Melvyn & Jan John

Melvyn and Jan John is a residential care home providing personal and nursing care to one person living with severe learning disabilities and Autism. People live together as a family in a two bedroomed terraced house in Ripple.

The service was registered prior to the guidance ‘Registering the Right Support’. However, the service has been developed 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

People lived in a service which supported them to stay safe and protected from discrimination, abuse and avoidable harm. The providers were knowledgeable about how best to minimise risks and were aware of possible triggers and risk factors. People were encouraged and supported to take positive risks and their rights to freedom were promoted. Restrictions were kept to a minimum and people felt safe and secure living with the providers as part of a family. The providers regularly reflected on changes in people’s behaviour to help identify possible triggers and reduce the risk of reoccurrences.

People were supported by the two providers who were both trained and experienced learning disability nurses. They had lived together as a family for many years. People had a circle of support, a group of family, friends and health care professionals, who gave support and friendship to people.

People’s care and support was planned, monitored and reviewed in line with evidence-based guidance, such as the British Institute of Learning Disabilities. The providers kept their knowledge up to date and were registered with the Nursing and Midwifery Council.

People continued to be supported to eat healthily and meal times were social, family occasions. People were involved in cooking and shopping for the service. The providers worked closely with health care professionals to make sure people remained as healthy as possible. People had a communication passport to make sure important information about their needs and preferences could be shared with other health care professionals when required.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. 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.

People were treated with kindness and compassion and had clearly built trusting relationships with the providers who knew them well. The providers noticed small changes in people’s behaviour which may indicate a decline in their health or be a sign of distress. People were constantly reassured and appeared very settled. People’s privacy and dignity were respected, and their independence was promoted.

People’s care and support needs were planned and reviewed with their circle of support to ensure their needs and preferences were met. People were supported and encouraged to maintain relationships with those who were important to them. People continued to stay as active as possible with many holidays and regular trips out, for example to wildlife parks. People were offered choices and given information in the way that suited them best, such as using picture cards.

People were supported in a positive, open and inclusive environment where they were valued for their individuality. The providers constantly researched ways to improve people’s lives. They demonstrated compassion and enthusiasm to provide the best support they could and welcomed feedback from people’s circle of support.

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 (Report published 28 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.

Melvyn and Jan John provide care and accommodation for people who have Autism and learning disabilities. The home is set in a rural area.

The service had a registered manager. 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 culture of the home was totally person centred and people were supported to have the lifestyle they chose. The registered manager and staff found out how people wanted to be supported and how they wanted to spend their time. Meetings were held regularly with people and their circle of support, to plan and discuss their goals and aspiriations, so that the service was run in the way people wanted.

The home was run as part of a family. It was warm, friendly and people’s individuality was respected and nurtured. The registered manager and staff were skilled and competent to support people in their care. A person’s friend commented, “The life offered to [person] is one of culture, travel, nature, art, music, food and meaningful relationships with people.”

The providers were qualified nurses for people with learning disabilities and had the right skills and competencies to give people outstanding care. They had extensive knowledge and experience in supporting people with Autism and learning disabilities and made sure they kept up to date with current good practice and knowledge based on research in the areas that related to the people in their care.

People were cared for and supported to develop their independence and confidence. People chose what they wanted to do each day. There was a mixture of a familiar routine and different activities offered so that people’s daily life was secure and varied. The providers were committed and worked hard to provide a service that increased people’s quality of lifestyle.

All eventualities were taken into consideration rationally and systematically, and responded to in a way that if the experience was going to enhance a person’s life then it was worth trying.

By learning what was important to people to help them feel secure and finding out innovative ways to assist with this, the registered manager and staff had helped people develop their self confidence. The result of this was that they had overcome situations that had previously limited their experience. There was a familiar routine full of techniques and predictable activities that helped people know where they were in time and place and gave them the self confidence to be able to try new experiences.

As a result people’s world had opened up and they had countless new experiences and opportunities to visit places and engage in activities that they had previously not had the opportunity nor confidence to try. For example when one person first moved to the service they had no idea how to walk in the countryside, negotiate stiles and rough ground, run, eat in a socially acceptable manner at home or in a restaurant, ride a horse, bounce on a trampoline, go on an aeroplane or ferry, go upstairs, grate cheese, stir gravy, indicate agreement, attract someone’s attention, request something and look at anything more than about 15 feet away. Now the person had flown on holiday three times to the Canary Islands, had been to music concerts and ballets, had climbed to the top of Ben Nevis, had eaten in countless restaurants and been camping, boating and even went canoeing. These were amazing achievements where the person had needed to overcome fears from past experiences, sensory confusion and communication difficulties.

The providers supported people effectively to help them overcome any barriers to relationships with other people and to enrich their lives by developing meaningful friendships. People had as many opportunities as they wanted to go out and about meet people and live an ordinary lifestyle. Time had been spent to enable people to have a circle of support that was meaningful to them and provided advocacy support. People regularly went away with the registered manager and staff to meet and stay with friends. One person had recently been able to attend and enjoy a friend’s wedding celebration.

People and their circle of support were involved in any new decisions that needed to be made including recruiting new staff. Potential staff were thoroughly vetted to make sure they were safe to support people. People had the time they needed to get to know potential staff before they were able to offer any support or work in the service.

People were supported to keep well and healthy and if they became unwell the staff responded promptly and made sure that people accessed the appropriate services.

People behaved in a way that expressed that they felt safe in the service and staff had a clear understanding of what could be abuse and how to report it. There was a relaxed and calm atmosphere and people were treated with kindness and compassion.

Consideration had been given to people’s safety and potential risks had been assessed. People had the equipment and support needed to prevent unnecessary accidents and incidents. Positive risks were taken to help people develop their independence and try new experiences. Each situation and opportunity was assessed for how it would enhance the person’s quality of life.

Mealtimes were organised in the way each person preferred. People were involved in making drinks, snacks and meals as much as wanted and were encouraged to eat a healthy diet.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Mental capacity assessments had been carried out to determine people’s level of capacity to make decisions in their day to day lives and for more complex decisions when needed. Applications for DoLS authorisations had been made for people who needed constant supervision because of their disabilities. There were no unnecessary restrictions to people’s lifestyles.

People were supported to maintain a healthy, active lifestyle. People’s days included plenty of exercise and activities.

The registered manager used effective systems to continually monitor the quality of the service and had on-going plans for improving the service people received. There was a clear complaints procedure and process that was designed to enable people to express their views and were responded to in a way they could understand. The registered manager welcomed complaints and used the opportunity to improve the service.

Plans were in place so if an emergency happened, like a fire, everyone knew what to do. Safety checks were carried out regularly throughout the building and the equipment to make sure they were safe to use.

The person was assisted to express their views and make day to day decisions because the providers helped them with their communication and spent time with them. When the person needed to make important decisions they also had the support of an independent advocate.

The person received support to maintain a healthy, active lifestyle. They were able to pursue a variety of hobbies and interests at home and out in the community. The person was assisted to manage health conditions and was given the support they needed with their physical and mental health.

The home was well maintained and checks were in place to make sure it provided a safe environment for the people who lived there.

The person was assisted to express their views and make important decisions because the providers helped them with their communication and spent time with them.

The person received support to maintain a healthy, active lifestyle. They were able to pursue a variety of hobbies and interests at home and out in the community. The person was assisted to attend health care checks and was given the support they needed with their physical and mental health. A healthy balanced diet was offered and the person was supported to develop their independence skills, including making snacks and drinks.

The owners are the only staff and keep themselves up to date with current good practice through training courses and journals. The service was reviewed by the funding authority and there was a good relationship with neighbours and people in the local community.