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Inspection carried out on 17 September 2019

During a routine inspection

About the service

Cygnet House is a residential care home providing accommodation for people who require personal care. People do not live at Cygnet House, they visit for a short break. The support is provided within the providers own home. Some people used the service a few times a year, others regularly for evening and overnight support. The remainder of the time people live with their families in the community.

At the time of inspection, 14 people were regularly using Cygnet House, with a maximum occupancy of two people at any one time. The providers ran the service. No other staff were needed or employed at the time of our inspection.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures 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. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the management team at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

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

We have made a recommendation about the providers processes and keeping their knowledge up to date.

We have made recommendations about mental capacity and deprivation of liberty.

The providers demonstrated an open and fair culture. Relatives had confidence in the provider.

Relatives felt their loved ones were safe. The provider had a good knowledge of safeguarding processes. Peoples needs were assessed prior to receiving a service and care plan and risk assessments reflected this. People received their medicines safely.

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.

People were treated with kindness and compassion. People’s privacy and dignity was maintained. People were encouraged to be independent.

People were encouraged and supported to access the community. People were supported in a person-centred way. Peoples personal preferences were identified in their care plans.

The service used positive behaviour support principles to support people in the least restrictive way. No restrictive intervention practices were used.

The service applied the principles and values of Registering the Right Support and other best practice guidance. The outcomes for people using the service reflected the principles and values of Registering the Right Support and focused on them having as many opportunities as possible. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence

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 rating for this service was good (published 23 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We w

Inspection carried out on 20 February 2017

During a routine inspection

Our inspection was announced. It took place over two dates 20 February and 1 March 2017.

At our previous inspection we rated the service as ‘Good’ overall. We found however, that the ‘Well-led’ section ‘Required Improvement’ as we found that records were not concise regarding the receipt people’s medicines when they arrived at the service for their stay. There was no monitoring of the temperature of the cupboard where medicines were stored and that no record of the support provided to people each day or the activities the people engaged in were made. This inspection we found that those issues had been/or were in the process of being addressed.

The provider is registered to deliver personal care. People lived with needs relating to their learning disability or an associated condition. At the time of our inspection 19 people used the service. The personal care provided was within the providers own home on a ‘respite basis’. Respite means that people are supported in a care environment rather than by family or friends for short periods of time. People used the service for varied amounts of time. Some people used it a few times a year; others regularly for evening and overnight support, and some people used the service whilst their main carer went on holiday. The remainder of the time people lived with their families in the community. The providers ran the service. No other staff were needed or employed at the time of our inspection.

One of the two providers was also the registered manager. 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 providers had policies in place and had received training on procedures they should follow to ensure that any risk of harm and/or abuse was prevented. They had undertaken risk assessments to maintain the safety of the people who used the service. The provider’s had been trained to manage medicines safely. Medicines were given to people as they had been prescribed. The providers ran the service and people’s needs were met so no additional staff were required.

The providers had received the training they required to give them the knowledge they needed to support the people in their care. The providers understood that people must receive care in line with their best interests and would not unlawfully restrict any person. People were encouraged to make decisions about their care. If they were unable to, their relatives were involved in how their care was planned and delivered. The providers supported people appropriately with their nutritional needs. Meal options were offered to ensure that people’s food and drink preferences were catered for.

People and their relatives told us that both providers were kind and caring. People’s privacy, dignity and independence was promoted and maintained.

The providers were available to meet people’s individual needs. People were offered and enabled to engage in recreational activities that they enjoyed and met their preferred needs. People were supported to continue to go to their colleges or other community facilities whilst using the service. Complaints systems were in place for people and their relatives to raise their concerns or complaints if they had the need to.

All people and their relatives were very satisfied with the care and support given. They complimented both providers on all aspects of the service.

Inspection carried out on 3 January 2016

During a routine inspection

Our inspection was announced. It took place on Sunday 3 January 2016. This was the provider’s first inspection since they had been registered with us.

The provider is registered to deliver personal care. People lived with needs relating to their learning disability or an associated condition. At the time of our inspection 21 people used the service. The personal care provided was within the provider’s own home on a ‘respite basis’. Respite means that people are supported in a care environment rather than by family or friends for short periods of time. People used the service for varied amounts of time. Some people used it a few times a year; others regularly for evening and overnight support, and some people used the service whilst their main carer went on holiday. The remainder of the time people lived with their families in the community. The provider’s ran the service. No other staff were needed or employed at the time of our inspection.

One of the two provider’s was also the registered manager. 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 provider’s had policies in place and had received training on procedures they should follow to ensure the risk of harm and/or abuse was prevented. They had also undertaken risk assessments to maintain the safety of the people who used the service.

The provider’s had been trained to manage medicines safely. Medicines were given to people as they had been prescribed.

The provider’s were available to meet people’s individual needs. Relatives described both provider’s as kind and caring.

The provider’s had received the training they required to fully equip them with the skills they needed to support the people in their care.

The provider’s understood the requirements of the Mental Capacity Act (MCA) This ensured that people received care in line with their best interests and would not be unlawfully restricted.

People were encouraged to make decisions about their care. If they were unable to, their relatives were involved in how their care was planned and delivered.

The provider’s supported people with their nutrition and dietary needs to maintain their health.

People were offered and enabled to engage in recreational activities that they enjoyed and met their preferred needs. They were supported to continue to go to their colleges or day centres whilst using the service.

Complaints systems were in place for people and their relatives to raise their concerns or complaints.

All relatives and staff felt that the quality of service was good. They complimented both provider’s on the service provided.