Welwyn

People’s experience of using this service:

People living here experienced extremely good levels of care, support which promoted positive outcomes. The management of the service had sustained outstanding practice and actively sought to improve the care they offered. People benefitted from an outstandingly responsive service where communication was key. Care and support was tailored to meet people's needs and enabled flexibility, choice and continuity of care. People were consistently involved in and consulted about all aspects of their care and support. Staff had an excellent understanding of people’s social diversity, values and beliefs and how these might influence their decisions on how people wanted to receive care and support.

The home promoted understanding and a positive attitude towards different types of disability and difference. Staff had opportunities for learning, development and reflective practice on equality and diversity, which influenced how the home was developed. Social activities offered to people were innovative, met people’s needs and preferences so people could be supported to live as full a life as possible. People were consulted about events before and after the event. The home had a key role in the local community and links with other community organisations which provided information and support to people.

The culture in the home focused high-quality, person-centred care. Staff put people at the heart of the service and their views were at the core of home's quality monitoring and assurance arrangements. Staff were motivated by and proud of the home. Continuous learning was embedded in the home's culture.

People told us they felt safe at the home and there were the systems and processes in place to safeguard them. People had personalised risk assessments so staff knew how to keep them safe.

The premises were safe and well maintained. Regular safety checks were carried out on the environment and on the equipment used. There were enough trained staff on duty to meet people's needs. People were provided with their medicines in a safe way. The management team ensured lessons were learnt and improvements made when things went wrong.

Rating at last inspection: Welwyn was last inspected on the 4th and 5th May 2016 and maintained a rating of Outstanding.

Why we inspected: This was an unannounced, scheduled inspection based on the previous inspection rating.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Welwyn provides accommodation and personal care and support for six people with learning difficulties. In addition people are supported with complex needs including visual impairment, profound physical disabilities, communication difficulties and associated behavioural issues. At this inspection six people were living there.

A registered manager was in post and was present during our inspection. 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.

People were actively engaged in the development of their own risk assessments and to take ownership of their own safety. People had the opportunities to take acceptable risks in their lives with the support of staff. Activities were planned around what people wanted and not restricted because of the potential for harm. Where necessary the provider took action to reduce the risk of harm whilst helping the person to do what they wanted. Any incidents or accidents were fully investigated with the emphasis on what can be learnt to reduce the potential for harm whilst not restricting individual’s personal development.

People were safe as staff knew how to recognise different signs of abuse and knew what to do if they suspected anything was wrong. The provider made appropriate notifications to other agencies when needed and sought advice and guidance when required to keep people safe. People were supported to safely take their medicines by trained and competent staff whose skills were regularly assessed to ensure safe practice was followed. The provider followed safe recruitment processes to ensure people received care from a staff team who were suitable to support them.

People and those that mattered to them were involved in the development of their care and support plans which were regularly reviewed and accounted for any changes. Staff were knowledgeable about the people they supported including life histories, hopes and dreams. People were supported to identify and achieve what they wanted to in life and did not see personal support needs as a constraint. People took part in a wide range of activities including education, vocational and leisure. People were supported to identify and achieve goals in their lives. They were supported by a staff team who were passionate and motivated to encourage people to achieve their aspirations without restriction.

People benefited from the involvement of the provider’s speech and language therapy team who worked with individuals and staff to develop personal communication styles. Staff were knowledgeable about different forms of communication and practiced these different strategies with people in their home and during activities outside of the house. People had access to the provider’s physiotherapy team. This maximised people’s potential for movement and trained staff to provide consistent therapeutic care based on the needs of individual people receiving support.

Staff were supported by the provider and felt valued in the role they performed. They received training which assisted them in the jobs and were encouraged to develop their skills by attending training specific to those they supported. Staff felt they were part of the wider organisation as they received regular communication from the management team regarding development in the service provided.

The management team were accessible to those receiving support and staff providing assistance. People and relatives felt included in the developments of the service and were confident their suggestions or concerns would be listened to and acted on. The provider undertook regular quality monitoring exercises designed to identify and drive improvements in the support they provided.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We met four of the six people who lived at Welwyn. We also spoke with three representatives of people who received a service. We found that people were very satisfied with the service they received at the home. They told us that they felt, 'Safe'. People said that they were happy with their support and with the staff team.

We observed the morning routine. We saw that overall people were supported in a relaxed and unhurried way. We found that staff were knowledgeable about the individual needs of the people they supported. Representatives of people who received a service told us that they considered staff to be well trained and skilled to meet the individual needs of the people they supported.

Staff told us that they were well trained and supported. They said that they had the skills to meet people's individual needs safely.

We saw that risks were being continually assessed and records showed how risks were reduced and, where possible, eliminated.

Is the service effective?

We saw individual plans that reflected how people led full and active lives with the appropriate staff support. Everyone we spoke with told us that people had daily opportunities to further their education and / or access chosen leisure activities. Records seen reflected this. We saw that activities were arranged in consultation with the people who received a service and by knowing individual's likes and interests. Information was seen recorded in care plans. People told us about activities and outings that they had recently enjoyed.

People's health and care needs were assessed and actions were taken to ensure that those needs were met. The registered manager told us that the staff worked with outside health and social care professionals as required. We saw how this joined up working was documented in care plans for consistency.

Is the service caring?

We saw that staff on duty were kind and patient. We also saw that when staff needed additional support to manage a situation they were given it discreetly. The staff that we spoke with told us that they felt well supported.

We looked at care plans and saw that people's preferences, interests, aspirations and needs had been recorded. Records were written in a sensitive and positive way. Pictures supported text to make information easy to understand.

Is the service responsive?

We saw how staff listened to people and acted in accordance with their wishes. We saw how staff asked people what they wanted to do. They also made suggestions to ensure that necessary daily tasks were also considered. For example one staff member asked if people would like to combine a trip out with some shopping for a birthday present.

We saw that meetings took place regularly to gather the views of the people who received a service. We saw the minutes of these meetings. The latest meeting discussed meals and there was evidence that people's suggestions had been listened to.

Representatives of people who received a service told us that they attended reviews where their views and opinions were listened to and considered. They also told us that they regularly visited the home or spoke with staff on the phone. They told us that they could share any worries or concerns and confirmed that these would be addressed promptly. This meant that people's needs and wishes could be met in ways that they preferred.

Is the service well-led?

The registered manager of Welwyn was handing over their registered status to the current home manager. The home manager was in the process of being registered with the Care Quality Commission. The current registered manager told us that they would then take on a supervisory role within the organisation. Staff were clear about the changing roles within the management team.

We saw how the home manager had started to implement regular audits of the service provided. They told us that they had input from senior managers to do this. We saw records of checks. The home manager told us that these checks enabled them to monitor and assess the quality of the service provided. We saw how the home manager produced an action plan to demonstrate how issues were to be addressed. We saw that the home manager had signed to say that actions had been completed.

The service was well led and the registered manager and the home manager were approachable and understanding of their roles and responsibilities. Staff told us that they felt well supported. The service was able to respond to people's changing needs and they also worked with outside agencies to ensure people received the best care. People who received a service and their representatives spoke positively about the leadership and commitment of the management and the staff team.

We saw people were supported to attend health appointments to maintain their health and welfare. People had their own pictorial health guide in place to tell doctors and hospitals about their health and the best ways to support them to get the right treatment and healthcare. Staff worked closely with each individual and key people to ensure their needs were effectively met, monitored and regularly reviewed.

There were enough staff on duty to meet people's individual needs and safeguard their health, safety and welfare. We saw staffing was planned in advance and that staffing levels were flexible dependent on people's needs and activities.

The provider had a system in place for identifying, receiving, handling and responding appropriately to complaints. People we spoke with were aware of how to complain if they were unhappy with their care.