Moordean

Updated 13 December 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 17 August 2017 and was announced. We gave short notice of the inspection so that people may be less anxious by our presence in their service. The inspection team consisted of two inspectors and an expert by experience. An expert by experience was a person who had personal experience of caring for someone who uses this type of care service. The expert by experience observed care and talked to people and visitors to gain their views of the service provided.

Before the inspection, we asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We looked at notifications about important events that had taken place at the service, which the provider is required to tell us by law. We used this information to decide which areas to focus on during our inspection.

People used a range of communication styles and their abilities to verbally tell us about their experiences was limited. However, people communicated with us, either by us observing how they responded to staff when care was delivered or by them talking to us about things that were important to them. We spoke with three people about their experience of the service. Two people invited us to view their bedrooms and we asked them about their experiences of the care. We spoke with three relatives and four staff including the registered manager, a team leader, a shift lead and a support worker. We received feedback about the service from a commissioner at the NHS Swale Clinical Commissioning Group and an external Psychiatrist.

We spent time looking at records, policies and procedures, complaint and incident and accident monitoring systems. We looked at four people’s care files, three staff record files, the staff training programme, the staff rota and medicine records.

The service had been registered with us since 05 September 2016. This was the first inspection carried out on the service to check that it was safe, effective, caring, responsive and well led.

Updated 13 December 2017

The inspection was carried out on 17 August 2017 and was announced.

Moordean is a care service providing personal care and accommodation for six adults with complex learning disabilities, mental illness and behaviours that may cause harm to themselves or others. People were at risk of being socially excluded due to their behaviours. This service is one of a group of seven care services owned by Insight Specialist Behavioural Service Ltd. The person centred positive social support people received prevented them from becoming isolated and enabled people to fully participate at service and within their local community.

People had transferred to Moordean within the last year from another service also run by Insight Specialist Behavioural Service Ltd. The move to Moordean had resulted in people living in a more homely setting designed to reduce people stress and anxiety levels. Moordean had been adapted to suit the individual complex needs of the six people who lived there. The building was spacious and airy and has been designed with input from people themselves and the specialised behaviour support team to ensure it met people’s specialist and individual needs. Everyone had access to an on-suite shower room and some people had their own kitchenette facilities. The service also had a communal kitchen, bathroom with a bath, dining/lounge room, and secure garden. One person was learning to be more independent and lived in their own self-contained annex on site.

The providers had fully embraced the principals of Positive Behavioural Support (PBS). PBS is recognised in the UK as the best way of supporting people who display, or are at risk of displaying, behaviour which challenges care services. The providers had resourced and modelled people’s care in accordance with current PBS best practice principles.

Staff clearly understood their roles in minimising risk. Risk assessments were reviewed regularly to ensure that the level of risk to people was still appropriate for them. One member of staff said, “The behavioural management training we get shows us how to minimise risk for each person to keep them safe.”

The appropriate positive responses were delivered through individualised behavioural strategies which consistently reduced the instances, severity and intensity of harm or potential harm to people, staff and others. This created an improving picture of life experiences and choice for people, whom, in the past, may have been excluded, marginalised and isolated from wider society.

Person centred care and people’s safety was at the heart of the care people experienced. The provider’s shared their vision and values with staff and others so that they were understood and acted on. Staff told us that the positive culture and providers values were embedded from the first day of their induction training. Staff saw themselves as enablers, promoting people’s rights and participation.

Positive Behaviour approaches supported social inclusion and was used in maintaining contacts with family members. The providers maintained their own professional knowledge and understanding of best practice in learning disability services.

People were protected from institutionalisation. People’s lives were based on person centred circles of support. (A circle of support is a group of key people that can help someone with a learning disability, mental illness to make decisions about their life.) The providers and staff worked with families to overcome some of the challenges they faced in maintaining contact with their loved ones who may not always respond to them positively. Key family members were involved in planning positive behavioural therapies.

To promote exceptional outcomes for people who may otherwise be excluded the providers led by example and visited the service every week, chairing clinical meetings and overseeing the detailed planning and daily operations of the service.

A health and social care professional commented about the qualities at Moordean. They said, “The service provides a positive and safe environment, staff have great knowledge of the people they care for, are person centred, take positive risk and are empowering of individuals by supporting them on their pathway with a holistic approach to individual care.”

The providers were innovative and creative and constantly strived to improve the quality of people's lives, consistently implementing positive behavioural therapies, using research and gathering individualised data to assist people with different and often challenging communication styles to develop skills and positive experiences. For example, people’s challenging behaviours were declining. When challenging behaviours did occur, these were being increasingly managed by staff using verbal interventions rather than physical interventions.

The providers, registered manager and staff participated in research and the collection of behavioural data aimed at improving the quality of outcomes for people. They recognised that harmful behaviours were also a form of communication.

Staff were consistently supported to understand how people communicated their needs, how to meet people’s needs and how to respond calmly when people’s challenging behaviours escalated, either at service or within the community. Staff received specialised training based on each person’s conditions.

Each person had access to a member of staff called a mentor with enhanced training in Positive Behavioural Therapies (PBT). Incidents and accidents were recorded in such a way as to provide data to the Positive Behaviour Therapist who met with the person involved, with staff, the registered manager and the provider’s to see what steps could be taken to prevent incidents happening again. When people presented negative responses to experiences, they were not excluded, but the approach to the activity by staff was adapted to try and turn negative responses into positive outcomes. Changes in behavioural strategies were supervised by the head of the Insight Positive Behaviours Service (PBS) team who was a Dr in Counselling Psychology. Additional Specialist support was also provided by psychiatrists and mental health nurses.

Positive Behavioural Therapies enabled staff to use data collected about people’s moods and behaviours to identify trigger points that indicated people may be unwell. Staff making prompt referrals and enabling access to medical care via GPs supported people to maintain their health and wellbeing. Information about health monitoring and communication was appropriate collected and shared with external health care services, for example ambulance and hospital staff. Staff had been trained to assist people to manage the daily health challenges they faced from conditions such as epilepsy and diabetes. Staff understood the challenges people faced and supported people to maintain their health by ensuring people had enough to eat and drink. People were supported to make healthy lifestyle choices around eating and drinking.

All the staff were involved in monitoring the quality of the outcomes based care people experienced. Audits systems were connected to the providers risk based management system which fed back into clinical reviews and quality development. The provider shared their learning with all the services in the group.

Positive risk taking was promoted and safety systems were consistently reviewed and audited to reduce the risk of harm. Risk assessments were extremely detailed and were seen as working documents. Risk levels were constantly reviewed and changes to interventions and staffing levels were linked to individual risk levels from hour to hour.

The provider gave people the opportunity to share their views by training staff to understand people’s communication styles, for example using objects of reference and collecting detailed data about people’s moods, facial expressions and body language. Actions taken by the provider and planned improvements were focused on improving people's quality of life, based on the research and in partnership with external experts. People, their relatives and healthcare professionals were encouraged to share their opinions about the quality of the service, to ensure planned improvements focused on people's experiences.

The training and supervision staff received enabled them to recognise and respond to communications and behaviours to reduce the risk of violence and aggression occurring. Staff consistently implemented responses that were tailored to the individuals needs and that had been planned by behavioural analysis and specialist behavioural therapist and external health and social care professionals.

Staff provided friendly compassionate care and support. The providers valued their staff and understood they needed additional management support to manage stress and work intensity. Staff were kind and calm at all times. People were encouraged to get involved in making decisions about their everyday lives. People had choices about what activities or routines they wanted to follow. Staff were deployed to enable people to participate in community life, both within the service and in the wider community.

The registered manager produced information about how to complain in formats to help those with poor communication skills to understand how to complain. This included staff understanding people’s moods, behaviours and body language. Staff frequently checked with people if they were unhappy about anything in the service. If people complained, they were listened to and the registered manager made changes or suggested solutions that people were happy with. The actions taken were fed back to people.

Staff had received training about protecting people from abuse. The management team had access to and understood the safeguarding policies of the local authority and followed the safeguarding processes.

Recruitment policies were in place. Safe recruitment practices had bee