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Inspection carried out on 15 August 2017

During a routine inspection

Mill House is a large detached stone built property which provides accommodation for up to five people with autism. At the time of our inspection there were five people in receipt of care from the service.

At our last inspection in May 2015 the service achieved an overall rating of ‘Good’. This inspection took place on 15 August and 5 September 2017. We also spoke with relatives and professionals on 21 August 2017. At this inspection we found the service remained Good overall and was rated ‘Outstanding’ in the responsive domain.

People received high quality person-centred care from staff who understood their needs. The service had in place a number of good practice systems which facilitated people being able to communicate to staff the type of care they wanted to receive.

Care documents were significantly detailed and accurately reflected to a high degree each person’s history and needs. Guidance given to staff on to how meet people’s needs was very specific. Regular reviews were carried out with people who used the service and included their relative’s voice to ensure people’s care provision was up to date and reflected their individual preferences.

The staff had extensively researched holidays abroad when the people using the service wanted to go on a group holiday. This included researching the needs of people with autism when using airports. Staff found and implemented autism passports at their departure airport which assisted people going through security checks and prevented any distress to the people from the service who were going on holiday.

We found people were enabled to live extremely fulfilling lives in which they were given choice about their activities. Staff supported people to carry out highly individual choices and suggested alternative activities, for example growing vegetables, to give people who used the service a broad spectrum of options. Staff had also introduced themed events around different cultures. This enabled people to learn about diversity and participate in events which were new and meaningful to them.

Risks assessments in the service were well-documented and were highly personalised. Staff demonstrated they understood the risks and the required actions to keep people safe.

Staff understood the needs of people with autism and the very individual needs of each person who lived at Mill House. We found when there was a transition to be made, people’s needs were considered in great detail.

We spoke to relatives who told us they had no concerns about the service and confirmed they had not made any complaints. The manager told us no one had made a complaint about the service. Relatives said they felt involved in the service and in the care of their family members.

Staff were supported through a programme of induction, training and appraisal. We saw staff recruitment was robust. Staff underwent pre-employment checks before they started working at the service. Managers in the service were due to start management development training.

Staff had been trained in safeguarding and were confident if they raised a concern with their manager they would respond appropriately. Relatives told us they had confidence in the management of the home.

We reviewed people’s medicines and found there were safe systems in place for their storage and administration. Guidance was available to staff to support them to give people medicines which were required on an ‘as and when’ basis.

Relatives and professionals alike told us they thought people who used the service were well cared for. We found staff respected people’s privacy and dignity. People’s independence was encouraged by staff.

People were supported 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 had systems and processes in place to monitor quality. Audits were regularly carried out. The service used an ex

Inspection carried out on 12 and 14 May 2015

During a routine inspection

This inspection took place on 12 and 14 May 2015 and was announced. This meant the provider did not know we were arriving.

Mill House is a new service and has not previously been inspected.

The service provides accommodation for five people with learning difficulties and is set in a rural part of County Durham.

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 time of our inspection there was a registered manager in post.

We found people’s medicines were managed safely. Records showed how people preferred to take their medicines and staff were aware of people’s preferences.

We found all areas of the home including the laundry, kitchen, lounges and bedrooms and bathrooms were clean, pleasant and odour-free.

In people’s care records we found the numbers of staff required to care for each individual was described. These were included on the staff rota and we found the required number of staff were on duty.

The provider had carried out robust checks on staff before they started working in the home. This ensured people who were employed by the provider were assessed as being safe to work with vulnerable people

All of the staff had received safeguarding training and the staff on duty were able to articulate to us the different types of abuse.

The registered manager and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The registered manager had submitted applications to deprive people of their liberty.

We found staff were appropriately supported through the use of induction, supervision, appraisal and training.

Staff were aware of people’s eating habits and had put arrangements in place to support people who required special diets.

People had in place communication passports which contained information on the best ways to communicate with people who used the service. We saw the service used pictures and photographs to support people.

During our inspection we found involvement was a key theme of the home. We saw the provider had put in place arrangements to support people being involved in decisions about their home.

We observed people were comfortable in the presence of staff and staff worked with people in gentle ways whilst being firm and maintaining safe boundaries.

The service spoke up for people and used advocacy services to make sure any decisions taken about people were in their best interests.

We found the provider had in place a comprehensive set of care plans which described people’s needs, wishes, hopes, dreams and aspirations. We saw people met with their keyworkers and were involved in reviewing their care plans. Staff were given detailed guidance on how to care for people.

People were engaged in activities which they liked and staff looked for activities to help people achieve their goals.

The registered manager had in place a broad range of audits to monitor the service quality and produced a monthly report for the provider which detailed what had happened in the service.

The registered manager also maintained a number of logs from which she could monitor the service and check its progress.

Staff were confident in the registered manager’s knowledge and experience to lead the service.