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Inspection carried out on 23 November 2018

During a routine inspection

What life is like for people using this service:

Segal gardens has three separate houses; Segal Gardens, Oakwood and Berrybridge. Each house had their own team of core staff to ensure consistency for people living there. People received care and support from staff that knew them extremely well, and had the knowledge and skills to meet their individual needs whilst providing a better quality of life.

The service had worked hard to ensure that people could live harmoniously amongst each other and be supported by staff they felt comfortable with. Through extremely detailed initial assessments the service ensured they were able to provide the right support before moving into the home. People already living in the home were provided with support to prepare them for new people arriving; this helped to provide a smooth transition for all involved.

A holistic approach had been adopted in the assessing, planning and delivery of people’s care and support. Care plans were extremely detailed and identified intended outcomes for people. Staff provided excellent care and support that was met in a way people preferred and provided consistent and positive outcomes that exceeded expectations. Staff worked hard to provide a consistently better quality of life for people by supporting them to develop in areas such as communication, social interaction, education and independence. People spoke highly of the support provided and told us how they had achieved improvements in their own abilities, independence and confidence.

People were supported to live enriched lives and do what they chose. Staff encouraged them to be as independent as possible whilst ensuring they remained safe. Risks that people faced were identified and assessed and measures were put in place to manage them and minimise the risk of harm occurring. Staff showed a good understanding of their roles and responsibilities for keeping people safe from harm. Medicines were managed safely and people received medication at the right time. Family members told us they felt extremely confident their relatives were safe.

Staff showed a genuine motivation to deliver care in a person-centred way based on people’s preferences. The management team and staff had developed strong, familiar and positive relationships with people and family members. Throughout the inspection the management team and staff were observed to be warm and affectionate towards people and often displayed physical contact that was appropriate and accepting from people. Family members described staff as being extremely caring and that the service ‘went the extra mile’ for people to ensure they lived a good quality life.

The leadership of the service promoted a positive culture that was person centred and inclusive. Family members and staff all described the management team as supportive and approachable. The management team showed a continued desire to improve on the service and worked closely with other agencies and healthcare professionals in order to do this. Effective systems were in place to check on the quality and safety of the service and improvements were made when required.

Rating at last inspection: Good (report published 4 May 2016)

About the service: Segal Gardens is registered to provide personal care and accommodation for up to 15 young adults with complex needs. They are located in the Parr area of St. Helens. There were 12 people living at the service on the day of inspection.

This service has been developed and designed in line with the values that underpin 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.

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 o

Inspection carried out on 9 March 2016

During a routine inspection

This inspection took place on 9 March 2016 and was unannounced.

Segal Gardens is registered to provide personal care and accommodation for up to 15 young adults with complex needs. They are located in the Parr area of St. Helens. There were 11 people living at the service on the day of inspection.

The home had 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 were supported to take their medicines by staff who were appropriately trained. People received care and support from staff that knew them very well, and had the knowledge and skills to meet people’s individual needs. People told us staff always treated them well and promoted their choices regarding their care, support and the activities they participated in. People and their relatives spoke very positively about staff, their comments included, “I am happy with my support team, I like them” and ”The staff are highly trained and always professional”.

People were supported to live a full and stimulating life, to do what they chose and staff had safeguards in place to allow outings and activities to go ahead. Risk assessments were regularly reviewed and also when peoples needs changed and the staff approach was flexible to allow for changes in circumstances. The staff ensured people were protected from the risk of harm.

Staff were trained in safeguarding adults and understood how to recognise and report any abuse. The service had policies and procedures in place that informed staff of how to keep people safe and these were followed.

Staffing ratios were in place to meet peoples assessed needs and were responsive to people’s changing needs and preferences. This allowed for people to make full use of all of the facilities the home had to offer, to go out on trips, both as a group and individually, and to experience well-paced and attentive support.

People were protected by the service’s safe recruitment practices. Staff underwent the necessary checks which determined they were suitable to work with vulnerable adults, before they started their employment.

People’s risks were anticipated, identified and monitored. Staff managed risk effectively and supported people’s decisions, so they had as much control and independence as possible.

Care plans provided staff with clear direction and guidance as to how to meet people’s individual needs. The service was flexible and responded to people’s needs. Relatives told us how well staff responded to individuals and always ensured they went the extra mile. They also told us staff and management team always welcomed suggestions to improve the service further.

People knew how to raise concerns and make complaints. People and their relatives who had raised concerns confirmed they had been dealt with promptly and satisfactorily.

There was a management structure within the service which provided clear lines of responsibility and accountability. There was a positive culture within the service, the management team provided strong leadership and led by example. Staff said “I have never been so well supported by a company” and “I feel really valued as an employee”.

There were quality assurance systems in place to make sure that any areas for improvement were identified and addressed. Members of the management team were visible in the service and regularly visited people and sought their views about the service.

During a check to make sure that the improvements required had been made

We reviewed this outcome to follow up on non-compliance found at an inspection in November 2013. At the time of this inspection, appropriate measures were not in place to monitor and reduce risks associated with the water system.

The managers of the home sent us information that demonstrated this concern had been addressed.

Inspection carried out on 22, 25 November 2013

During a routine inspection

We were not able to directly gather the views and experiences of people living at Segal Gardens due to people’s complex communication needs. We instead contacted three people’s relatives to ask them for their views. All were very complimentary about the staff team and the care and support being provided. One relative said, “The staff have a genuine desire to be part of their lives.” Another relative said, “They are exceptional, and have gone above and beyond what was expected.”

We reviewed two people’s care records and found they contained the information staff required to provide care in a way which met people’s individual needs.

We were shown around the building and checked maintenance records for fire, water, gas and electrical safety. The building and grounds had been well maintained. Work was required to review the water system to reduce the risks posed by Legionella and scalding.

We checked the recruitment records for three members of staff. There was evidence appropriate checks had taken place to ensure people were suitable to work within the home. There was a complaints system available.

Inspection carried out on 23 May 2012

During a routine inspection

“We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences. We spoke to the relatives of three people, who told us,

"Our son definitely gets treated with dignity and respect",

" he's free to come and go. Nobody goes into his room without his permission",

"we have regular meetings with the home, always beneficial",

"All staff are fine , no problems and always very professional",

"The staff seem to be well trained. I know that the newer staff have been receiving training",

"we are very happy with the service. It's been a hard transition, but things have worked out well",

"The staff are marvellous, we've had regular meetings and we are sent care plans",

"we get on well with the all of the staff",

"We can't fault any of the care being provided. Always feel assured that people are safeguarded and protected",

"staff are really good with, (named person) it's a nice place and a good home. Always talks about staff in a positive way",

"They are very good with anything medical. Always kept informed of any health issues. Let us know if going to any appointments and any changes in medication",

"We are very happy with him being there. So satisfied with the service and everything about it",

"they are like (Staff) an extension of the family. We can call them anytime",

"Always put the young person first. It's done on a personal basis, everything is done to personalise care",

"They always keep us informed on a day to day basis. Communication is key",

"I'ts amazing to see the relationship they have with (named person).We can see how happy she is",

"It's a caring and happy environment",

"Introductions are always made to new members of staff",

"They work so hard, (named person) has come on leaps and bounds".

Reports under our old system of regulation (including those from before CQC was created)