Restormel House

Updated 25 October 2018

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.

People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The inspection was undertaken by one adult social care inspector on 10 and 11 and 18 September 2018.

Prior to the inspection, the provider had completed 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 what improvements they plan to make. We reviewed the information included in the PIR along with other information we held about the service, such as feedback we received from health and social care professionals and notifications. A notification is information about important events, such as incidents, which the provider is required by law to send us. At the last inspection in January 2016 we did not identify any concerns with the care provided to people.

People living at Restormel House had some communication difficulties due to their learning disability and/or mental health. However, we were supported by staff to spend time with people who were able to share some of their views about living at the service. We spent time with people, observing their daily routines, talking to them about their interests and plans and observing any support being provided. This helped us gain a better understanding of people and the care they received at Restormel House.

During the inspection we spoke with the registered manager, area manager and regional director. We also spoke with a healthcare professional who was visiting the service and seven members of the care staff who were on duty during the inspection. We looked in detail at the care records of three people. In addition, we looked at a range of records relating to the care of all the people who lived in the home. These included, daily monitoring forms, positive behaviour support plans and medicine administration records.

Updated 25 October 2018

Restormel House is a residential Care Home, which provides accommodation and supports the needs of people with a learning disability and associated conditions such as autism and Asperger’s. In addition to a learning disability some people may also be living with mental health needs. The service is currently registered to accommodate and support a maximum of six people. At the time of the inspection five people were living at the home.

People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during 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.

People living at Restormel House had a range of complex care needs and required a high level of support with daily living inside and outside the home. Some people had previously lived in settings where they had been restricted from making everyday choices and others were experiencing change as they moved from being a child into adult services. Although people had capacity, some of their communication skills were limited. We met all five people during our visit and were able to observe interactions and talk to people about their daily routines and plans.

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 person’s’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated regulations about how the service is run.

At the last inspection on the 20 January 2016, the service was rated as good in the domains of safe, effective, caring, responsive and well led. This meant the service was rated as good overall. At this inspection we found the service remained good in safe and effective, but had improved to outstanding in caring, responsive and well led. This means that at this inspection the service is rated as Outstanding overall.

Why the service is rated outstanding.

There was a very positive culture within the service. The management team provided strong leadership and led by example. Relatives, staff and other agencies were very positive about the leadership of the service. They described the registered manager as, “Excellent”, “Supportive, always available” and “Proactive, always thinking ahead”. We observed positive and compassionate interactions between staff and the people they supported. Staff said they loved their work and were passionate about providing high standards of care. The provider really inspired staff to provide an excellent quality service. Staff had been nominated and received awards to celebrate their contribution to care and a number of aspiring leadership opportunities were available to encourage progress and development.

There was a ‘can do’ approach to working with people. The registered manager and staff recognised that people they supported were young and despite their needs wanted to experience the same opportunities as other young people their age. Risks in relation to people’s care were assessed, understood and managed well. Staff worked very hard to manage risks, whilst not restricting people’s opportunities. For example, one person wanted to attend an event to see favourite film and TV characters. Staff supported the person to consider the risks involved in this activity and to plan the event safely. The person’s involvement, staff skills and determination resulted in the person having a wonderful experience, which we were able to see had been documented for them in photographs.

People were encouraged to lead active lives and were supported to participate in community life as much as possible. Small steps had been taken to help people achieve their goal. For example, one person who had previously spent most of their time at home had been supported to go out into the community. Staff initially supported them to look online at items in a shop, then went with the person in the car several times to familiarise themselves with the route before finally going into the shop to buy what they had seen. Staff said these were often long processes, “But we aim to get there in the end”. Another person had been supported to access work opportunities and had successfully secured paid employment.

There was a strong emphasis on people being able to develop their independence and to move on from Restormel House if they chose to do so. We heard about people who had moved on from the service since the last inspection and these achievements had been documented in the homes ‘Journeys file’. Staff had supported people to plan their move, access advocacy services and organise their finances. People’s progress and achievements were recognised and celebrated.

People’s safety was paramount in the service. People were supported to understand how to keep safe. The local police diversity officer visited the service to talk to people about safety topics such as, keeping safe in the community, bullying and hate crime. A staff member had attended a training course at a local drug and alcohol service so that they could provide people with information and advice when the needed it. This included information about sexual health and relationships. They told us “We support young people who need good, clear information and support to keep them safe and healthy”.

Staff undertook regular safeguarding training and understood how and when to report any concerns about abusive or poor practice. People using the service also had access to relevant contact numbers if they wanted to report any safeguarding concerns. Safeguarding was discussed regularly within staff and resident’s meetings. Robust recruitment practices ensured staff employed in the home were suitable to work with vulnerable people.

The service had a culture which recognised equality and diversity amongst the people who lived in the service and the staff team. People were not discriminated against in respect of their sexual orientation. Staff recognised that some people were exploring their sexuality and supported them sensitively and appropriately when required. Staff had supported one person in relation to their particular lifestyle choice. Staff had spent time with the person to gain a better understanding and had developed a plan with the person to help ensure appropriate support was provided. Innovative and sensitive methods had been used to protect people’s privacy at all times.

Staff were sensitive and respectful in relation to people’s religious and cultural needs. The Regard Partnership mission stated that they wanted staff to experience a ‘positive, inclusive, working environment where diversity is celebrated’. Recruitment processes and the planning of staff demonstrated that the provider and registered manager recognised the benefits of having a diverse community of staff who valued one another and the different contributions they could make.

The registered manager and staff had been creative and innovative in ensuring they responded appropriately and effectively to people’s communication needs. Care plans, risk assessments, behaviour support plans and health information had, where appropriate, been translated into pictures and symbols for the person to understand. People’s daily routines, menu’s and activity plans were also provided in a way the person could understand and use to organise their time. Easy read information had been developed covering a range of topics, which people might require access to, including, equality, diversity and human rights, confidentiality, resident’s money and sexual health issues. This helped to ensure people had access to the information they needed in a way they could understand it. The registered manager continued to explore the use of technology to assist with responding to people’s individual care needs. People either had their own computer or access to the homes computer system. We saw one person writing their weekly menu and shopping list on the home’s computer. The registered manager said this was a very important task for the individual but also allowed staff to spend valuable and positive time with them. Each person had a memory stick to allow them to access information about their support arrangements and identify any issues or changes.

Restormel House mainly supported younger adults. The atmosphere in the home reflected this younger age group with lots of laughter, jokes, music and activity. When we arrived, some people were busy getting ready for their day and others were either having a lie in or relaxing having breakfast and chatting with staff. We observed people were making choices and leading a busy and full life. People clearly saw Restormel House as their home and were empowered to treat it as such. We observed people answering the door to visitors, using the kitchen freely to prepare drinks and snacks and offering their views and feedback as we inspected the service. Staff were enthusiastic and energetic. We saw how staff were patient and respectful towards people at all times even when faced with challenging and unpredictable situations.

Personalised care was central to the homes philosophy and staff demonstrated they understood this when talking about how they met people’s individual care and support needs. People’s care records and support arrangements were highly personalised, which ensured care was tailored to meet their individual and diverse needs. The values of the service included ‘compassionate care’,’ excellence’ and ‘hard work’ with a vision to provide excellent care a