No 36

We found the following examples of good practice.

There were suitable arrangements to keep people safe during the COVID-19 pandemic. These included well organised systems where allocated staff took responsibilities for overseeing COVID-19 testing, checking people's wellbeing and health daily and making sure the environment was clean.

There were suitable policies and procedures in place and the provider had assessed risks for people using the service and staff. There were regular infection prevention and control audits.

The staff undertook training and had the information they needed to support them in this aspect of their role. The provider set up learning sessions for staff where they discussed specific topics. These included COVID-19, the impact of the pandemic and infection control. The staff also shared information with friends and families to make sure they knew about changes in guidance as well as the procedures followed at the service.

The staff told us they had developed their knowledge and understanding during the pandemic. They had worked well as a team learning when things had gone wrong and supporting one another through difficult times.

The staff told us they felt a strong sense of community and support for one another, the people using the service and their families.

People using the service had continued to have active and full lives, even during periods of lockdown. The staff had used the home environment to create new activities, had helped people develop skills such as cleaning and cooking and had helped people develop their literacy and numeracy skills. People had continued to access the community in a safe way and had regular opportunities to see their friends and families.

No 36 is a care home for up to nine adults with a learning disability. Some people also have autism. At the time of our inspection nine people were living at the service. The home is managed by LD Care Limited, a private organisation who also manage three other homes in the London Boroughs of Hounslow and Richmond upon Thames.

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.

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

The culture of the service was one where the individual needs of people were central to how the service operated. The provider's representative explained, ''Our ethos is very much about being active and participating, we make sure that everyone understands there are no limits. [People] have also established a sense of responsibility, most take part in daily chores for themselves and the home. This has also helped give the sense of belonging and pride.'' This was very much evident within the service we saw, in everyday life there and in the feedback from others.

People received personalised care and support in an exceptional way. The staff were very responsive to their needs and wishes, planning care and activities to reflect these. People were an integral part of the local community. They took part in social and leisure activities which reflected their age and interests and were given opportunities to provide a service to others in need.

The atmosphere at the service was like a family home. There was no differentiation between the staff and people using the service in the way they were treated. They interacted with each other like friends or siblings would. There was an emphasis on having fun, respecting and valuing one another as equals. Staff and people who used the service were encouraged to invite their own families to special events, meaning there was an extensive community who shared successes and memories together.

Feedback from family members, staff and external professionals was very positive with one professional telling us, ''I honestly wish there were more services like this out there.'' Comments from the staff included, ''It is not like coming to work, this is my second home'' and ''There is a different feeling here, like a family we all care for each other so much.''

Whilst some people had communicated with aggression in the past, the way in which they were supported by the staff had reduced this so that people were able to live fulfilling and varied lives. Careful planning and coordination between the staff and other professionals meant they constantly reflected on what was best for the people who used the service. The medicines used to manage people's mental health needs had been reduced so that they were more active and aware. This allowed them to make informed choices about their lives with positive results.

There were numerous examples of care which exceeded people's and their families' expectations. These included thoughtful interventions by individual staff, as well as changes to the service and environment in response to a particular need or wish. The staff also acted as advocates for people, defending their rights when they had been challenged in the wider community.

The staff had the support, training and information they needed to care for people and also to develop their own skills and interests. People using the service, staff and other stakeholders felt able to discuss their ideas with the managers and felt these were listened to and valued.

There were appropriate systems for monitoring and improving the quality of the service. These had been implemented effectively and we saw how the service had developed and improved since the last inspection.

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.

The service applied the principles and values of Registering the Right Support and other best practice guidance. 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.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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 registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.

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

Rating at last inspection

The rating at the last inspection was outstanding (published 10 May 2017)

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

The inspection took place on 28 March 2017 and was unannounced.

The last inspection took place on 24 February 2015 when we found that the provider was meeting all the required Regulations.

No 36 is a care home for up to nine adults who have a learning disability. The service is managed by LD Care Limited, a private provider based in the London Borough of Hounslow. The provider has two other care homes which are located close to No 36. Since the last inspection the provider had increased the number of registered places at the service from six to nine because they had built an extension to the property. At the time of the inspection there were nine people living at the service. They all had a learning disability and/or autism.

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 and associated Regulations about how the service is run. The registered manager oversaw the running of the whole organisation. The day to day management of the home was carried out by an additional manager and house leaders. All of the management team worked across the provider's three care homes.

People received extremely personalised care. Although some people could not communicate their needs verbally, the staff found creative ways to involve them and to understand what the person wanted. They displayed empathy and helped people overcome fears and challenges. This had resulted in positive and measurable changes for the individuals who lived at the service. For example, some people had expressed the way they felt through aggression or self-neglect. Since they had lived at the home the incidents of aggression had reduced significantly and people were happier, more relaxed and were developing a positive self-image. This was confirmed by people's relatives and external professionals who worked with people who lived at the service.

The culture at the service was exceptionally inclusive. The staff, family members and external professionals worked together to support people. This meant that people's best interests were always being discussed and planned for. The provider was willing to adapt and change approaches based on information from the staff, families or others. They constantly reviewed people's care and the staff reflected on their own practice. This meant that the staff anticipated and responded to changes in people's needs and took action to provide the support they needed at all times.

People felt safe living at the service. The staff had a proactive approach to supporting people. There was clear information about situations and environments which might trigger people's anxiety or agitation. The staff were aware of these and responded to triggers by supporting people to feel calm, removing the trigger and diverting people's attention. This approach had a positive outcome for people which was measurable in the reduction of incidents and challenging situations that occurred. Families of people who lived at the home felt it was safe. People received their medicines in a safe way. There were sufficient numbers of suitably qualified staff who had been recruited in a safe way. The staff were aware of the provider's procedures for safeguarding people from abuse and how to prevent avoidable harm.

People were being cared for by well supported and trained staff. The staff were happy working at the service. They had opportunities to learn, develop and reflect on their work. The provider was working within the principles of the Mental Capacity Act 2005 and people were supported to make choices and consent to their care and treatment. When people did not have capacity to make decisions, these were made in their best interests by people who were important to them. People had enough to eat and drink and food was freshly prepared at the service. People's healthcare needs were being met by the staff working alongside external healthcare professionals.

The staff were kind, caring and gentle. People had good relationships with the staff.