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Inspection carried out on 3 May 2018

During a routine inspection

This was an unannounced inspection which took place on 03 May 2018.

Peppard House is a care home (without nursing) which is registered to provide a service for up to seven people with learning disabilities. People had other associated difficulties such as behavioural issues and being on the autistic spectrum.

People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Peppard House accommodates people in a large domestic sized building. The service was run in line with the values that underpin the “registering the right support’’ and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism can lead as ordinary a life as any citizen.

At the last inspection, on 23 February 2016, the service was rated as good in all domains. This meant that the service was rated as overall good. At this inspection we found the service had improved to outstanding in two domains and therefore had improved to an overall rating of outstanding.

Why the service is rated outstanding.

The service was exceptionally responsive and strove to meet people’s aspirations and lifestyle choices. It was flexible and readily adapted to meet people’s changing, diverse and complex needs. It was extraordinarily person centred and people were seen and responded to as individuals. Activity programmes were creative and designed to meet people’s individual preferences and choices. Care planning was highly individualised and regularly reviewed which ensured people’s current needs were met and their equality and diversity was respected.

The registered manager was extremely experienced, respected and highly thought of by staff, families and other professionals. She and the management team ensured the service was exceptionally well-led. The registered manager and the staff team were committed to ensuring they offered people the very best care possible and that people were as involved as possible in running the service. The quality of care the service provided was constantly assessed, reviewed and improved by the provider, people and the staff team.

People continued to be protected from all forms of abuse. Staff were trained in safeguarding people and knew what action to take if they identified any concerns. The service identified general health and safety and individual risks. Action was taken to reduce identified risks. All aspects of safety were considered and actions were taken to assist people to remain as safe as possible.

People continued to be supported by appropriate staffing ratios, which were reviewed on a daily basis. Staff were able to meet people’s specific needs, including any diversity, safely. Recruitment systems made sure, that as far as possible, staff recruited were safe and suitable to work with people. People were supported to take their medicines, at the right times and in the right amounts by trained and competent staff.

A well-trained and knowledgeable staff team remained able to offer people effective care. They met people’s diverse needs including their current and changing health and emotional well-being needs. The service worked very closely with health and other professionals to ensure they offered individuals the best care in the most effective and comfortable way.

People continued to be 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.

The caring, committed and enthusiastic staff team continued to meet people’s needs with kindness and respect. They ensured they promoted people’s privacy and dignity and communicated with them effectively.

Inspection carried out on 23 February 2016

During a routine inspection

This was an unannounced inspection which took place on 23 February 2016.

Peppard House is a residential care homes operated by Community Homes of Intensive Care and Education Limited (CHOICE). It is one of a number of services run by the provider. Peppard House is registered to provide care and support for up to seven people who have learning disabilities. They may be living with associated conditions, such as autistic spectrum disorders and behavioural difficulties. There were six people living in the service on the day of the visit. The house is built over two floors. Everyone who lives on the first floor of the home is able to negotiate stairs safely.

There is a registered manager running the service. 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 who live in the service, staff and visitors were kept as safe from harm, as possible. Staff were trained in the protection of vulnerable people and knew how to keep them safe from any form of abuse. Staff were trained in and understood health and safety and followed the relevant policies and procedures to keep people as safe as they could. The service identified any individual or general risks and action was taken to minimise them. There were enough staff to look after people safely. The recruitment procedure was designed to make sure staff were safe and suitable to work with the people who live in the home. Medicines were given safely by properly trained staff.

People’s health and well-being was maintained and improved by staff following effective care plans and responding to people’s needs. The staff team sought advice from and worked closely with health and other professionals, as necessary, to meet people’s needs in the best way. People’s physical and emotional needs were met to ensure people were able to enjoy their lives as much as possible.

People were supported to make as many decisions and have as much control over their lives as they were able to. Peoples’ human and civil rights were understood, and upheld by the staff and registered manager of the service. The service understood the relevance of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS) and consent issues which related to the people in their care. The Mental Capacity Act 2005 legislation provides a legal framework that sets out how to act to support people who may not have capacity to do so.

People’s care was provided by a committed staff team who knew people and their needs well. Staff were attentive, knowledgeable and responsive to changes in people’s needs and wishes. People’s equality and diversity was respected by staff who fully understood individualised (person centred) care. People were provided with a variety of activities, according to their needs, abilities and preferences.

The service was well-led by an effective, supportive and knowledgeable registered manager and management team. The registered manager had an open management style and encouraged people, staff and others to express their views and opinions. The quality of the care provided was regularly monitored. Improvements had been made and further developments were ongoing.

Inspection carried out on 3 February 2014

During a routine inspection

Some of the people who use the service had complex learning disabilities and were not able to speak to us. Some people were able to speak with us and we spoke with one person. They told us they were happy living at the home and the care staff were "alright". We spoke with two relatives of people who use the service. One relative told us "the care is good" another told us "staff seem to look forward to working with him and generally care".

Care was planned to meet people's needs and was regularly reviewed to reflect any changes to people's needs. We observed the support people received reflected their assessments. People and their relatives were involved in planning their care.

There were arrangements in place to protect people from the risk of abuse. Staff had received training and were clear in understanding their responsibilities. One person who uses the service told us "they keep me safe".

The provider had systems in place for training and supporting staff. Mandatory training had been identified and staff had received the training. Supervisions and appraisals were designed to support staff, however we noted that not all staff had received timely appraisals and supervisions. The manager took action to address this at the time of our inspection.

We found the provider had effective systems in place for monitoring the quality of the service. This included obtaining the views of the people who used the service.

Inspection carried out on 7 February 2013

During a routine inspection

Some of the people who used the service had complex learning disabilities therefore they were not able to respond to our questions independently. We spoke with two people who use the service who confirmed they liked living at the home.

Staff were able to describe how they sought consent from people who use the service, whether by speaking with the person, or by observing people�s behaviours where they were not able to communicate verbally. However, the provider did not always consider peoples capacity to consent in line with the Mental Capacity Act 2005.

People�s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Staff were knowledgeable about people's care requirements. Relatives we spoke with told us they were involved in people�s care planning. One person told us the care their relative received was �very good�. Another said �they are doing wonders for him�.

There were effective systems in place to reduce the risk and spread of infection. Relatives we spoke with told us the home was clean. One person told us standards of cleanliness were �pretty good�.

The provider had systems in place to deal with comments and complaints and Information about complaints was provided in a format that met people's needs and people were made aware of the complaints system. However, inaccurate information was provided to people on how to escalate complaints outside of the organisation if they needed to.

Inspection carried out on 6 February 2012

During a routine inspection

People living in the home had individual communication needs and were unable to provide their views about their experiences of living in the home. However we saw that people were involved with their care and the running of the home.