We carried out a review of the data available to us about Guyatt House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Guyatt House, you can give feedback on this service.
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. This was evident in the promotion of choice and control, independence and community inclusion. People's support focused on them having as many opportunities as possible, gaining new skills and growing in confidence and independence.
People’s experience of using this service:
¿ Guyatt House provided people with an outstanding service. People led full and inclusive lives where they were supported to be in control.
¿ The provider has demonstrated they successfully focused on continuous improvement since our last inspection. We previously found the service met the characteristics of an outstanding service in safe and caring at our last inspection. At this inspection we found the service had improved to an Outstanding service in safe, caring, responsive and well-led domains. We received exceptional feedback on how staff supported people and went the extra mile to get people’s support just right for them.
¿ People were at the centre of the service delivery. Staff worked exceptionally hard to find different ways of presenting information to people, using objects of reference or symbols for example. This enhanced way of communication ensured people were at the forefront of their care and support.
¿ People lived in at exceptionally person-centred service. The culture focussed on the promotion of people's rights to make choices and this resulted in people being valued and treated as individuals.
¿ People were supported by remarkable caring staff that knew them well and understood
how to maximise their potential.
¿ People were supported by staff who recognised their rights to take measured and considered risks in order to lead their lives as they wished. People’s aspirations and wishes were paramount.
¿ The provider continued to promote a culture of person centred support. A high-quality service and been sustained and further developed resulting in especially positive outcomes for people.
¿ There was a remarkable positive workplace culture and staff we spoke with provided irrefutable feedback about the provider and management team.
Rating at last inspection: The service was rated ‘Outstanding’ at our last inspection on 30 March 2016. The report following that inspection was published on 15 July 2016.
Why we inspected: This was a planned inspection based on the rating at the last inspection.
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.
This unannounced inspection took place on 30 March 2016.
At the time of the inspection there was a registered manager in place. 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 told us that they liked living at Guyatt House and very much saw it as their home. They were involved in making decisions about all aspects of their lives. People spoke fondly of the staff at Guyatt House and especially of their keyworkers. Relatives of people spoke highly of the care and support their family members received. Healthcare professionals involved with the people living at Guyatt House all felt that the home was well managed, had a good staff team and continuously strived for improvement. The service provided excellent and innovative care and
supported people to enable them to live fulfilled and meaningful lives in a way they wanted.
The Care Quality Commission (CQC) is required by law to monitor the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The provider was acting in accordance with the requirements of the MCA including the DoLS. The provider was able to demonstrate how they supported people to make decisions about their care. Where people were unable to do so, there were records showing that decisions were being taken in their best interests. DoLS applications had been submitted to the appropriate authority. This meant that people did not have restrictions placed on them without the correct procedures being followed.
People felt safe and relatives said that they had no concerns about the arrangements that were in place to keep people safe. Staff built good relationships with people that enabled them to report any concerns to their own safety. Staff were skilled at ensuring that people did not have their choices restricted due to the effective management of assessed risks. Staff had an understanding of how to protect people from harm and knew what action they should take if they had any concerns.
Staffing levels ensured that people received the support they required at the times they needed it. The service responded flexibly to ensure suitable staffing arrangements were available at all times. The recruitment practices were thorough and protected people from being cared for by staff that were unsuitable to work at the home. People living at the home were thoroughly involved in the recruitment procedures, with only the most appropriate staff being selected for a job.
Staff were kind and compassionate when working with people. They knew people well and were aware of their history, preferences, likes and dislikes. People’s privacy and dignity were upheld.
People were supported to take their medicines as prescribed. Records showed that medicines were obtained, stored, administered and disposed of safely. People were supported to maintain good health as staff had the knowledge and skills to support them and there was prompt and reliable access to healthcare services when needed.
The vision and values of the staff team were person-centred and made sure people were at the heart of the service. They looked at innovative ways of including people in planning their care, gaining their views and in choosing activities.
Comprehensive care plans were in place detailing how people wished to be supported and had been produced jointly with people using the service. People had agreed what care and support they needed and were fully involved in making decisions about their support. People were able to choose how they spent their time and what activities they participated with. People participated in a range of activities within the home or in the community and received the support they needed to help them to do this. Some people had been supported to find employment.
People helped to choose, shop for and prepare food and drink that they enjoyed. People were offered advice and support to maintain a healthy and balanced diet.
There was a complaints procedure in place and people felt confident to raise any concerns either with the staff or the registered manager if they needed to. The complaints procedure was available in different formats so that it was accessible by everyone.
People had confidence in the registered manager and the way the service was run. There were many opportunities for people and staff to provide feedback about any improvements that could be made, and these were listened to and acted on.
Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.
Is the service safe?
People were supported to live in a clean, hygienic and well maintained house.
The recruitment process used by the service and the checks that were in place before staff started work ensured, as far as possible, that people were supported by staff who had the right values, skills and experience and were of good character. This upheld people's safety.
People were supported to have dreams and aspirations, and risk assessments were in place to support them to maximise their opportunities whilst minimising the risk of harm.
The manager and staff had a strong understanding of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberties Safeguards (DoLS). They demonstrated commitment to ensuring that people were always assumed to have the capacity to make their own decisions unless there was good reason to believe otherwise. They worked hard to ensure that every effort was put into supporting people to understand decisions they were making. No DoLS applications had been made but staff and the manager were aware of the circumstances under which it would be appropriate to do so.
Is the service effective?
The manager and staff were working very hard to ensure that people were making choices for themselves and having control over their own lives. People were consulted about their support and made choices about all aspects of their lives. People had very good support in relation to communication and access to meaningful information. This increased their opportunities to make informed decisions.
People participated in many meaningful activities, both through day services and work, and through leisure pursuits. They were very involved in the day to day running of the service, and were involved in negotiating how tasks, such as cleaning, would be completed.
Is the service caring?
People were supported by staff who genuinely cared about their welfare, achievements and success. We saw staff working collaboratively with people to complete tasks, consulting with people about what they would like to do and laughing with people and having fun.
Is the service responsive?
We saw from records that people were supported to have access to other health and social care professionals as necessary and that staff followed the advice given by these professionals. This meant that the service was responsive to people's health and social needs.
We saw that support plans and risk assessments were updated and reviewed regularly to ensure that people's current needs were identified and met. Where people's needs could fluctuate depending on their current mental well-being, this was clearly identified on the care plan. This meant that the support was flexible and changed to respond in the most appropriate way to meet the person's needs at any given time.
Is the service well led?
The service was well led. It was clear from discussions with the manager and staff, as well as from our observations during our visit, that the service was committed to the provision of high quality, person centred care that maximised peoples independence and control over their own lives.
We saw evidence from records and through observation that people were continuously consulted and that their views were acted on. The manager had a range of effective audits in place to monitor the quality of the service.
The relative of one person living at Guyatt house told us, "It's what we'd always wanted for [their relative]."
The people living at Guyatt House were encouraged to be involved in all areas of the running of the home. On the day of the inspection one person was seen dusting the lounge and another person was cleaning the kitchen cupboards with lots of positive encouragement and praise from staff. People told us that they could make decisions about what time they went to bed and how they spent their leisure time.
Care records were written in detail and provided clear guidance to staff members and had been regularly reviewed to ensure they were current. Information was made available in ways that meant people living at Guyatt House could access it.
People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.
Staff members received supervision and training from the provider or from external sources to ensure they had the skills and support to properly carry out their roles and care for people.
The service had developed folders with each person which people's relatives had written positive comments about the care and support being received. The folders were in an easy read format showing the lifestyle, preferences and family history of each person with contributions from the people living at Guyatt house.
We found that the service was providing good, person-centred care to people, which met each of their individual and specific needs. Staff were found to be experienced in their roles and had taken time to acquaint themselves with people's preferences and requirements ensuring they remained happy and healthy.
Relatives spoke highly of the service and comments we received included, 'I drop my daughter there after she's been home for the week-end and I always say goodbye feeling happy and knowing she's in really good hands'. Another parent told us, 'When my daughter comes home, she is always so keen to get back to Guyatt House; she has such a busy life there'.
One GP who knows the home well described it as, 'A really good place'.
We received many positive comments about the service from staff at a number of day centres that people attended. One day centre manager told us, 'It's one of the best homes we deal with, and people seem really happy living there'.
All the health and social care professionals we spoke with told us of the good communication they had with staff at the home. Comments included, 'Any problems or blips are sorted immediately and staff and managers often pop in to see us and how the guys are doing. We're always invited to people's reviews and to the parties held at the home too.' Another worker stated, 'They always send letters to tell us when people are on holiday or when they're not going to attend'.
People told us of the varied and frequent activities that people living at the home were supported to attend. One day services worker told us, 'I was at the ballet just last week to see Giselle, and I was delighted to see X (person using the service) there as well. That was just great; most other people we support get taken shopping to Tescos as their form of activity.'
All the evidence we received from people using the service, their relatives and health and social care professional clearly demonstrated that this was a well run home where people received high quality care, provided by skilled and caring staff.