Cascade (Wilson House)

This service provides care and support to people living in two ‘supported living’ settings, so that they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

Cascade Supported Living provides personal care for people with a learning disability and autistic spectrum disorder. 13 people were receiving a service at the time of 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. Registering the Right Support CQC policy.

Not everyone using Cascade Supported Living receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

We were supported during this inspection by 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.

Positive outcomes for people routinely exceeded expectations. Staff worked hard to provide a consistently better quality of life for people by supporting them to develop in areas such as communication, social interaction, education and independence. People spoke highly of the support provided and told us how they had achieved improvements in their own abilities, independence and confidence.

The provider placed a clear emphasis on good governance, and promoted a transparent culture of leadership. The service was routinely challenged by feedback from people, staff and other stakeholders. Quality assurance was robust with an emphasis on learning from mistakes and being open and honest when things go wrong. The provider demonstrated an innovative high level of experience and capability to deliver excellent care; they were extremely knowledgeable and inspired confidence and passion in the staff team. They promoted a culture that was extremely person-centred and inclusive and which provided high-quality care with good outcomes for people.

People were encouraged and supported to take positive risks without unnecessary restrictions, to live meaningful lives. Staff showed an excellent understanding of their roles and responsibilities for keeping people safe from harm. They routinely questioned any areas where risks or ‘near misses’ were evident and implemented innovative solutions to keep people safe. For example, the implementation of ‘Social stories’ were used to embed routine and safety into people’s lives.

People were assured of receiving care and support to develop their daily living skills, independence, goals and aspirations. A holistic approach which included people, their relatives, staff and other health professionals had been adopted in the assessing, planning and delivery of people’s care and support. Care plans were extremely detailed and identified intended agreed outcomes with people. People were supported to monitor and evaluate their progress using a ‘spectrum star’ which consisted of between five and ten distinct areas that are important to the person’s overall quality of life and to the aims of the service.

The provider was creative in seeking people's feedback and people were actively involved in making

decisions about the care that they received. Their opinions were respected and listened to. The service was run very much around the needs of those living there.

Everybody enthused about how consistently kind and caring staff were. The provider worked in close partnership with other health professionals who consistently recorded positive feedback of how the service exceeded ‘normal’ expectations for a supported living service of this kind. The provider had developed strong familiar relationships with people and family members and were described as ‘going above and beyond’ in order for them to live an excellent quality of life.

People were protected from, and had an awareness of what constituted abuse and how to maintain their safety. Staff had received inclusive and comprehensive up to date safeguarding training and systems and processes were in place to support them to routinely raise any concerns for further investigation.

People were supported to take their medicines safely as prescribed. People were supported to take control of their medicines and to understand and reduce the reliance on medicines used to manage behaviour resulting in positive health benefits. Health professionals confirmed people’s reliance on medicines to manage behaviour had reduced because alternative interventions had been agreed and implemented to support people at difficult times.

Staff supported people to meet their needs safely and in a person-centred way. Staff worked with people to plan their care and support them to attain achievable goals and outcomes. People confirmed they received care and support from regular care workers who they knew. We found people were involved in safe recruitment and selection procedures to ensure new staff were suitable and had the appropriate skills, knowledge and compatibility to meet their individual needs.

Consent to care and support was sought in line with legislation and guidance. Staff were confident when working with regards to the Mental Health Act 2005. Restrictive practices were kept to a minimum and reviewed in best interest meetings for their effectiveness. People were supported to make choices, according to any beliefs or personal preferences. Information was communicated in a range of formats that was accessible to everyone regardless of their ability.

The Supported Living (SL) service is registered to provide personal care for people with a learning disability/Autistic Spectrum Disorder. People using the service live in their own flat located in a large property that is situated in Withernsea, a seaside town in the East Riding of Yorkshire. It is close to the sea front and town centre amenities and there is on-street parking.

There were eight people receiving personal care and support on the day we inspected. There was a registered manager employed at this service. 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 safety of people who used the service was taken seriously and the management team and staff at Cascade Supported Living were aware of their responsibility to protect people’s health and wellbeing. There were processes in place to ensure people’s safety, including risk assessments. These identified how the risks to people were minimised but also ensured people’s rights to choice and freedom.

Where people required assistance to take their medicines there were arrangements in place to provide this support safely.

People told us that they were supported by a consistent team of support workers who they had developed good relationships with. People valued the relationship they had with the service’s management team and support workers.

There were systems in place to ensure that people’s rights to respect, privacy and dignity were promoted and respected. There were sufficient numbers of support workers to provide a flexible service and staff were trained and supported to meet people’s individual needs.

Where people required assistance with their dietary needs this was planned for to ensure it was appropriate and safe. Where support workers had identified concerns around people’s wellbeing, appropriate action was taken to contact other health and social care professionals to support people’s wellbeing.

People and their representatives (where appropriate) were involved in making decisions about their care and support. People’s care plans had been tailored to the individual and contained information about how they communicated and their ability to make decisions.

The service was committed to person centred care and ensured that people using the service were at the centre of everything that they did. People's potential was recognised and they were supported to develop their skills and knowledge through learning. The registered provider was seen to constantly strive to ensure people who used the service were able to achieve their full potential and people's choices were acted upon by staff and management who went the extra mile to support them to live a fulfilled life and cared for them in a way they preferred. There was evidence of positive outcomes for people, and people had pursued new opportunities, progressed over time, gained new skills and increased their independence. There was a strong emphasis on person centred care and we found all staff and management were exceptionally kind and caring, very positive in their attitude to the organisation and their role and they said they were committed to the support and care of the people who used the service.

The service had developed and sustained effective links with professionals and this helped them have a multidisciplinary approach in supporting people. We saw written evidence from family members and health care professionals and the care files we looked at showed that people’s needs were continually reviewed. The plans ensured staff had all the guidance and information they needed to enable them to provide individualised care and support. People were consulted and involved in assessments and reviews.

People who used and worked for the service felt able to express their views and opinions to influence service delivery. The management team provided an excellent support network for staff and acted on the views of people. People and staff without exception told us they thought the service was well managed.

Systems to continually monitor the quality of the service were effective. The registered provider gathered information about the quality of their service from a variety of sources including people who used the service, their family and professionals.