The Regard Partnership Limited - Restormel Terrace

8, Restormel Terrace (known as Douglas House by people who live there) is a residential care home, which provides accommodation and support to people with a learning disability and/or autism. The service is registered to support a maximum of four people. At the time of the inspection four people were living at the service.

We found the following examples of good practice.

Visiting arrangements were in place, which ensured people could keep in touch with their loved ones. There was a system in place to ensure any visits were staggered and allowed for social distancing. People were supported to occupy their time in a meaningful way when they were unable to spend time outside of the service.

Staff had received infection, prevention and control training, they wore PPE correctly, understood the importance of it, and spoke confidently about how they put it on and took it off in line with infection control guidelines. People who lived in the service were supported to understand the importance of handwashing and some chose to wear face coverings when out in the community and in communal areas of the home.

Cleaning routines at the service had been increased which now included high touch areas, such as door handles and light switches. People who lived in the service were supported to understand the risks associated with COVID-19 and were involved in the cleaning of the house and their personal space.

There was an enthusiastic approach to testing, and the vaccine had been rolled out to people and staff. Risk assessments were in place as required and measures were being taken to protect people and staff who were assessed as being in a vulnerable category.

The registered manager had a good understanding of infection, prevention and control guidance and was confident in their decision-making processes, liaised with relevant agencies, and knew how to access local support.

To assess and monitor ongoing infection and control practices within the service, the registered manager had spot checks in place. The registered manager and provider had reflected on a previous outbreak in the service and had learnt lessons and made changes to minimise risks in the future. Should an outbreak occur the registered manager had a robust contingency plan in place and staff were confident about what action to take.

8 Restormel Terrace (known as Douglas House by the people who live there) is a residential care home, which provides accommodation and supports the needs of people with a learning disability and associated conditions such as autism and Asperger’s.

The service is currently registered to accommodate and support a maximum of four people. At the time of the inspection four people were living at the home.

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

The care service has been developed and designed 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 using the service can live as ordinary a life as any citizen.

There was a registered manager in post. 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.

At the last inspection, on 19 and 20 October 2015, the service was rated as outstanding in the domains of caring, responsive and well led. This meant that the service was rated as outstanding overall. At this inspection we found the service remained outstanding in those domains and therefore overall.

Why the service is rated outstanding.

People living at 8 Restormel Terrace had complex care needs and required a high level of support with daily care needs inside and outside the home. We met with all four people during our visit and observed some interactions between them and the staff. People had capacity and were able to verbalise their views and staff also used other methods of communication, for example visual choices and information sharing. The focus was on including people and seeking their involvement in every aspect of their lives.

When we arrived people were going about their day and following their planned routines. These planned routines helped provide reassurance to people who were living with autism. People were living a full life and there was a busy but relaxed atmosphere during the day. As the day went on people were either enjoying time on their own, with staff interaction when they needed it or going out on a planned activity. This was all based on people’s individual wishes.

People were encouraged to live active lives and were supported to participate in community life as much as possible using small, achievable goals that were obviously working. People were now able to attend community groups on their own, meet peers living nearby, attend social skills courses and practice independent shopping with less support. Activities were developed for people who perhaps had not tried certain activities before in order to increase the choices available to them. Other activities reflected people’s existing interests. The environment and the outside spaces had been designed for people living with autism to allow people to safely be on their own in the communal areas and courtyard in most weathers and to have support to choose what they wanted to do. There were quieter spaces where people could go if areas got too noisy or they wanted some quieter time.

The provider and registered manager had taken innovative steps to ensure people were at the heart of the service and involved in all aspects of the running of 8 Restormel Terrace, whilst encouraging and promoting independence. People’s opinions were regularly sought and valued. For example, people were enabled to achieve activities that had previously been a challenge for them and these were celebrated with consent in a ‘Douglas House achievements folder’ and visually with a digital photo frame. This all promoted a positive focus in people’s lives and celebrated success. Careful planning and involvement of those living at 8 Restormel Terrace clearly showed that the service was person centred and promoted a high quality of life. Family contact, holidays and people’s management of their own health, activities and work was important. A gentle, encouraging approach had resulted in an increase in positive behaviours and inclusion within the community. People and staff also knew each other well and were supported to live together in harmony, understanding each others needs.

People had their health needs met. People received visits from healthcare professionals, for example speech and language therapist and GPs to ensure they received appropriate care and treatment to meet their health care needs. Professionals confirmed staff followed the guidance they provided. The provider and registered manager also pro-actively sought advice from external agencies to further enhance people’s lives and enable them to move forward and grow. For example, people’s behaviours related to anxiety, alcohol abuse and repetitive negative behaviours had very much positively improved since living at the service. People, as well as staff, took on champion roles in a meaningful way and ensured their subsequent specialist knowledge was used to benefit everyone at 8 Restormel Terrace. For example, people had been trained to meaningfully become health and safety and first aid champions, as well as attending training with staff in topics that benefitted everyone. For example, in men’s health and oral care. This meant that when one person needed additional support, this was addressed in a general way involving everyone living at the home so they could all work together and understand each other without one person being singled out.

Some people had more complex communication needs and these were individually assessed and met. People were encouraged and supported to make as many decisions and choices whenever possible in their day to day lives, this was often through visual images, patient encouragement and information sharing and through social stories. This had enabled people to prepare fully for holidays, trip out and health appointments to reduce negative behaviours and anxiety with success. People were supported to access the community and promote their independence. For example, people who had previously been reluctant to go into the community independently for a long time, now had a programme developed and encouraged by staff to support them and regularly discussed people’s feelings about their progress. Other people had been able to take foreign holidays or take a trip to visit a relative. Staff and relatives worked together to support people in their own home. Families and staff were very involved in care and risk planning and sourced different ways for people to access the community safely.

People were now able to access many areas in the community due to the support they had received from staff to further enhance their quality of life within their community. This included support to seek voluntary work experiences, be involved in relevant charities and spend time with peers living in the provider’s other services nearby.

Staff were observed supporting people with great understanding about how individuals living with autism saw the world and displayed patience and kindness. Compassionate care was really important to the values of the service and was clearly reflected in how staff cared for people. People were matched with staff who they particularly got on well with and all had a named key worker whom they spoke of. One person said, “He’s [staff member’s name] my friend really.” Valuing people and enabling them to feel they mattered was important and staff enabled people to help in the running of the home. For example, a cooking club enabled people to plan meals and do the shopping on a regular basis. People used their chosen easy read recipes which enabled them to eat together when they wanted to and people took it in turns to choose the meat for the Sunday roast. The staff had built strong relationships with the people they cared for and respected people’s privacy. People or their representatives, were very involved in decisions about the care and support people received. People were able to voice their opinions and aspirations knowing they would be listened to. For example, one person had expressed a desire to move nearer their family and this was being looked at with the person, including discussing the reality of moving and visiting possible services.

People, relatives and staff felt the service was extremely well led. Relatives and staff described the registered manager as very approachable, available and supportive. Staff talked very positively about their jobs and took pride in their work, all telling us how much they found their work enjoyable and rewarding. Comments included, “I like working a Douglas house because everyday is different, the team are really good and I class them all as friends. I like seeing people progress and learn new things.”

People lived in a service where the provider’s values and vision were embedded into the service, staff and culture. The registered manager and staff were very passionate about the service. They had very robust quality assurance processes in place with the support of a head office. Audits were conducted to ensure any issues in the quality of care and environment were identified promptly. Accidents were investigated and, where there were areas for improvement, these were shared for learning with people, staff, other services and health professionals.

The provider had a complaints policy in place and the registered manager said any complaints received would be fully investigated and responded to in line with the co

People we spoke with told us they were very happy with the care they received from the service and they were enjoying their lives. One person told us "The staff are great and they are helping me to become more independent'. The deputy manager told us 'The people we care for have an enormous amount of input based on their likes and dislikes. We are always encouraging their independence'.

We saw that people had specific and individualistic care plans. These had been completed daily in accordance to people's wishes. Care plans were easy read with pictures and colour coded charts. This demonstrated an awareness of the individual persons understanding and abilities to read and understand their own care plan.

Support staff worked at a level required by the individual and promotion of independence was evident. Staff had all received a thorough core training programme that included safeguarding and attended regular updates.

There were sufficient support workers to meet people's needs and appropriate background checks had been completed on all staff. Audits were in place to continually monitor and assess the quality of care and support provided.

Comments from people we spoke to included;

'The staff are nice, I like to go to the disco and swimming every week. The staff help me understand about healthy food so that I think about my diet and what I eat'

" I have a key worker, and we meet every month to discuss my care and the things I am doing'

During our visit we saw that staff treated people respectfully at all times, promoting choice and independence whenever possible. Staff were aware of when people may be anxious or upset and used their skills and knowledge to provide reassurance and support.

People were supported to develop their daily living skills. One person said 'We have a rota so that we know when to clean our rooms, the staff help us when we ask them'

We found that people engaged in a range of age appropriate and meaningful activities inside and outside the home. Sufficient staffing levels were in place to support people when needed.

All of the staff we spoke to were aware of the systems in place to keep people safe. People using the service were provided with information about keeping safe and who they needed to speak to if they had any concerns. One person said, 'I like living here, I feel safe'

The provider regularly reviewed the quality of the service and was able to demonstrate that changes had been made as a result of any feedback received.