110 West Street Care Home

Updated 17 February 2022

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.

As part of CQC’s response to the COVID-19 pandemic we are looking at how services manage infection control and visiting arrangements. This was a targeted inspection looking at the infection prevention and control measures the provider had in place. We also asked the provider about any staffing pressures the service was experiencing and whether this was having an impact on the service.

This inspection took place on 8 February 2022 and was announced. We gave the service one days’ notice of the inspection.

Updated 17 February 2022

About the service

110 West Street is registered to provide care and accommodation to 17 people with a learning disability. It is divided into three adjoining Houses. House A and B provides more traditional residential accommodation for short term group living for people in need of an assessment or in crisis. House C comprises five flats for people who behave in a way that may challenge others. The office for the service is situated in House C.

People admitted to this service were often in crisis due to their behaviours having led to police involvement or due to placements having broken down elsewhere as services were not able to provide the level of support needed.

This is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

Staff had high regard for the safety of the people they were supporting. They undertook training in safeguarding and protecting people from abuse and avoidable harm and were confident to report any concerns. People were pro-actively supported to take risks safely. There were enough staff to keep people safe and recruitment procedures checked staff were suitable to work at this service. Medicines were given safely. Communication and sharing of information between staff was very good and lessons were learnt when things went wrong.

People and their families received outstanding high-quality, person-centred care from a caring and exceptionally well-led service. People with a wide range of complex needs were supported by staff to lead full, interesting and meaningful lives. We saw that people had excellent, warm, caring relationships with the staff and enjoyed their company.

We found the culture of the service was one of empowerment for both staff and people who used the service. Without exception staff told us they were proud of what they had supported people to achieve and showed a passion for their work and the people they supported. There was a clear sense that this was embedded across the whole staff team.

Staff were extremely kind, compassionate and caring. They provided fully personalised support that focussed on what the people living in the service wanted. Staff fully understood how to support people's privacy and dignity and they encouraged people to be as independent as possible. Staff supported people to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The service provided to people was highly personalised and responsive and focussed on making people’s quality of life as good as possible and all staff were fully engaged in this process. Each person had an ‘All about me’ file which had been drawn up with them and provided a clear picture of everything about the person including their needs, wishes, fears and aspirations.

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. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

The service was well-led by a highly motivated registered manager who inspired the staff team to put the people they were supporting at the heart of everything they did. The provider's values were put into practice by the staff and governance systems ensured the service provided was of the highest possible quality. People, their relatives and staff were always involved in improving all aspects of running the service and their voices were heard.

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 carried out a survey with the registered manager at this inspection. This 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. No restrictive intervention practices were used.

All staff we spoke with demonstrated the vision and values of the service which are to enable people to live their lives at their optimum level, through a person-centred approach where positive risk taking is promoted.

Innovative and inclusive management systems were in place to put people at the heart of the service with opportunities for all people involved to voice their opinions and suggestions.

The registered manager had recently taken up her position but had previously been the deputy manager for the service, they were instrumental on the last inspection to lead the service to an outstanding rating. At this inspection the registered manager and service manager demonstrated their commitment to delivering high-quality care and their commitment to develop the service. The service was well-led. The registered manager, management team and staff were extremely open to hearing feedback on the service and acted immediately to correct any issue identified. There was an open, caring culture and all staff were passionate about their work.

Everyone told us, this culture emanated from the registered manager and service manager.

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 Outstanding (published 09 March 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.