and there were infection control processes in place.

The provider and registered manager had systems in place to monitor the quality of the service through audits and checks. However, we became aware of some issues through feedback with relatives and health professionals, as part of the inspection that the registered manager and provider should have known.

The building utilities and fire equipment were safely maintained, but we saw that there was outstanding maintenance to the building required. At the time of writing this report we were shown a plan to address these building improvements.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection:

The last inspection at which a rating for the service was given, was good (published 20 June 2019).

Why we inspected:

This was a planned inspection based on the previous rating. This report only covers our findings in relation to the Key Questions Safe, Effective, Caring and Well-Led.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up:

We will continue to monitor information we receive about the service, which will help inform when we next inspect.