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Options Watermill Lodge Outstanding

Reports


Inspection carried out on 26 January 2018

During a routine inspection

Options Autism (2) Limited Options Watermill Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Watermill Lodge is registered to provide accommodation and personal care for up to four younger adults with a learning disability, autistic spectrum disorder and associated complex needs. Many of the people the service supports had previously challenged traditional services and require bespoke and flexible support packages. There were four people living at the service at the time of our 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 a learning disability and/or autism using the service can live as ordinary life as any other citizen.

At the last inspection, the service was rated Outstanding. At this inspection, we found the service remained Outstanding.

The service has built on their previous success and sustained the outstanding model of care and was committed to personalising the services they provided and to following the recommendations outlined in ‘Putting People First’. (A shared vision in transforming adult social care to put people first through a radical reform of public services, enabling people to live their own lives as they wish, confident that services are of a high quality, are safe and promote their own individual needs for independence, well-being and dignity) and the Autism Act (2009)). The service was accredited with the National Autistic Society (NAS), which drove best practice to deliver outstanding care to people who used the service.

The strong person-centred culture apparent at our previous inspection continued to be a driving force in delivering a consistent approach to support and enabled people to try new things and to make positive changes in their lives. The provider, the registered manager and staff team all had an excellent understanding of positive risk taking and positive behaviour support strategies (PBS) were in place to support people that have previously challenged services, to reach their full potential. Personalised programmes and flexible staffing arrangements continued to enable people to live meaningful and fulfilled lives. Positive risk taking was driven throughout the organisation, balancing the potential benefits and risks of choosing particular actions over others, in order to support people to lead as ordinary a way of life as possible.

Staff had a clear understanding of systems in place to manage medicines, safeguarding matters and behaviours that are challenging to others. People’s medicines were managed so that they received them safely. A robust recruitment and selection process was in place which ensured prospective new staff had the right skills and are suitable to work with people using the service.

Staff were compassionate, kind and caring and had developed good relationships with people using the service. People were seen to be comfortable in the presence of staff and relatives and professionals confirmed staff looked after people very well. People benefited from staff having exceptional skills around understanding each person’s needs and aspirations. This included an excellent understanding of sensory impairment and how to support people to be as independent as possible in all areas of their life, through positive communication. Information was available in each person’s preferred format including policies and procedures such as activity programmes and complaints.

People continued to be supported to access health care professionals when required and supported to have maximum control over their lives and staff supported them in the least restrictive way possible; policies and

Inspection carried out on 10 and 16 November 2015

During a routine inspection

This inspection took place on 10 and 16 November 2015 and the inspection was unannounced, which meant the registered provider did not know we would be visiting the service.

The service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission [CQC] 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. There was a manager registered with the Care Quality Commission [CQC]; they had been registered since December 2010. At the last inspection on 28 October 2013, the registered provider was compliant with all the regulations we assessed.

Watermill Lodge is registered with the CQC to provide accommodation and personal care for up to four younger adults with a learning disability, autistic spectrum disorder and associated complex needs. Many of the people the service supports had previously challenged traditional services and require bespoke and flexible support packages. There were four people living at the service at the time of our inspection.

Accommodation consists of four purpose built, individual self-contained ground floor flats in the grounds of Watermill House. Each flat has a bedroom, lounge/dining area, with shower or bath depending on people’s preference, and a fully equipped kitchen. An office and laundry room are also provided separately within the building. This meant that people who used the service had the opportunity to practice their independence skills and continue to develop these further with a view to living more independently in the future, should they wish to do so.

Every flat had access to its own garden area, which people are involved in maintaining. Other on site facilities included; a sports hall, an activity barn, a woodland area, sensory room, computer room, external gardening, hydrotherapy pool and specialist outdoor activity equipment.

An outstanding feature of Watermill Lodge was the time spent developing the service, using creative and flexible ways to support people to move forward. The environment had been carefully considered and specialist adaptations provided to ensure a homely environment for people, whilst meeting their individual needs. The registered provider was seen to constantly adapt and strive to ensure people who used the service were able to achieve their full potential.

Positive risk taking was driven throughout the organisation, balancing the potential benefits and risks of choosing particular actions over others, in order to support people to live lives in as ordinary a way as possible. In delivering this consistent approach people were supported to try new things and make changes in their lives. The registered provider, the registered manager and staff had an excellent understanding of managing risks and supported people that had previously challenged services to reach their goals and fulfil their aspirations. Thorough systems were in place to protect people from the risk of harm or abuse. People lived in a safe environment that had been designed and adapted to meet their specific needs.

The registered manager ensured staff had a clear understanding of people’s support needs whilst recognising their individual qualities and attributes. Staff were positive about the support they received from their managers. They were encouraged to be reflective in their practice and strive to support people to move forward.

The service provided outstanding care and support to people enabling them to live fulfilled and meaningful lives. People had positive relationships with staff, who understood them well and used their shared interests to help people live interesting lives. Staff were skilled at ensuring people were safe whilst encouraging them to challenge their potential and achieve as much independence as possible. This was based on the philosophy of the organisation ‘fitting a service around you, not fitting you within a service’. Staffing levels were flexible and provided based on individual needs. The registered manager and team demonstrated passion and commitment to providing the best care possible for people, celebrating individual’s personal achievements with them.

Care plans had been developed to provide guidance for staff to support in the positive management of behaviours that may challenge the service and others. This was based on least restrictive best practice guidance to support people’s safety. The guidance supported staff to provide a consistent approach to situations that may be presented, which protected people’s dignity and rights.

There was a strong person-centred culture apparent within the service. Person centred means care is tailored to meet the needs and aspirations of each individual. People were encouraged and involved in planning their support to enable them to receive a service that was based on their personal needs and wishes. The service was flexible and responded positively to changes in people’s needs. Throughout our inspection we saw the service had creative ways of ensuring people led fulfilling lives and they were supported to make choices and have control of their lives.

Relatives confirmed both they and their family members were included in decisions and discussions about their care and treatment.

Staff described working together as a team, how they were dedicated to providing person-centred care and helping people to achieve their potential. Staff told us the registered manager had strong leadership qualities, led by example, promoted an ‘open door policy’ and was visible within the service, making themselves accessible to all. They told us the registered manager had strong values in promoting the delivery of best practice.

The people who used the service had complex needs and were not all able to tell us fully about their experiences. We used a Short Observational Framework for Inspection [SOFI] to help us understand the experiences of the people who used the service. Staff were observed to treat people with respect and dignity and it was clear they knew people’s needs well.

We found staff were recruited in a safe way; all checks were in place before they started work and they received an in-depth comprehensive induction. Staffing was flexible, and provided on an individual needs led basis to meet people’s health and welfare needs.

The registered manager ensured staff had a clear understanding of people’s support needs whilst recognising their individual qualities and attributes. Staff had the skills and knowledge to meet people’s needs. They received training and support to equip them with the skills and knowledge required to support the people who used the service. Training was based on current best practice and guidance, so staff were provided with the most current information to support them in their work. A clinical team was available to support staff further with specialist training and advice.

Staff had received training in dealing with concerns and complaints and knew how to report any concerns. There was a clear complaints procedure in place which was also available in pictorial format. Records and discussion with relatives and the registered manager showed that people were listened to and complaints or concerns were taken seriously and responded to appropriately.

Medicines were ordered, stored, administered or disposed of safely. Personalised support plans had been developed to ensure people received their medicines in line with their preferences.

People who used the service accessed a range of community facilities and completed activities within the service. A vocational life skills supporter had been appointed to promote further structured activities based on individual need and preferences. People participated in a range of personal development programmes. Individual programmes were designed to provide both familiar and new experiences for people and the opportunity to develop new skills. One person had been supported to develop their literacy skills and was working towards a recognised qualification. People were encouraged to follow and develop social interests and be active and healthy.

People’s nutritional needs were well met and they had access to a range of professionals in the community for advice, treatment and support. Staff monitored people’s health and wellbeing and responded quickly to any concerns. We observed staff treated people with dignity and respect and it was clear they knew people well and their preferences for how they wished to be supported.

The registered manager demonstrated strong values and a desire to learn about and implement best practice throughout the service. Staff were very highly motivated and proud of the service. The service had developed and sustained effective links with organisations that helped develop best practice.

The registered manager used effective systems to continually monitor the quality of the service and had ongoing plans for improving the service people received.

Inspection carried out on 15 September 2014

During a routine inspection

The inspection was carried out by an adult social care inspector over one day. We considered all the evidence we had gathered under the outcomes we inspected.

We used the information to answer the five questions we always ask:

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

Is the service safe?

People who used the service were treated with dignity and respect by the staff.

Risk assessments were completed so staff had guidance in how to support people in ways that minimised risks.

The registered manager and staff were aware of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberties Safeguards (DoLS); two DoLS authorisations had been approved for two people who used the service.Training records showed that the care staff had completed training courses in MCA and DoLS.

Staffing levels were made available based on each person�s identified need. These levels were reviewed for example when people were accessing community activities, to ensure adequate levels of staff were available and people were safe.

Is the service effective?

People were able to make choices about aspects of their lives and had the opportunity to be involved in a full programme of planned activities based on their individual needs, preferences and aspirations.

People�s health and social needs were assessed with them and their relatives. Specialist needs in relation to speech and language, psychology, psychiatry, mobility, behaviour management, health and nutrition were identified and planned for.

At this inspection we found people�s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. The records were regularly reviewed and updated which meant that staff were provided with up to date information about how people's needs were to be met. From our observations and time spent at Watermill Lodge we saw that the people living there were receiving the care and support they needed in an individual way and wherever possible staff tried to facilitate choice.

People were asked for their consent prior to care and support and were asked for their views about activities of living on a daily basis. Care records we viewed showed consideration of the Mental Capacity Act 2005(MCA). Mental capacity assessments were carried out and best interest meetings held when people lacked capacity and important decisions were required.

Is the service caring?

Relatives of people who used the service told us "They call it home, they love it there." and "It is the first time in nine years that they have had things on their wall." " It has definitely been a positive move for them."

We found the service provided a calm and homely environment that enabled people to live an independent lifestyle where possible. We found that staff were understanding of people�s individual needs. Care files were person centred and reflected people's needs and preferences. Routines, likes and dislikes had been recorded and care and support was provided in accordance with people�s wishes and choices.

People were supported by staff who were attentive and who treated them with dignity. We saw that staff showed encouragement and patience when supporting people.

Is the service responsive?

We observed staff involved people and offered each one choice in regard to their needs. The staff approach to people who used the service was calm, respectful and friendly.

Records showed that where people�s needs had changed staff had taken appropriate action to regularly review care plans. De briefs were held following all incidents and the senior management team reviewed these and where required appropriate action plans had been put in place to address any shortfalls.

Is the service well-led?

There was a structured quality assurance system in place to assess the homes performance. This included surveys and audits which were also available in user friendly format. We saw action plans had been put in place to address any shortfalls.

There was a registered manager in post to oversee the management of the home and they were supported by a deputy manager and a house manager. There were staff meetings held and staff were provided with supervision and training.

What people told us who used the service and those that matter to them said about the care and support they received:

We spoke with one person who was complimentary about the staff and said they were nice and friendly. They told us, �I like the staff.�

Relatives of people who used the service told us they trusted the staff and they consulted and involved them in aspects of their daily lives.