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Inspection carried out on 3 July 2018

During a routine inspection

Roxby House is a care service providing accommodation and personalised support for up to 29 younger adults with autistic spectrum conditions, learning disabilities and complex needs, in the village of Roxby. Roxby House consists of four separate units. Each self- contained unit provides either individual or shared occupancy flats for between two to four people.

At our last inspection in June 2015 we rated the service outstanding. At this inspection we found the evidence continued to support the rating of outstanding. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated Outstanding.

Although the care service had not been developed and designed in line with the values that underpin the Registering the Right Support, in that it was registered to accommodate up to 29 people and would be considered a congregate setting, the service was registered prior to CQC implementing this guidance.

Other values such as, choice, promotion of independence and inclusion underpin the ethos of the service and what it continually strives to achieve for people. The service continues to support an extremely person-centred approach and people whose behaviour may have previously isolated them, have been fully supported by the service to develop new skills and successfully become involved in their local community and achieve extremely positive outcomes. People with learning disabilities and autism using the service can live as ordinary a life as any citizen

The service is committed to a continual and credible programme of training that encourages bespoke programmes for the development of academic, vocational, social and life skills, all designed to aid a move towards independent living. The organisation utilises their own innovative and robust evidence based models, clinical and best practices to support and enable people to achieve the best possible outcomes. People who have previously experienced failed placements elsewhere have been supported and enabled to move on to more supported living, after spending time at Roxby House.

We saw the provider was committed to personalising services and also followed the recommendations outlined in ‘Putting People First’(a shared vision in transforming adult social care to put people first through a radical reform of public services, enabling people to live their own lives as they wish, confident the services are of high quality, are safe and promote their own individual needs for independence, well-being and dignity) and the Autism Act (2009). The service is also accredited with the National Autistic society (NAS), which drives best practice to deliver outstanding care to people who used the service.

An outstanding feature of the service was the time invested developing innovative and flexible ways to support people to move forward and achieve their full potential and accommodate their changing needs. Positive risk taking was driven throughout the organisation to support people to lead fulfilling lives. A consistent team approach meant people were supported to try new things and experiences. Feedback from relatives included, “I can’t fault the place. It has changed all our lives for the better.” and “I thank my lucky stars every day that we found Roxby. It is the best thing that could ever have happened. [Name] has a life now.”

The registered manager demonstrated strong values, implemented good practice delivery throughout the service and led a committed staff team in delivering a person-centred approach. The service employed ‘life skills instructors’ to support people with daily needs and a ‘vocational life skills instructor’ for supervising and facilitating activities. These employees are referred to as 'staff' throughout the report.

Support for people was outstanding and enabled them maximum choice and control of their lives. Policies and systems used by the service supported this.

Thorough s

Inspection carried out on 18 and 19 June 2015

During a routine inspection

This inspection took place on 18 and 19 June 2015 and the inspection was unannounced, which meant the registered provider did not know we would be visiting the service. There was a manager registered with the Care Quality Commission (CQC); they had been registered since 13 March 2013. At the last inspection on 10 July 2013, the registered provider was compliant with all the regulations we assessed.

Roxby House is a care service providing accommodation and personal care for up to thirty younger adults with a learning disability and autistic spectrum disorder. There were twenty eight people living at the service on the day of our inspection. Roxby House consists of four separate units.

Each unit provides either individual or shared occupancy flats for between two to four people. The single occupancy flats are fully equipped and comprise of a kitchen, lounge/diner, bedroom and en-suite bathrooms which includes either a shower or bath depending on the individual’s needs. The shared flats comprise of; a communal kitchen, lounge/diner, toilet, laundry and bathroom and shower room; some also have a conservatory. Each person has their own individualised bedroom. Every unit has access to a patio or garden area. People who use the service have access to the facilities on site which include; a café, sports hall, farm, woodland area, cycle track, sensory room, computer room, gardening, woodworking, music room, hydrotherapy pool and hairdressing salon.

An outstanding feature of Roxby House was the time spent developing the service, using innovative and flexible ways to support people to move forward. They were seen to constantly adapt and strive to ensure people were able to achieve their full potential. Over a period of time we have seen people be supported to develop and move on to more independent living..

We found personalised programmes and flexible staffing enabled people to learn to live as independently as possible with the minimum of support. This was based on the philosophy of the organisation ‘fitting a service around you, not fitting you within a service’.

There was a strong person-centred culture apparent within the service. [Person centred means care is tailored to meet the needs and aspirations of each individual]. People told us they felt included in decisions and discussions about their care and treatment. Staff described working together as a team, how they were dedicated to providing person-centred care and helping people to achieve their potential. Staff told us the registered manager led by example, had a very ‘hands on’ approach and was visible within the service, making themselves accessible to all.

The people who used the service had complex needs and were not all able to tell us fully about their experiences. We used a Short Observational Framework for Inspection [SOFI] to help us understand the experiences of the people who used the service. People’s language difficulties meant we were only able to speak with five people who used the service and have limited discussions with them.

We observed staff treated people with dignity and respect and it was clear they knew people’s needs well.

We found staff were recruited in a safe way; all checks were in place before they started work and they received an induction. Staff received training and support to equip them with the skills and knowledge required to support the people who used the service. Training was based on best practice and guidance, so staff were provided with the most current information to support them in their work. There were sufficient staff on duty to meet people’s health and welfare needs.

People’s nutritional needs were met and they had access to a range of professionals in the community for advice, treatment and support. We saw staff monitored people’s health and responded quickly to any concerns.

Systems were in place to protect people from the risk of harm or abuse. Staff had received training in dealing with concerns and complaints and knew how to report any concerns. Medicines were ordered, stored, administered or disposed of safely. Personalised support plans had been developed to ensure people received their medicines in line with their preferences.

We saw people had assessments of their needs and care was planned and delivered in a person-centred way. Throughout our inspection we saw the service had creative ways of ensuring people led fulfilling lives and they were supported to make choices and have control of their lives. People

participated in a range of personal development programmes. They accessed a range of community facilities and completed activities within the service. They were encouraged to follow and develop social interests and be active and healthy.

Care plans had been developed to provide guidance for staff to support in the positive management of behaviours that may challenge the service and others. This was based on best practice guidance and least restrictive practice to support people’s safety. The guidance supported staff to provide a consistent approach to situations that may be presented, which protected people’s dignity and rights.

People lived in a safe environment that had been designed and adapted to meet the specific needs of people who used the service. Staff made sure risk assessments were carried out and took steps to minimise risks without taking away people’s right to make decisions. There was a system of audits, checks and analysis to identify shortfalls and to rectify them so the quality of care could continually be improved and developed.

Inspection carried out on 10 July 2013

During a routine inspection

We used a number of different methods to help us understand the experiences of the people who used the service, because the majority of them had a variety of complex needs and communication difficulties and were not able to tell us their experiences.

We found before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. The manager confirmed they would complete an assessment if capacity to make decisions was in doubt and a best interest meeting would be held. We were able to speak to one person who told us how they spent their time in the home and how staff supported them. They told us, “I normally give it thumbs up living here."

The relatives of three people who used the service commented, “Both myself and my son are included in his care arrangements.” “Our son is always happy to return to Roxby House and we have always been very satisfied with the care provided- he has an extensive and varied list of activities.” Other relatives told us, “I couldn’t be happier – he has a great life there – if he could stay at Roxby for ever I would be happy…he has come on leaps and bounds…his programme is superb…he comes home regularly to spend time with us…we only have positive things to say about Roxby. ” and “Roxby house is an excellent place for our daughter…the activities are brilliant, the house manager is brilliant – runs a really good set up and the communication with us is excellent.”

We observed people were supported throughout the day and structured activities were available. These were provided both on site and within the local community.

Staff helped to make sure health and social care was coordinated by a range of professionals.

We found that all staff employed in the service received regular supervision, training and support to enable them to fulfil the role expected of them.

Inspection carried out on 19 October 2012

During a routine inspection

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

We were able to speak to one person who used the service and a relative during the visit. We were told that choice was offered to people using a variety of different methods including symbol and picture documentation, individualised activity planning programmes and person centred planning. The person who used the service commented, “I like living here”, “It’s my home and I want to stay here”, “I have lots of activities” and “I help out at the Red Cross shop.”

The relative we spoke with commented, “We looked at 15 other places before deciding on Roxby House. My son has settled very well and I have no concerns whatsoever”, “The staff are brilliant and there is a structured programme”, “My son is never in because of all the activities” and “I cannot praise the service enough, it’s a fantastic place.”

We spoke with one person who used the service and they told us they liked living in the home and said they felt safe. They also told us they liked their bedroom and had chosen the colour it was painted. They also said that staff were polite and helped them.

We observed that people were able to convey their views to staff and had developed their own ways of communicating.

Inspection carried out on 24 November 2011

During a routine inspection

A number of the people currently using the service have a variety of complex needs and communication difficulties and we were not able to communicate with them, however we observed interactions between them and the staff that support them.

We were able to speak with two people during the visit who were keen to tells us about their life at the home, how they spent their time and how the staff supported them.

One of the people using the service told us how staff supported them to be more independent and that this was good. They told us how they could now travel independently on the bus into the local town and how the staff travelled separately and would meet them. Another person told us about the activities they enjoyed at weekends such as going to watch football matches.

During our conversations with people they showed us lots of photographs of their trips out and activities they enjoyed with other young people at the service.

They told us they liked living at the home and the staff were nice and friendly, comments included “I like my key worker, she is nice and teaches me lots of things” and “I am happy here”.

We observed how people were supported throughout the day and structured activity programmes were in place. People were supported with a range of activities and therapies such as exercise programmes in the gym, gardening, working in the café, art work and using the drum kit in the music room.

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