Norwood - 30 Old Church Lane

At the last inspection on 19 November 2015, the service was rated Outstanding.

At this inspection we found the service remained Outstanding.

Norwood – 30 OCL had a manager registered with the Care Quality Commission (CQC), however the registered manager had been promoted to Head of Care Services and an acting manager had been appointed to undertake day to day management of Norwood – 30 OCL. The registered manager was still present for about two days per week at Norwood – 30 OCL and the acting manager will register with the CQC in April 2018. 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 safe. Staff demonstrated thorough understanding and knowledge of how to protect people who used the service from harm. The service ensured that sufficient levels of staff were deployed to make sure people’s needs were met at any time. People who used the service were listened to and consulted as to what made them anxious and supported them to take a full part in their home and in the community. Norwood – 30 OCL introduced creative ways of retaining and developing staff, which ensured consistency and meant people who used the service were supported by staff which knew them well. Risk assessments formed part of the care planning process and encouraged people to stay as independent as possible without compromising their safety. Risk assessments were reviewed regularly by involving people who used the service, their relatives and staff who supported them. Medicines were continued to be managed safely with the emphasis of reducing rather than increasing the medicines people who used the service were prescribed. This was in particular paramount in relation to medicines prescribed to manage behaviours that challenge the service.

People who used the service, relatives and befrienders spoke highly about the care provided and received at Norwood – 30 OCL. The service consistently supported people who used the service to maintain and build relationships internally and externally. Norwood – 30 OCL looked at creative ways to help people who used the service to gain new skills, become more independent and become a valued member within the community, by following their aspiration of gaining payed employment. Staff and people maintained excellent professional relationships and staff demonstrated an exceptional understanding of people’s needs, abilities and likes and dislikes. People who used the service continued to take part in national and international fundraising events with the help of staff.

Each person had a clear and detailed care plan tailored to their individual needs. The care plans highlighted specific support needs, particularly involving anxiety and how to support the person to manage these. All people had a specific autism care plan which gave detailed information about the person’s condition and information where the person required additional support to maintain their independence. All people made a wish list annually, which looked at aspirations and goals individuals and the service wanted to achieve. People had developed an individual timetable of activities, which was communicated with people through pictures to help them to understand better of what they were doing each day. Some people were doing voluntary work, while others had a leaflet distribution job which they were paid for. People developed their social skills by interacting with peers regularly and were also supported to plan trips to visit relative’s that did not live locally.

The registered manager, acting manager and staff were continuously praised for their support and people, staff and relative’s felt they were extremely open and approachable. Staff felt as part of an open and empowering culture where they were respected as individuals and as part of a team. Relative’s had the utmost confidence in management and always felt welcomed and kept up to date with how people were.

The staff team at Norwood – 30 OCL had a sound understanding of the Mental Capacity Act (MCA) 2005.The service promoted choice and decision making in particular regarding decisions about people’s care and safety. Nevertheless the manager and staff understood their responsibilities under the Deprivation of Liberty Safeguards (DoLS).These provide legal safeguards for people who may be deprived of their liberty for their own safety. Staff had sought support from health professionals to enable people to make decisions about their own health and wellbeing.

Staff told us that they felt supported and listened to, they praised the regular supervisions and appraisals which helped them to develop their understanding of people and also was a contributing factor to staff working at Norwood – 30 OCL for a number of years. This in return benefitted people who used the service who were supported by a staff team who knew them well and understood their routines. Staff received a wide range of specialised training to ensure they could support people safely and carry out their roles effectively.

People were supported to maintain their health. Over the past year Norwood – 30 OCL had supported people who used the service with serious health concerns, via visits and being treated by specialist consultants. Relatives spoke highly of the healthcare support people who used the service received. Annual health action plans and hospital passports were designed together with people to ensure healthcare was consistent when moving between different healthcare disciplines. There were clear guidelines in how to support people when accessing different health professionals such as the GP, Dentist or Chiropodist.

The registered manager and registered provider had developed robust systems to ensure that quality audits were completed monthly and included checks on the building, people and staff’s welfare. People and staff had regular meetings where they were given updates on the service and the opportunity to voice any concerns. The registered manager and registered provider looked for ways to continually improve the quality of the service. For example they had continuously developed systems to monitor behaviours; challenged poor practice and involved people used the service and relatives to contribute to the running of the service and organisation.

Further information is in the detailed findings below.

30 Old Church Lane (30 OCL) is a service for eight people with learning disabilities. Some of the people have autism and behaviour which challenges the service. All people who use the service are from the Jewish faith. The service is spacious and provides accommodation on the ground and first floor. There is also a small two bedroom flat, which was used for people to become more independent. 30 OCL is located close to Stanmore town centre, which provides good transport links and shopping facilities.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

An outstanding feature of 30 OCL was the work the service did in providing, supporting and safeguarding people to maintain and have consensual, loving, caring and safe relationships in-house or with people in the community. Another outstanding feature was the time spent in developing the service, using innovative strategies to help people with gaining independence skills and supporting people to achieve their full potential.

We found that 30 OCL provided a highly personalised, person-centred and autism specific service. People were in control of their support and participated in decision-making for the service and organisation as a whole. People were encouraged and enabled to learn new skills and become more independent. Support that staff provided to people was outcome-focused and systems were in place to document this. There was evidence that the service looked for and used innovative strategies to help people gain greater independence. For example using face time to communicate with relatives or using specific applications of the computer to support people’s communication.

People consented to their support and staff and the registered manager of the service worked together with people’s parents and relatives to ensure all involved were aware of the legal limits of their role in decision-making. Feedback about the service was encouraged and there were a range of mechanisms to support this. For example people who used the service produced a wish list of what they expect from staff and used this during recruitment of new staff.

Staff were aware of the requirements of their role and were vetted appropriately before starting work. Staff supported people safely and knew what to do to protect people from the risk of abuse.

Recruitment procedures ensured staff had the appropriate values when they were employed and gained skills and qualifications shortly after they started work. Ongoing training was provided and staff were encouraged to pass on their expertise to their colleagues through workshops and team meetings in various aspects of service delivery.

The service put in the time and effort to find a safe and secure medicines administration system to support people who were able to self-administer their medicines. People received their medicines in a safe manner and staff recorded and completed Medicine Administration Record (MAR) charts correctly.

People had excellent access to healthcare services and received on-going healthcare support for example through their GP, hospital doctors and specialists. Referrals were made to other professionals such as speech and language therapists and dieticians if the need arose. People met with their psychiatrist and behaviour specialists to ensure that their behaviours were managed appropriately by staff.

Risk assessments and care plans for people using the service were effective, individual and autism specific in capturing the required information. People’s individual care needs were recorded daily in great detail; this demonstrated that their needs had been met. There was a strong focus on supporting people in becoming more independent by working together with the family, the person and the day service to achieve the best possible outcome. This included sourcing additional funding to access and obtain assistive and information technology to support and gain skills for people to communicate their needs, wishes and decisions more independently.

No complaints had been received within the last year, but people had the opportunity to comment on the service at regular meetings. The service had received a number of compliments in regards to the newsletter provided and designed by people who used the service with the support of staff.

Quality assurance systems were in place to assess and monitor the service people received. The service worked well in partnership with other organisations to ensure current practice was followed and a high quality service was provided to people. The service strived to make continuous improvements through regular consultation, research and reflective practice. This ensured that the service continued to provide an outstanding service to people with autism and behaviour that challenges the service.

At the time of our inspection, the home was providing care for eight people.

We used a number of different methods to help us understand the experiences of people who used the service, because some people who used the service had complex needs which meant they were only able to communicate using key words, body language, gestures, facial expressions and objects of reference.

We observed the care provided and the interaction between staff and people who used the service. We also spoke with five care staff and the registered manager. We also read feedback from relatives.

Below is a summary of what we found. The summary describes what people using the service and staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People who used the service had support plans and risk assessments which helped to ensure their safety and welfare.

We found the home had safeguarding, whistle blowing and Deprivation of Liberty Safeguards (DoLS) policies and guidance in place. Training records showed staff had received training in safeguarding and DoLS. When speaking to them, they were able to provide examples of what constituted abuse and how they could identify abuse. They were aware of action to take and how to report allegations or incidents of abuse to the relevant authorities.

The Care Quality Commission (CQC) monitors the operation of DoLS which applies to care homes. While no applications have been submitted, appropriate policies and procedures were in place. When speaking with staff we found they had an understanding of the Mental Capacity Act (MCA) 2005 and the DoLS and how they applied to the people they were providing care and support to on a daily basis.

Is the service effective?

We found the home had taken steps to ensure that people were included and involved as much as possible in their care and support. We found staff used various methods of communication to engage and involve people who used the service as much as possible such as pictures, gestures, sign language, key objects and words.

We looked at four care plans and saw that people's needs had been assessed and care and treatment were planned and delivered in line with their individual care plan. Risk assessments and behavioural support plans had been carried out. We found these were detailed and specific to each person and their needs.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Staff were trained in areas of relevance to their job roles and demonstrated knowledge of people's individual needs and requirements.

Is the service caring?

We found good feedback had been received about the home.

Feedback from one relative read 'you have always addressed [relatives] needs' and another relative commented 'everyone I speak to is very helpful and pays attention to what we have to say'. When asked whether they felt that their relative was well cared for and that their needs were fully met, one relative commented 'Yes [relative] is happy here and that's all that really matters'.

During the inspection, we saw people being treated with respect and dignity. We observed staff provided prompt assistance and were patient when supporting people. Staff communicated well with people and explained what they were doing and why. We observed people were given a choice by staff and asked what they wanted to do and staff adhered to their wishes.

Is the service responsive?

There was evidence that people's needs were monitored. We saw risk assessments and support plans had been regularly reviewed and updated when people's needs changed.

People's health and medical needs were assessed and we viewed records demonstrating that they were supported and had access to health and medical services when necessary.

Is the service well-led?

We found the home had a system in place to obtain feedback through surveys which showed good feedback about the service had been received.

There were regular consultations and resident meetings with the people who used the service which gave them the opportunity to relay any issues or concerns they had and if they had any complaints they wished to make.

We also found regular staff meetings took place which ensured staff had the opportunity to communicate their views about the service and to discuss the care and support needs of people who used the service.

The home had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others. Checks had been conducted on all electrical equipment, and maintenance checks and service records were up to date.

We saw evidence that people's individual needs were fully assessed and that activities that they had chosen were organised for them. It was explained that all the people who used the service were going on holiday to the Isle of Wight for a one week holiday. The people we spoke to about this were excited and planning what they wanted to do whilst they were there.

We found that people's care plans were detailed and individual to each person who used the service. The staff knew what was in each person's care plan, but the care plans were not reviewed according to the providers arrangements.

The arrangements in place to manage the stock of medicines were not effective and we found that some medicines had not been accounted for.

People were supported in promoting their independence and making choices in their daily life. We observed people moving to different areas of the home without restrictions. Some people stayed in bed late as it was the weekend and others were up sitting in the lounges talking with staff and among themselves. One person said 'I can listen to music and watch football on TV'.

People had opportunities to engage in the local community and to develop independent living skills. For some people this included developing skills to prepare meals and for others to manage their personal finance. Each person had an individual recreational and activity programme that addressed the things they enjoyed doing and that had been identified as areas where they could develop skills.

Whilst people appeared well cared for during the inspection and they were happy with their care, there were risks that they might not be protected against poor care. This was because their care plans were not reviewed according to the provider's arrangements, to ensure these were up to date. Risk assessments were not in place for all people to address their safety and that of others.

The arrangements in place to manage medicines were not effective to ensure people were protected against the risks associated with the management of medicines.