Insight SBS ltd 201 London Road

Insight SBS ltd 201 London Road is a care home providing support for up to three people with learning disabilities in one adapted building. There were three people living at the service at the time of the inspection. Insight SBS Ltd 201 London Road and Aspley House work together as one service but are registered separately. This means that both services are inspected and reported on separately. The services are across the road from each other. The registered manager and staff work at both services and the main office of the two services is at Aspley House.

Insight SBS ltd 201 London Road 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.

At the last inspection on 24 November 2015, the service was rated Good. At this inspection we found the service was Outstanding.

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, relatives and health and social care professionals were consistently extremely positive about the service. Relatives told us that people had less incidents of behaviour that challenged and had seen improvements in people’s health. People told us that they were more independent and happier. One person said, “I am really happy now that I have moved in here, I feel more in control of my life”. The registered manager told us that since the last inspection they had embeded new ways of working and people had more choice and control over their lives.

Some people at the service could display behaviours that had a detrimental effect on them and the people around them. Staff responded exceptionally well to people who are at risk of displaying behaviours that may harm themselves or others. There was a positive behaviour support team which ensured that people had the help they needed to identify and manage the causes of these behaviours and reduce their occurrence. People and staff were supported to maintain a positive relationship after an incident of behaviour that challenged.

The provider had adopted a nationally recognised comprehensive training system to support people with behaviours. This system enabled staff to gain the skills needed to support people with behaviour that challenged in an effective way. There was a focus on learning and development and supporting staff to meet their potential. Staffing was tailored to people’s individual care and behavioural needs through assessment, planning and best practice. This also ensured that there were sufficient numbers of staff to meet people’s needs and support people to live meaningful lives. Staff training had been consistently updated and staff had the skills and knowledge they needed to support people with learning disabilities. Staff had regular supervision meetings and annual appraisals and told us that they felt happy in their roles and well supported.

People were involved in the recruitment process in a meaningful way and they had an influence on the outcome of staff appointments. People had been supported to teach other people about the recruitment process and then they too became involved in staff recruitment. This contributed to new staff being suitable for people’s needs as well as them being recruited safely as pre-employment checks were carried out.

People were supported to enjoy a meaningful lifestyle and restrictions on their freedom were minimised. There was a person centred planning coordinator dedicated to ensuring that there was a personalised approach to assessing and addressing people’s needs. People’s needs were continually holistically assessed and support plans were frequently updated and monitored to ensure that they remained up to date and accurate. People were continually involved in decisions about their support and support was built around the person and adapted to suit them. People are supported to have maximum choice and control of their lives. Staff planned how they could support people in the least restrictive way possible. There were policies and systems in the service support this practice. Staff assessed and minimised risks to people and risks were managed in the least restrictive way. People were involved in planning how risks were managed through meetings with the provider, the person centred coordinator and positive behaviour support staff. Staff were aware of people’s decisions and respected their choices and had the guidance they needed to support people effectively.

Since moving in to the service people had become more independent and have achieved goals that they previously thought were unobtainable. Staff supported people to become more independent with aspects of daily living. People were learning how to shop and cook for themselves, use public transport and go out in to the community. People were supported to increase their engagement in activities of daily living. People had control over their diet and chose what they ate and when. People were encouraged to eat healthily and were provided with the information they needed to help them make their own healthy life choices.

People took part in a variety of activities and were supported to try new things. Staff continually assessed where they could reduce the support people needed to engage in activities to enable them to be more independent.

People were supported by staff to access the health care they needed to maintain and improve their health and well-being. Peoples’ health and long-term conditions were well managed and people had seen their health improve. When people accessed other services such the GP they were supported by the service staff and there was continuity of care.

People’s privacy was respected and they were supported to lead dignified lives. Staff were kind and treated people with respect. Staff recognised when people were upset or distressed and responded to this. People were provided with emotional support in a way that suited them. Staff knew people well and had developed effective ways to support people to communicate about issues they felt anxious discussing. People were supported to maintain positive relationships with those who were important to them, meet new people and build new relationships. People were well known in the community.

There was a complaints system in place if people or their relatives wished to complain. People were encouraged to express their views through a variety of ways. There were systems in place to gather feedback from staff, professionals and relatives. Feedback was used to improve the service. Relatives told us that they felt well informed and that communication was positive and proactive. People were supported to discuss their wishes and preferences for the end of their lives.

The environment met people’s individual needs and was personalised to reflect the people that lived there. The service was clean and well maintained. Staff were aware of infection control and the appropriate actions had been taken to protect people.

People, staff, relatives and health and social care professionals told us the service was well-led. The provider had a clear vision and values for the service which staff understood, shared and acted in accordance with. The provider visited the service weekly and attended meetings with people every two weeks. Staff and the registered manager understood their roles and responsibilities. The service had good working relationships with health and social care professionals and worked jointly with them to plan peoples support.

The registered manager and positive behaviour support team regularly audited the service to identify where improvements were needed. Audits thoroughly covered all aspects of the service provided. Findings from audits were analysed in depth and was used to monitor the effectiveness of the support people received. The service regularly reviewed and challenged their own practice and sought new ways to support people to improve their lives. When things went wrong lessons were learnt, learning was shared and improvements were made. Staff understood their responsibilities to raise concerns and incidents were recorded, thoroughly investigated and acted upon. Lessons learnt were shared and trends were analysed.

There was a registered manager at the service who was supported by a deputy manager. 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.

There continued to be systems in place to keep people safe and to protect people from potential abuse. Staff had undertaken training in safeguarding and understood how to identify and report concerns. Medicines were managed safely and people received their medicines on time and when they needed them. People were supported and encouraged to manage their own medication where appropriate and in a safe way.

People had been supported to consider and record their personal wishes for the end of their life.

Insight SBS Ltd 201 London Road is a privately owned care home, providing personal care and accommodation for up to three adults with learning disabilities. There were two people living at the service at the time of the inspection. People had complex needs, including mental health and physical health needs. Insight SBS Ltd 201 London Road and the registered service Aspley House work together as one. The services are across the road from each other. The registered manager and staff work at both services and the main office of the two services is at Aspley House. Insight SBS Ltd 201 London Road is one of a group of five care homes owned by Insight Specialist Behavioural Service Limited.

People had a limited ability to verbally communicate with us or engage directly in the inspection process. People demonstrated that they were happy in their home by showing warmth to the staff that were supporting them. Staff were attentive and communicated with people in a warm and friendly manner. Staff were available throughout the day, and responded quickly to people’s requests for care and support. We observed staff supporting people with their daily activities.

The service had a registered manager. 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 registered manager is registered for both Insight SBS Ltd 201 London Road and Aspley House.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

Where people lacked the capacity to make decisions the staff were guided by the principles of the Mental Capacity Act (MCA) 2005 to ensure any decisions were made in people’s best interests. Staff were trained in the Mental Capacity Act 2005 (MCA) and showed they understood and promoted people’s rights through asking for people’s consent before they carried out care tasks.

Staff had been trained in how to protect people from abuse, discussions with them confirmed that they knew the action to take in the event of any suspicion of, or actual abuse. Staff understood the whistle blowing policy and how to use it. They were confident they could raise any concerns with the registered manager or outside agencies if this was needed.

Guidelines were in place for staff to follow in order to support people with behaviours that may challenge. Staff demonstrated that they understood these guidelines and put them into practice to help minimise people’s anxieties and the impact of their behaviours.

Staff were knowledgeable about the needs and requirements of people using the service. Staff involved people in planning their own care in formats that they were able to understand, for example pictorial formats. Staff supported people with making arrangements to meet their health needs.

Staff were recruited using procedures designed to protect people from the employment of unsuitable staff. Staff were trained to meet people’s needs and were supported through regular supervision and an annual appraisal so they were supported to carry out their roles.

Medicines were managed, stored, disposed of and administered safely. People received their medicines when they needed them and as prescribed.

People were provided with food and fluids that met their needs and preferences. Menus offered variety and choice.

There were risk assessments in place for the environment, and for each individual person who received care. Assessments identified people’s specific needs, and showed how risks could be minimised. People were involved in making decisions about their care and treatment.

There were systems in place to review accidents and incidents and make any relevant improvements as a result.

The registered manager investigated and responded to people’s complaints and people said they felt able to raise any concerns with staff.

Staff respected people and we saw several instances of a kindly touch or a joke and conversation as drinks were being made.

People were given individual support to take part in their preferred hobbies and interests.

There were systems in place to obtain people’s views about the quality of the service and the care they received. People were listened to and their views were taken into account in the way the service was run.

We set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? 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, 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 found that the home was well presented and clean in all areas and there were reliable procedures in place for the ongoing cleanliness of the premises. Each bedroom in the home was personalised and each room looked bright and cheerful . The garden was secure and well maintained. We found that the home was appropriately staffed.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

People told us they felt safe. Staff had a good understanding of how to protect people in the home and how to report concerns.

Records were generally kept up to date. We did find a food monitoring chart that had not been completed accurately. We also found that some documents had been misfiled.

Is the service effective?

People's health and care needs had been assessed and care plans were in place. There was evidence of people being involved in assessments of their needs and planning their care, we also found evidence to show that relatives had been involved, particularly when people lacked capacity to give consent.

We saw that some best interests meetings had taken place for some people who lived in the home. We found that the home had made Deprivation of Liberty Safeguard (DOLS) applications to the local authority which showed that they had a good understanding of the Mental Capacity Act and DOLS.

We found that staff had received training, support and supervision in order for them to carry out their roles.

Is the service caring?

Staff supported people to take part in planned activities. We saw that staff offered encouragement for people to join in with activities both in the home and community. We observed that people were given space to interact with their peers by staff.

People who use the service said that the staff provided "Good Advice" and that the staff respected their choices and privacy.

Staff told us that the manager "Walked round the home daily" and that the manager is supportive.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's needs and likes.

Is the service responsive?

People's views were listened to and taken into account in the ongoing management and monitoring of the home's progress. The provider sought the views of people who lived in the home, relatives and other stakeholders.

We looked at the likes and dislikes detailed in care plans for people that used the service. We saw that these were clear.

Is the service well-led?

The provider had effective systems to identify, assess and manage risks to people's health, safety and welfare.

We did saw that the provider met with people who used the service to gain feedback. We also saw that the provider met with relatives and all staff to gain feedback. We saw meeting minutes that showed meetings were held regularly.

People who used the service had a person centred planning meeting every six weeks to review their care plan and discuss their goals and aspirations. Staff provided support to people to fulfil their goals.

We found that a range of audits had been undertaken by the service. These included medication audits, audits of care records and checks of behaviour monitoring charts.