We carried out a review of the data available to us about Bigwig House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Bigwig House, you can give feedback on this service.
Bigwig house provides care and accommodation for up to three people who have autistic spectrum disorders. At the time of the inspection three people were living at the service. The service is part of the Green Light group who run several similar services throughout Cornwall, for people living on the autistic spectrum.
The service has been developed and designed 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
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.
Staff enabled people to live as fulfilling live as possible and achieve the best possible outcomes. Staff knew people exceedingly well and worked together as a team. They set high standards for people to achieve and strived to support people to reach their full potential. The care and support people received was exceptionally compassionate and kind.
People were supported to try new experiences while any related risks were identified and action taken to help reduce the risks. Staff were exceptionally skilled at understanding and managing people’s complex needs and behaviour. This knowledge, and the strategies put in place, had enabled people to exceed expectations in the skills they had learnt and how their independence and well-being had been enhanced.
People received care and support that was individual to their needs and wishes. Care plans were regularly reviewed and updated and were an accurate reflection of people’s needs. Staff actively supported people to maintain links with the local community, their friends and family.
People were supported to pursue their interests, hobbies and gain new skills. Staff were flexible and responded to people’s needs and wishes, adjusting activities accordingly, as well as exploring and trying new ideas with people.
People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately. Staff helped people to plan meals and shop as well as preparing and cooking meals. Staff encouraged people to eat a well-balanced diet and make healthy eating choices.
Staff were recruited safely and there were sufficient numbers to ensure people’s care and social needs were met. Staff received induction, training and supervision to assist them to carry out their work.
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/ did not support this practice. Any restrictive practices were regularly reviewed to ensure they remained the least restrictive option and were proportionate and necessary.
There was a clearly defined management structure and regular oversight and input from senior management. Staff were positive about the management of the service and told us the registered manager was supportive and approachable.
The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.
As part of thematic review, we considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people. The service used positive behaviour support principles to support people in the least restrictive way. The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.
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 good (report published 22 February 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.
Bigwig House provides accommodation and personal care for up to three people who have autistic spectrum disorders. It is part of the Greenlight group which offers care and support to people with learning disabilities and autistic spectrum disorders living in Cornwall. At the time of the inspection three people were living at the service.
There was a registered manager in post. 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 service had not gained consent in respect of a person's care and support. The service had introduced a reward system for carrying out daily tasks. However it also imposed penalties for behaviours which challenged the service. There was no evidence to demonstrate this had been developed and discussed with the person or a best interest meeting arranged before the plan was started, in order to give them choices and consent to the design of their care and support.
Risk assessments were completed and regularly reviewed. However, we found instances where appropriate risk assessments had not been completed.
Where appropriate people were assessed in line with the Deprivation of Liberty Safeguards (DoLS) as set out in the Mental Capacity Act 2005 (MCA).
There was a positive culture within the service as demonstrated by how staff interacted with the people they supported and what we were told by staff when we spoke with them. Staff felt empowered by the organisation to support people as individuals and encourage and help them to reach the goals they set for themselves in their lives.
The service was organised to suit the needs of the people who lived there. One professional we spoke with, who knew the service, commented positively about how the service ran, “Bigwig are very proactive in their communication and are always keen to try new ideas and feedback on progress. Staff are very attentive to people’s needs and interact appropriately with residents.”
We observed that people were relaxed and comfortable during the inspection. Staff interacted in a friendly manner and supported people as they needed whilst encouraging them to be independent. Staff demonstrated a caring attitude towards the people living at Bigwig House. People were supported to maintain strong relationships with their families. People’s preferred method of communication was taken into account and respected.
Staff recognised the importance of family relationships and friendships. People were encouraged and supported to develop and maintain social networks. People had access to a range of activities which supported them individually. All three people took a holiday in the summer months and were supported by staff to choose where to go and plan the holiday. People were supported by two staff members when they went on holiday due to their level of need. People had been able to fulfil long term goals, such as visiting historical sites in the UK and abroad which had brought them much pleasure.
Care records were person centred and contained detailed and specific information to guide staff who were supporting people. There were some parts of the care plans which included information about the person in a format which was meaningful for people. This included large print and pictorial information. Care documentation was regularly reviewed and updated to ensure it reflected the current situation for each person who lived at Bigwig.
Staff were supported by a system of supervision and training. New staff were required to complete a formal induction programme, introducing them to the service's policies and procedures as well as working with other staff before working alone. Staff also undertook the Care Certificate within their first 12 weeks of employment if new to the role. Annual appraisal and professional development opportunities were provided to all staff. Regular staff meetings were held and staff commented that they felt, 'very supported' by management at the service.
Staff completed a recruitment process to ensure they had the appropriate skills and knowledge to carry out their role. Clear information was available to ensure there was a clear audit of when a Disclosure and Barring Service check (DBS) had been received and when the staff member had commenced employment.
The service was well led. Accidents and incidents were appropriately recorded and analysed. There were robust quality assurance systems in place including gathering the views of people who used the service as well as their families, advocates and other professionals who worked with the service. People’s views of the service were positive.
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 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.
We announced the inspection visit two days in advance. This was because this is a small service and we wanted to ensure people would be available to talk with us. Bigwig House was last inspected in July 2013, no concerns were identified at that inspection.
Bigwig House provides accommodation and personal care for up to three people with autism or Aspergers syndrome. On the day of the inspection visit three people were living at the home. The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. At the time of the inspection the registered manager was in the process of leaving the service and the deputy manager was running the service. The Care Quality Commission (CQC) had been properly notified of this arrangement. The deputy manager would be applying for the position of registered manager for Bigwig House.
People were relaxed and happy on the day of the inspection. We saw staff talking with people in a friendly manner. We saw they assisted people as they needed whilst encouraging people to be independent.
We saw care records were of a high standard and contained detailed information to guide staff who were supporting people. Risk assessments were completed and regularly reviewed. We found people were supported to live full and active lives and access the local community. People were able to take part in a varied range of activities which reflected their individual hobbies and interests.
Staff demonstrated a caring attitude towards the people living at Bigwig House. People were supported to maintain strong relationships with their families. People’s preferred method of communication was taken into account and respected.
Staff were well supported through a system of induction, training, supervision, appraisal and professional development.
There was a positive culture within the service which was demonstrated by the attitudes of staff when we spoke with them and their approach to supporting people to develop their independence. We saw the service was organised to suit the needs of the people who lived there.
The service was well-led. Accidents and incidents were appropriately recorded and analysed. There were robust quality assurance systems in place.
We saw that, where possible, people were supported to be involved in decisions about their care and treatment.
We observed staff interacting with people who used the service in a kind and calm manner. We saw staff showed, through their actions, conversations and during discussions with us empathy and understanding towards the people they cared for. We saw people's privacy and dignity was respected.
We examined people's care plans and found the records were up to date and reviewed as the person's needs/wishes changed.
Systems for safeguarding people from abuse were robust and were understood by staff and used to protect people's rights.
Staffing levels were consistent with the hours commissioned and ensured people were supported well.
It was evident, from our observations, that staff and people who lived at Bigwig had a comfortable and respectful relationship with each other.
Staff interactions with people, and people's behaviour showed they felt safe living at Bigwig.
From our inspection we found that people's views and experiences were taken into account in the way the service was provided and delivered in relation to their care and peoples needs was assessed and care and treatment was planned and delivered in line with their individual care plan.
People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening and people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.
There were enough qualified, skilled and experienced staff to meet people's needs and the provider had an effective system to regularly assess and monitor the quality of service that people receive.