During a routine inspection

About the service

Montrose Barn is a care home that provides accommodation and personal care support for up to two adults with learning disabilities. The service specialises in the care of people who have a learning disability. At the time of our inspection two people were living at the service.

The service is in a rural location. People had their own rooms with en suite facilities.

The service had been open for some years and therefore had not been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. 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. 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 service was rated Outstanding in Well Led at our last inspection. At this inspection the service remained Outstanding in Well Led. We found the registered manager and staff team were highly motivated and proud of the service they delivered to people. There was a visible person-centred culture at the service. There were consistently high levels of engagement with people using the service, families and other professionals. There was a strong commitment to ensure the service was inclusive and that people had the opportunity to extend their lives in the community.

The service was also Outstanding, at responding to people’s needs. Staff were exceptional in the way they supported people to learn new skills and maintain their independence. People planned for activities that met their needs and preferences and they were supported to follow their interests. A social care professional told us the service excelled at the way it supported people in promoting their independence.

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 supported by staff who knew them well and were able to communicate with them in their chosen way. This ensured people could make choices about their day to day routines.

The service had safeguarding and whistleblowing policies and procedures in place and staff had a clear understanding of these procedures. Appropriate recruitment checks had taken place before staff started work and there were enough staff available to meet people's care and support needs. People's medicines were managed safely. Risks to people had been assessed to ensure their needs were safely met. The service had procedures in place to reduce the risk of infections.

People were cared for by staff who worked together to meet people's individual needs. Staff felt well supported and happy in their roles. This helped to create a relaxed and happy atmosphere for people to live in.

Where restrictions had been put in place to keep people safe this had been done in line with the requirements of the legislation as laid out in the Mental Capacity Act (2005) and associated Deprivation of Liberty Safeguards. Any restrictive practices were clearly recorded and regularly reviewed to check they were still necessary and proportionate.

People and their relatives (where appropriate) had been consulted about their care and support needs. The service had a complaints procedure in place. The service was exploring ways of identifying people’s wishes to support end of life care and support if it was required.

The registered manager had worked in partnership with health and social care providers to plan and deliver an effective service. The provider took people and their relatives views into account through satisfaction surveys.

During a routine inspection

Montrose Barn provides accommodation and personal care for up to two people who have a learning disability and/or autistic spectrum disorder. During this inspection visit two people were living at the service.

The service is situated in a quite rural position close to the north Cornish coast. Besides the accommodation there is a large outdoor area where there are animals including pigs and chickens. People using the service were involved in their care and wellbeing. One person told us they liked looking after the animals. The provider lived in an adjoining property meaning that people had the use of the house to themselves. The provider had recently added a sensory room to the house. They told us, “It’s been a successful project but it is taking a bit of time for (Person’s name) to get used to it.”

At the last inspection the service was rated overall good with an outstanding rating in the domain well led. At this inspection the rating remained overall good with the domain well led remaining outstanding.

The registered manager had systems in place to record safeguarding concerns, accidents and incidents and take appropriate action when required. Recruitment checks were carried out to ensure suitable people were employed to work at the home. Our observations and discussions with staff and people who lived at the service confirmed sufficient staff were on duty.

Support was provided by a consistent staff team who knew people well and understood their needs. There were sufficient numbers of suitably qualified staff on duty. People were supported to access the local community and take part in a range of activities of their choice.

People were able to do things they enjoyed and keep in touch with those people who were important to them. Risks to people's safety were understood by staff and people benefited from receiving care and support which took into account their health and welfare. Staff understood what actions to take if they had any concerns for people's wellbeing or safety. Where required people were supported to take their medicines so they would remain well.

People were being supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were supported by staff that used their skills and knowledge so they would enjoy a good quality of life. Staff worked with other organisations and relatives so people's right to make decisions and their freedom was protected. Staff ensured people received help from staff to enjoy a range of food and drinks so they would remain well. Staff assisted people to attend health appointments and followed the advice given by specialist health services so people would receive the care they needed as their health needs changed.

People and relatives knew how to raise any complaints they had and were confident staff would take action if this happened. There was clear and open communication between the registered manager and staff, so staff knew what was expected of them. Robust checks were undertaken on the quality of the care by the registered manager/provider and actions were taken where developments had been highlighted. The registered manager/provider made sure there was a focus on continuous development of the service.

During a routine inspection

Montrose Barn provides accommodation and personal care for up to two people who have a learning disability. During our inspection visits two people were living at the home. The provider was also the home’s 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 and associated Regulations about how the service is run.

People were relaxed and happy at Montrose Barn. We saw people and staff laughing together and enjoying each other’s company. People said, “It’s nice here” and one person’s relative told us, “I feel that (the person) could not be in a better environment than that at Montrose Barn”. Health and social care professionals told us, “I would put this service right at the very top of those I deal with…. people have complex needs and the service is able to meet all of those needs”.

Care records were accurate, detailed and care had been planned effectively in order to provide people with customised and highly person focused care and support. Care plans included specific information about each person’s care needs and clear guidance for staff on the ways in which each person preferred to be supported.

The service used robust and effective risk assessment processes designed to enable people to take managed risks if they chose to do so. The risks assessments were site specific and included detailed guidance for staff on how identified risks should be managed. The provider’s health and safety management systems had recently been externally audited and found to be “very good”.

People were respected as individuals and staff worked to support each person to engage with a wide variety of activities in the home, the local environment, and with the local community. These activities reflected people’s individual interests and hobbies.

Staff and managers had a detailed understanding of the requirements of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards. They had received specific training in relation to recent changes to the interpretation of this legislation. Care records included numerous examples of best interest decision making with the involvement of family members and health and social care professionals.

People and staff were able to communicate effectively together using specific, individualised techniques that had previously proved effective. During our inspection we observed staff using a variety of different communication strategies while supporting people.

The staff team were highly motivated and well supported by the provider and deputy manager whose roles were well defined. Staff told us their training needs had been met and training records confirmed this. Their comments included “(the provider) is extremely supportive” and “training is always on-going”. Professionals told us, “It’s fantastically well managed”. Montrose Barn’s staff management systems complied with current best practice and had been accredited by Investors in People.

There were robust quality assurance systems in place at Montrose Barn. Regular quality assurance audits had been completed and any issues identified promptly resolved. People had been supported to provide feedback on the quality of care they received. We saw feedback was valued by the provider and staff. All feedback received was used as a leaning opportunity and was used to improve the service and ensure each person’s individual needs were met.

During a routine inspection

People we spoke with said they were happy with how staff supported them. We observed staff facilitating people to make choices and participate in a variety of activities. People who used the service told us they enjoyed the activities.

We spoke with two members of staff who confirmed their understanding of people's care needs. During the inspection we saw clear and comprehensive records of people's health care in their care plans. The care plans reflected the needs, preferences and diversity of all the people who lived at Montrose Barn.

It was clear the practice at Montrose Barn was person centred. Throughout the inspection we observed that people who used the service received consistency of care. There was effective communication from those who delivered care and support.

There was evidence that newly employed staff received comprehensive induction and training. This ensured people who used the service were supported by staff who were properly trained, supervised and appraised.

During a routine inspection

We spoke with both of the people who lived at Montrose Barn to seek their views of the service provided. Some of the people had limited verbal communication skills, but both people were able to tell us they were happy with the care and support they received.

When we inspected the home it was clean and odour free. Accommodation was homely and comfortable. At the time of the inspection staffing levels were satisfactory and there were satisfactory systems in place to ensure people received a good quality service.