The Old Red Lion

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has changed to outstanding.

This meant people’s outcomes were consistently better than expected compared to similar services. People’s feedback described it as exceptional and distinctive.

This service scored 92 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider demonstrated outstanding practice in assessing people’s needs. Staff understood people’s needs could change rapidly, from moment‑to‑moment decisions to long‑term goals, and therefore carried out assessments routinely, including hourly, daily and weekly reviews. This highly responsive approach was only achievable because staff knew people exceptionally well and understood their communication methods, behaviours and emotional cues in depth.

When people were admitted to the home, the registered manager ensured assessments were thorough, accurate and truly reflective of the individual. They involved the person, their family and, where appropriate, external professionals to build a complete picture of the person’s needs, preferences and communication style. The registered manager did not simply accept previous assessments or restrictions at face value. They explained that some people had been misunderstood in their previous services because staff there had not recognised or interpreted their communication methods correctly. This had resulted in inappropriate assessments and unnecessarily restrictive care plans being adopted.

At this service, people’s needs were assessed in every situation, including during times of distress, anxiety or fear. Staff observed how people communicated discomfort, how they responded to reassurance, and what environmental or sensory factors influenced their wellbeing. This enabled staff to provide support that was effective, compassionate and delivered with the least possible restriction.

The continuous cycle of assessment meant staff could adapt support immediately when a person’s needs changed. Whether someone required help making a simple choice or needed a complete review of their long‑term goals, staff responded with skill, sensitivity and a deep understanding of the individual.

The provider demonstrated outstanding practice in delivering care and treatment grounded in evidence‑based approaches. The registered manager and staff consistently used structured, research‑informed techniques to support people’s development, communication and emotional wellbeing. Their commitment to applying proven methods, while tailoring them to each individual, resulted in highly effective and meaningful outcomes.

Staff used structured support and guidance to help people improve their social interaction skills. This included planned, step‑by‑step exposure to social environments, modelling communication strategies and offering predictable routines to reduce anxiety. As a result, people who had previously struggled in group settings were now able to attend friendship groups and day centres with confidence and enjoyment.

Naturalistic intervention techniques were also embedded throughout the service. Staff used everyday interactions to promote language development, communication and engagement. In one example, staff gave their own free time to learn words and phrases in a person’s native language. This not only strengthened communication but also demonstrated deep respect for the person’s identity and culture. These approaches helped people feel understood, valued and more able to express themselves.

We observed a wide range of communication tools available in people’s apartments and bedrooms, including visual schedules, emotion charts, symbol boards and personalised communication books. These tools ensured that, regardless of a person’s mood, sensory state or emotional experience, they had effective ways to communicate their needs. Staff were skilled at recognising when a person needed to switch communication methods and adapted seamlessly to ensure the person remained in control of their interactions.

The consistent use of evidence‑based strategies meant people received care that was not only compassionate but also highly effective. Staff’s ability to combine professional knowledge with deep personal understanding of each individual ensured interventions were meaningful, respectful and tailored to what worked best for the person.

The provider demonstrated good knowledge and practice in how staff, teams and external services worked together to support people. Although the need for external professionals was currently limited, staff remained highly knowledgeable about the range of community and specialist services available should people’s needs change. This ensured the team was always prepared to seek additional support promptly and appropriately.

Staff communicated effectively with one another, sharing observations, updates and insights throughout the day to ensure people received consistent, well‑coordinated care. Team meetings and handovers were used purposefully to review people’s progress, identify emerging needs and plan proactive responses. This collaborative approach meant staff could adapt quickly and confidently, ensuring people experienced seamless support.

When external involvement was required, the registered manager and staff worked in partnership with professionals, families and community services to ensure people received the right input at the right time. Their strong understanding of each person’s communication style, health needs and preferences meant they could advocate effectively and ensure external professionals had accurate, meaningful information.

Staff showed exceptional skill, patience and creativity in helping individuals overcome long‑standing barriers to good health, particularly where these were linked to autism, sensory needs or past experiences.

One person had lived for many years with a highly restrictive diet, eating only one food type due to sensory triggers associated with their autism. This had resulted in them becoming significantly underweight and at risk of further health complications. Staff approached this sensitively and gradually, using evidence‑based techniques to help the person explore new foods safely. They introduced visual and aroma‑based experiences first, allowing the person to become familiar with different foods without pressure to eat them. Staff also encouraged the person to socialise at mealtimes, observing others enjoying a variety of foods in a relaxed and positive environment.

Over time, the person began trying new foods at their own pace. With consistent reassurance, patient support and a highly personalised approach, they now eat a varied and balanced diet, including meals out in the community. As a result, they have reached a healthy weight and experienced a significant improvement in their overall wellbeing.

Staff consistently promoted healthy lifestyles for all individuals, supporting people to make informed choices about nutrition, physical activity, emotional wellbeing and community participation. Their approach was proactive, respectful and grounded in a deep understanding of each person’s needs, preferences and sensory profile.

The provider had highly effective systems in place to monitor people’s progress and ensure their care and support continued to meet their needs. Everyone living at the service had an allocated key worker who met with them weekly to review how they were feeling, reflect on recent progress and agree small, achievable aims and goals. These meetings were clearly recorded and demonstrated how staff supported people to build confidence, develop new skills and work towards outcomes that were meaningful to them.

In addition to weekly key‑worker sessions, people had a more detailed review every four weeks. These reviews brought together information from daily records, professional input and the person’s own views to ensure support plans remained accurate, responsive and reflective of any changes. Where new needs or patterns were identified, staff updated plans promptly and shared new strategies with the wider team to maintain consistency across the service.

The management team demonstrated an excellent standard of oversight. They monitored outcomes closely, identifying trends, celebrating achievements and ensuring any barriers to progress were addressed quickly. This structured and proactive approach meant people received support that remained person‑centred, effective and aligned with their ongoing development.

Staff consistently respected people’s rights around consent and ensured decisions about care were made in a way people could understand. Staff demonstrated a clear understanding of the importance of gaining consent before providing any care or support, in line with the expectation that people receive information in a way that is meaningful to them and have appropriate support to make informed decisions.

Because the people living at the home communicated non‑verbally or through subtle behaviours, staff were skilled in interpreting each person’s preferred communication style. They used personalised communication profiles, observed body language, gestures, expressions and responses to assess whether people were happy to proceed with care. Staff understood what “yes”, “no”, hesitation or uncertainty looked like for each person and adapted their approach accordingly.

When people were not able to give consent verbally or obviously, staff used consistent, person‑specific cues, offered choices in accessible ways, and provided time for people to process information. This ensured people remained in control of their care. Staff also recognised when people needed reassurance, space or alternative methods of communication to feel comfortable giving consent.