110 West Street Care Home

We found the following examples of good practice.

We observed staff following good infection prevention and control practices including appropriate use of Personal Protective Equipment in line with government guidance.

The people who used the service had COVID-19 risk assessments and care plans in place which were individual to them and took account of aspects such as health and social care needs and accessing the community.

The service supported people to maintain relationships with families and friends, either by visiting within the home or via video calls.

The registered manager had COVID-19 audits to assure themselves that staff continued to meet current guidelines around PPE, handwashing and infection control procedures.

Filtration units had been fitted to communal areas of the service to circulate and filter air in the communal areas.

110 West Street is registered to provide care and accommodation to 17 people with a learning disability. It is divided into three adjoining Houses. House A and B provides more traditional residential accommodation for short term group living for people in need of an assessment or in crisis. House C comprises five flats for people who behave in a way that may challenge others. The office for the service is situated in House C.

People admitted to this service were often in crisis due to their behaviours having led to police involvement or due to placements having broken down elsewhere as services were not able to provide the level of support needed.

This is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives 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

Staff had high regard for the safety of the people they were supporting. They undertook training in safeguarding and protecting people from abuse and avoidable harm and were confident to report any concerns. People were pro-actively supported to take risks safely. There were enough staff to keep people safe and recruitment procedures checked staff were suitable to work at this service. Medicines were given safely. Communication and sharing of information between staff was very good and lessons were learnt when things went wrong.

People and their families received outstanding high-quality, person-centred care from a caring and exceptionally well-led service. People with a wide range of complex needs were supported by staff to lead full, interesting and meaningful lives. We saw that people had excellent, warm, caring relationships with the staff and enjoyed their company.

We found the culture of the service was one of empowerment for both staff and people who used the service. Without exception staff told us they were proud of what they had supported people to achieve and showed a passion for their work and the people they supported. There was a clear sense that this was embedded across the whole staff team.

Staff were extremely kind, compassionate and caring. They provided fully personalised support that focussed on what the people living in the service wanted. Staff fully understood how to support people's privacy and dignity and they encouraged people to be as independent as possible. Staff supported people 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 service provided to people was highly personalised and responsive and focussed on making people’s quality of life as good as possible and all staff were fully engaged in this process. Each person had an ‘All about me’ file which had been drawn up with them and provided a clear picture of everything about the person including their needs, wishes, fears and aspirations.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

The service was well-led by a highly motivated registered manager who inspired the staff team to put the people they were supporting at the heart of everything they did. The provider's values were put into practice by the staff and governance systems ensured the service provided was of the highest possible quality. People, their relatives and staff were always involved in improving all aspects of running the service and their voices were heard.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used positive behaviour support principles to support people in the least restrictive way. No restrictive intervention practices were used.

All staff we spoke with demonstrated the vision and values of the service which are to enable people to live their lives at their optimum level, through a person-centred approach where positive risk taking is promoted.

Innovative and inclusive management systems were in place to put people at the heart of the service with opportunities for all people involved to voice their opinions and suggestions.

The registered manager had recently taken up her position but had previously been the deputy manager for the service, they were instrumental on the last inspection to lead the service to an outstanding rating. At this inspection the registered manager and service manager demonstrated their commitment to delivering high-quality care and their commitment to develop the service. The service was well-led. The registered manager, management team and staff were extremely open to hearing feedback on the service and acted immediately to correct any issue identified. There was an open, caring culture and all staff were passionate about their work.

Everyone told us, this culture emanated from the registered manager and service manager.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Outstanding (published 09 March 2017)

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

110 West Street is registered to provide care and accommodation to 17 people with a learning disability. It is divided into three adjoining Houses. House A provides more traditional residential accommodation for crisis minimal risk short term care. House B accommodates people who choose to remain long term and House C comprises five flats for people who may challenge. The office for the service is situated in House C.

People admitted to this service were often in crisis due to their behaviours having led to police involvement or due to placements having broken down elsewhere as services were not able to provide the level of support needed.

The service was last inspected in September 2013 when it was found to be compliant with the regulations inspected at that time. Compliance had been found on the two previous inspections.

There is a registered manager in place but they were not available on the day of our inspection. 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. The deputy manager was available to support the inspection process.

Safeguarding people was included at the interview stage for new staff and was followed through with induction and training. Staff demonstrated a thorough knowledge of, and commitment to, keeping people safe.

Staff had a positive and innovative approach to risk taking. Rather than minimising risks to people by reducing their opportunities to live a full life, people were supported to develop links with the community and seek new experiences whilst having support to manage any associated risks. Staff understood that risk assessments put the focus on what the person could achieve rather than the difficulties they faced. This positive risk taking meant people were able to lead fulfilled lives and seek new opportunities.

Accidents and incidents were monitored to look for any themes and trends for which action could be taken to minimise the risk of reoccurrence.

Systems for managing medicines were safe and staff employed imaginative ways of supporting people to be independent with their medicines. One person told us about the support they had received to manage their medicines in preparation for independent living.

Recruitment processes were followed to make sure new staff were safe and suitable to work in the care sector. People who used the service were involved in the recruitment of new staff. Staff followed a thorough and bespoke induction programme and then went on to complete the Care Certificate. Staff received training which was relevant and important to their area of work.

Staff received high levels of support from the management team. Supervision sessions were arranged on a four weekly basis and annual appraisals centred around setting personal goals and valuing staff performance. Staff told us the management team all encouraged professional and personal development. We saw this had a positive impact on morale and the care and support people received.

Systems were in place for making sure the premises were safe and infection control procedures followed. Checks were made on a daily basis to check standards of hygiene and availability of equipment to ensure effective infective control.

Staff understood their responsibilities under the Mental Capacity Act. We saw good and innovative examples of staff using communication aids to support people to voice their decisions and of how best interest meetings were used when people were unable to make an informed decision. There was a strong emphasis on supporting people in the least restrictive way possible. This allowed some people to flourish where in past placements they had been regarded as challenging to staff and others.

People were supported to plan their meals using information about the nutritional value of different foods. People who needed to follow a particular diet were supported in doing this. We saw an excellent example of staff supporting a person to access a local weight loss group. This allowed the person to be part of their community, develop new friendships and build a wider support network in readiness for independent living.

Staff were committed and excelled in ensuring people’s health care needs were met. We saw a number of examples of how staff actively supported people to make sure they received excellent levels of healthcare intervention and support to make sure they experienced optimum levels of physical and psychological well-being.

Staff consistently supported people to be as independent as possible and were proactive and creative in the ways they did this to ensure people’s lives were fulfilled. Staff engaged with people at every opportunity; listened and were interested in what people had to say. Staff knew people well as individuals and were able to tell us about their wishes and preferences in a way that showed it was clear people were truly at the centre of the support staff provided. One person told us, “I think this place is brilliant. The staff are not rude or disrespectful but they want to see people do things [for themselves]. You cannot fault them.

The service provided to people was extremely personalised and responsive and focussed on making people’s quality of life as good as possible and all staff were fully engaged in this process. Each person had an ‘All about me’ file which had been drawn up with them and provided a clear picture of everything about the person including their needs, wishes, fears and aspirations.

People were supported to engage in meaningful voluntary work through a local organisation, attend day centres and were supported in their preferred activities and interests. We saw an example in one person's care records which detailed they were a strong swimmer and needed a staff member who had the same ability so they could swim next to them when doing lengths.

Systems were in place for people to raise any concerns or complaints they had about the service. Where concerns were raised these were investigated and responded to appropriately.

All of the staff we spoke with demonstrated that the vision and values of the service are to enable people to live their lives at their optimum level through a person centred approach where positive risk taking is promoted. Innovative and inclusive management systems were in place to put people at the heart of the service with opportunities for all people involved to voice their opinions and suggestions.

We found the culture of the service was one of empowerment for both staff and people who used the service. Without exception staff told us they were proud of what they had supported people to achieve and showed a passion for their work and the people they supported. There was a clear sense that this was embedded across the whole staff team.

We saw records that showed us people had busy lives and were supported on an individual basis to choose how to spend their time. Care plans clearly reflected people's needs and the level of support they required. We observed staff supporting people to plan their evening and discussing future plans with them. There was a natural and friendly rapport between staff and people using the service. Staff were respectful and patient and clearly knew people well and understood their individual needs.

We saw that medicines were safely stored and administered and those people we asked told us they received their medicines and were satisfied with how this as handled by the home.

The home has a clear complaints procedure and people told us they would "Talk to staff" if they had any complaints. One person said "The staff will listen to me" and added "They ask me if I'm happy here, if I've got any problems".

The people that were able to tell us their views said they were happy with the care and support they received. They said they could talk to staff if they were worried about anything and felt their privacy was respected. The other people we met looked happy and relaxed. They had a good rapport with staff and moved freely around the service. Those that were able to accessed local the community independently and this was reflected in people's care plans and risk assessments.

We spoke to a relative of someone using the service and they spoke very highly of the care and support their loved one received. They said things like "Top marks to them", "They are doing everything they possibly can" and "It's done him the world of good". They also said they felt their relative was getting "The best of worlds" because if anything was wrong, for example with their health the staff were "Straight on it" but they were also being supported to do lots of activities and "Social things".