Kendall House

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. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

People’s experience of using this service and what we found

Right Support:

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 systems in the service supported this practice.

Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life. People were supported by staff to achieve their aspirations and goals. Staff enabled people to access specialist health and social care support in the community.

Right Care:

People were supported by staff that knew them well and who were committed to providing person centred care. People were involved in making decisions on how they wanted to spend their time. It was an active household with people enjoying each other’s company. It was evident the staff and people had built positive relationships. Staff were caring and passionate about the service and the people they supported. People told us they liked living in Kendall House and were happy with the staff that supported them.

Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. The service had enough appropriately skilled staff to meet people’s needs and keep them safe.

People's support plans reflected their individual needs. People were supported to lead active lifestyles of their choosing. People’s wellbeing was promoted, and their rights protected.

Right Culture:

People led inclusive and empowered lives because of the values, attitudes and behaviours of the provider, management and staff. Staff demonstrated their commitment to the values of the service that put people at the centre of the care and support provided. Staff felt supported and worked as team to ensure people’s care and support needs were met.

Staff placed people’s wishes, needs and rights at the heart of everything they did. People and those important to them, including advocates, were involved in planning their care. There was an open and inclusive culture where people and staff were valued, and their views sought to help drive improvements.

There were robust quality assurance processes in place that drove improvement.

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

Rating at last inspection and update

The last rating for this service was good (published 4 September 2018). The overall rating for the service has remained good based on the findings of this inspection.

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding. We inspected the domains of safe and well led.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained good.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Kendall House on our website at www.cqc.org.uk.

Follow up

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

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.

There was 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.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. These core values were very much part of living at Kendall House as evidenced in the main body of the report.

People were treated in a dignified, caring manner, which demonstrated that their rights were protected. Where people lacked the capacity to make choices and decisions, staff ensured people's rights were protected by involving relatives or other professionals in the decision making process.

People remained safe at the home. There were sufficient numbers of staff to meet people's needs and to spend time socialising with them. Risk assessments were carried out to enable people to receive care with minimum risk to themselves or others. People received their medicines safely.

People were protected from the risk of abuse because there were clear procedures in place to recognise and respond to abuse and staff had been trained in how to follow the procedures.

Systems were in place to ensure people were safe including risk management, checks completed on the environment and safe recruitment processes.

People continued to receive effective care because staff had the skills and knowledge required to effectively support them. People's healthcare needs were monitored by the staff. Other health and social care professionals were involved in the care and support of the people living at Kendall House. Staff were proactive in recognising when a person was unwell and liaised with the GP and other health professionals. Professionals were very complimentary about the service, the welcome they received and how they supported people.

The home provided an extremely caring service to people. People, or their representatives, were involved in decisions about the care and support they received. Staff were very knowledgeable about the people they supported. People were treated with kindness and there was a happy inclusive atmosphere in the home. Family and friends were part of life at Kendall House and were made to feel welcome. Feedback was extremely positive about the care and support people received. It was evident that people were seen as individuals and the focus of their care. There was a culture that had been embedded where Kendall House was viewed as people’s home rather than a care home. People were encouraged to try new things, voice their opinions and their independence promoted.

People received a very responsive service. Care and support was personalised to each person. People were assisted to take part in a variety of activities and trips out. Relatives were very complimentary about the service and the activities available to people and the ways that they were continuing to support people in finding appropriate activities. Staff were responsive to people’s changing health care needs. People were very much involved in decisions about their treatment.

The service was well-led. Relatives and staff spoke extremely positively about the commitment of the registered manager and the provider. They told us the registered manager was open and approachable. The registered manager and provider had monitoring systems, which enabled them to identify good practices and areas of improvement. It was evident there was a culture where people views were actively sought to drive improvements on how they wanted to live and be cared for.

There was a manager in post and they had submitted an application to become registered with the Care Quality Commission. 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 were receiving care that was responsive and effective. Care plans were in place that clearly described how each person would like to be supported. People had been consulted about their care and support. The care plans provided staff with information to support the person effectively. Other health and social professionals were involved in the care of the people living at Kendall House. Safe systems were in place to ensure that people received their medicines as prescribed. People were enabled to take control of their own medicines where they had been assessed as safe to do so.

People were protected from the risk of abuse because there were clear procedures in place to recognise and respond to abuse and staff had been trained in how to follow the procedures. Systems were in place to ensure people were safe including risk management, checks on the environment and safe recruitment processes.

Staff were genuinely caring and supportive and demonstrated a good understanding of their roles in supporting people. Staff received training and support that was relevant to their roles. Systems were in place to ensure open communication including team meetings and one to one meetings with the manager.

People were involved in structured activities in the home and the local community. These were organised taking into consideration the interests of the people and were organised in small groups or an individual basis. People were involved in the day to day running of the service. People were valued and supported to be as independent as possible. People’s rights were upheld, consent was always sought before any support was given. Staff were aware of the legislation that ensured people were protected in respect of decision making and any restrictions and how this impacted on their day to day roles.

People’s views were sought through care reviews, house meetings and surveys and acted upon. Systems were in place to ensure that complaints were responded to and, learnt from to improve the service provided.

People were provided with a safe, effective, caring and responsive service that was well led. The organisation’s values and philosophy were clearly explained to staff and there was a positive culture where people felt included and their views were sought.

Following the inspection we considered all of the evidence we had gathered under the standards we inspected. We used the information to answer the five questions we always ask:

' Is the service safe?

' Is the service caring?

' Is the service effective?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, the staff supporting them and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service caring?

People who we spoke with as part of our inspection were positive about the care they received. We received comments such as "this is my home I love it here', and 'I'm happy with all my friends here'.

People confirmed that staff treated them with dignity and respect. Staff had clear ideas about what these terms meant and gave examples of how they would put them in to practice when providing care.

The support plans that people had in place were detailed and provided clear and consistent guidelines for staff to follow that would allow care to be delivered in a person centred way. It was clear that people had been involved in discussions about their care and people signed to give their agreement to the support plan.

Is the service responsive?

People's needs were reviewed regularly and the dates of these were recorded on file. This meant that staff were able to respond to any changes in the level of support that a person required. One person that we spoke with said 'my keyworker shows me my plan and I can change it if I want to".

Where concerns arose that might indicate a person was at risk, appropriate action was taken in reporting the issues to the relevant authorities.

Is the service safe?

People that we spoke with told us that they felt safe in the presence of staff. One person said 'I've got nothing to be scared of, I love the staff, my keyworker is the best'.

Staff received training in safeguarding vulnerable adults and told us they would feel confident in identifying and reporting concerns. There was guidance and policies in place for staff to follow in the event of identifying a safeguarding issue. Staff understood the term 'whistleblowing' and knew that they could report concerns to outside agencies if they needed to.

There were risk assessments in place to ensure that people were supported in a safe way. This included clear instructions for staff to support people with their behavioural needs.

People who used the service were cared for by staff who knew how to protect them from the risk of abuse. The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (Dols). The registered manager stated that since a recent change in the criteria for making Dols applications, applications were to be made for a number of people and that advice had been sought from the appropriate authority. Relevant staff were being trained by the provider to understand when an application may be required. This meant that people were safeguarded from abuse.

Is the service effective?

People's packages of care were reviewed regularly to ensure that they were meeting the person's needs. These reviews allowed people to give their opinions on the care they received and for the service to make changes as required.

Staff received training and support to help ensure that they were able to carry out their roles effectively. Regular supervision took place to monitor staff performance.

Is the service well led?

There was a registered manager in place at the time of our inspection. Staff that we spoke with told us they felt well supported and could approach senior staff with any issues or concerns.

A programme of quality monitoring was in place, which included gathering the views of people who used the service. We viewed some returned satisfaction surveys and noted that the responses were positive.

During the first part of our visit we were assisted by two permanent members of staff. They were knowledgeable about people they supported and provided us with useful information about their experience and views about the quality of service provided.

It was evident they enjoyed working in the home and supporting people. They told us that staff morale was 'very good', they felt 'motivated' and that they were supported by the manager and team leader. The manager and team leader role had been established for approximately six months.

Staff said that the leadership and continuity had made the home a 'settled, happy place'. They felt this was because of the management's 'quality of knowledge and skills', 'they listened to new ideas from residents and staff' and 'they worked shifts and were part of a team'. The manager and team leader were available towards the end of our visit. It was evident they had established a positive working relationship which reflected in the care, support, kindness and attention that people received. They were enthusiastic about their role and responsibility and shared with us how they wanted to continue to improve services provided for people.

It was a positive visit and we could see that people were well cared for, supported and loved. We were invited to have lunch, we spoke with people all day and we were asked to play console games.

The two staff members were available throughout the day and both were very knowledgeable about people in their care, the policies, procedures and systems in place to ensure the continued smooth running of the home. They told us that a newly appointed manager would be commencing induction in January and that in the meantime the homes team leader was acting up so that people felt supported and continuity of care was maintained.