Rawlyn House

Rawlyn House provides care and accommodation for people with learning disabilities. The provider, Cream II Limited operates a further six homes for people with learning disabilities in the South West.

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.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 16 people and 16 people were using the service. This is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated because Rawlyn House is divided into two separate buildings. The main house provides accommodation for ten people. The other unit is purpose built and accommodates six people who require wheelchair access. In addition the building design fitted into the residential area with other large domestic homes of a similar size. Staff were not wearing anything that suggested they were care staff when coming and going with people.

People’s experience of using this service:

The service was extremely well led. The providers ethos was strongly promoted and modelled by the management team. This was a commitment to valuing people as individuals, supporting them to meet their full potential and achieve their individual aspirations. The management team demonstrated an open and transparent management style and were fully engaged with people and staff at the service. A focus was on developing and encouraging staff, had resulted in high staff retention rates, which meant people were supported by a consistent, knowledgeable and experienced staff team. Robust quality assurance systems ensured the continued quality and safety of the service and continued to drive improvement. This ultimately improved the outcomes for people living at Rawlyn House. Since the last inspection, they had continued to move forward and develop what was an already outstanding service.

People were valued and placed at the centre of the service. Staff promoted their privacy and dignity, enabling them to make choices and have as much control and independence as possible. They had gone the extra mile to achieve this, for example fund raising for technology that would support communication, and challenging social stigma and discrimination against people with a learning disability.

The management team and staff genuinely cared for the people they were supporting. They advocated for them at every opportunity and were proactive in challenging negative stereotypical views of the people they were supporting and the care sector. They offered a truly caring approach to people and their families when they were in hospital or at the end of their lives and made sure hospital staff understood what the person needed. They ensured people were able to maintain contact with their families, even when they were hundreds of miles away, using video telephony so that they could see them.

The environment was warm and homely, and designed to promote the independence and quality of life of the people living there. The service sought to offer people new experiences, through a wide range of individual activities which were meaningful to them., An ‘active support’ approach meant they were as engaged in activities of daily living and maintaining their home as they were able.

Staff knew people exceptionally well and were highly skilled at responding to their needs. Feedback from a visiting health professional stated, “Staff knowledge of each individual is outstanding both from clinical and personal information. Patients are treated as individuals and staff treat them as family members. Phenomenal care.”

Training was of a high quality and informed by research and best practice. It gave staff the skills and knowledge they needed to support people safely and effectively, as well as ensuring they were constantly learning and thinking about how they could enhance people’s lives. The management team were proactive in their own continued professional development, using their learning to improve their leadership skills and develop the staff team.

Rating at last inspection:

Outstanding overall. Published 29 November 2016.

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will monitor all intelligence received about the service to inform when the next inspection should take place.

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

The service had a registered manager in post. 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. The service had two registered managers, both working in the service most days.

We met and introduced ourselves with 14 people during our visit. Due to their complex needs people were not able to comment on all aspects of their care and support. However we were able to meet them and observed staff as they provided support. People used other methods of communication, for example pictures. A relative said; “I’m very impressed with the care.” A survey stated; “Very impressed with the quality of care you provide.”

The service provided outstanding care and support to people enabling them to live fulfilled and meaningful lives. The interactions between people and staff were positive. We heard and saw people laughing and smiling. People looked relaxed and were observed to be happy with the interaction between them and the staff supporting them. Care records were detailed and personalised to meet each person’s needs. People and/or their relatives were involved as much as possible with their care records to say how they liked to be supported. People were offered as much choice as possible and their preferences were sought and respected. Care records were focused on giving people control and encouraging people to maintain their independence. Staff responded quickly to changes in people’s needs, for example if their behaviour changed. People’s life histories, disabilities and abilities were taken into account, communicated and recorded, so staff provided consistent personalised care, treatment and support.

Due to people’s learning disability we saw a range of personalised communication methods and tools being used to support people. Communication aids were specific to people’s needs and were detailed as part of their support plan. We saw that people used this information and referred to these visual prompts to assist them when performing a certain activity or planning their day. We saw many examples of how the staff had really thought about people’s communication needs and ensured they were not a barrier to them achieving their goals and aspirations. We saw people being supported to use their individual communications methods and tools to help reduce anxiety and have greater control about their care and lifestyle.

People were supported to maintain good health through regular access to health and social care professionals, such as epilepsy nurses. Staff acted on the information given to them by professionals to help ensure people received the care they needed to remain safe.

People’s medicines were managed safely. All medicines were locked away. There were medicines policies and procedures in place. However, medicines audits completed had not picked up some minor issues. Action was taken on the day to update records and prevent reoccurrence.

People’s health and well-being needs were well monitored. The registered managers and staff responded promptly to any concerns in relation to people’s health and also encouraged people to attend health checks recommended for their age group and gender. People enjoyed the meals offered and had access to snacks and drinks at any time. People were involved in food shopping, planning and preparing meals as much as they were able. People were supported to say if meals were not to their liking.

People’s risks were documented and well managed. We saw many examples of how staff had considered ways of helping people achieve their goals and aspirations. People were encouraged to live active lives and were supported to participate in community life where possible. Activities were meaningful and reflected people’s interests and individual hobbies. People thoroughly enjoyed activities within the home such as arts and crafts, singing and dancing and excursions to places of their choice such as the theatre and those who wished to go away enjoyed holidays.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The Deprivation of Liberty Safeguards (DoLS) is part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom.

People’s mental capacity had been assessed which meant care provided by staff was in line with people’s best interests. Staff understood their role with regards to ensuring people’s human and legal rights were respected. For example, the Mental Capacity Act (2005) (MCA) and the associated Deprivation of Liberty Safeguards (DoLS) were understood by staff. Staff had completed safeguarding training and understood what constituted abuse and how to report concerns. Staff sought people’s consent before they provided care and support. However, some people who used the service were unable to make certain decisions about their care. In these circumstances the legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were being followed.

People were protected by safe recruitment procedures. Staff received a comprehensive induction programme and the care certificate (A nationally recognised set of skills training). Staff were very kind, caring and thoughtful. There were sufficient numbers of staff on duty to support people safely and ensure everyone had opportunities to take part in activities. Staff had completed training and had the right skills and knowledge to meet people’s needs.

There was an extremely positive culture within the service, the management team provided strong leadership and led by example. The registered managers had clear visions, values and enthusiasm about how they wished the service to be provided and these values were shared with the whole staff team. Staff had clearly adopted the same ethos and enthusiasm and this showed in the way they cared for people. Individualised care was central to the home’s philosophy and staff demonstrated they understood and practiced this by talking to us about how they met people’s care and support needs. Staff described the management as open, very supportive and approachable. Staff said they felt like part of a large family and talked positively about their jobs. Staff said both registered managers made themselves available and worked in the home regularly. All staff talked positively about their roles. There was an open, transparent culture and good communication within the staff team. A comment included; “I didn’t know such kindness existed until I came to work here.”

Relatives and professionals said there was an open door policy and staff always listened and were approachable. They told us they did not have any current concerns but any previous, minor feedback given to staff had been dealt with promptly and satisfactorily. Any complaints made would be thoroughly investigated and recorded in line with Cream II Limited’s own policy.

People, friends, relatives and staff were encouraged to be involved in meetings held at the home and helped drive continuous improvements. Listening to feedback helped ensure positive progress was made in the delivery of care and support provided by the home. There were effective quality assurance systems in place. However audits did not pick up errors in the people’s medicines. Any significant events were appropriately recorded and analysed.

Evaluation of incidents was used to help make improvements and keep people safe. Improvements helped to ensure positive progress was made in the delivery of care and support provided by the staff. Feedback was sought from relatives, professionals and staff to assess the quality of the service provided.

People lived in a home that was hygienically clean, spacious and suitably adapted for the people who used the service. All furniture and fittings were suitable to meet people’s needs. People had easy access to very attractive landscaped gardens with walkways and seating. All bedrooms had en-suite facilities. We found the provider had considered the design of the building and put arrangements in place to ensure the premises met people’s needs. This meant the provider had put in place facilities to support and improve the quality of life for people living in the home. When we inspected the sensory room in the garden we saw that the service had created a suitable friendly environment for people.

We watched the interaction between the staff on duty and people living in the home. People appeared very relaxed in the company of the staff and there was a good rapport between them. Staff were offering people choice, encouraging them to undertake tasks independently where possible and supporting them where needed.

Staff were observed working in a calm, unhurried way and knew the communication needs of people, responding to gestures and limited verbal responses. Staff we spoke with explained the various techniques people used to communicate, including body language and verbal responses. Staff spoke to people before doing anything, explained what was happening around them and made sure that people were safe as they walked around.

Relatives of people who lived at the home were all very positive about the care the home provided. They felt their family member was safe and well cared for. Relatives told us that that they were involved in discussions and decisions about care. One person said 'We talk it through together. They value my experience.' Another person told us, 'We are always kept informed of what is happening. I have been really impressed with the care'.

Health professionals who visited the home regularly told us that they observed good care by staff. When health professionals gave feedback to the home they responded to it. Staff at the home were positive about their work. They felt well supported by the management at the home and confident that they could get advice and support. Staff were supervised and supported well on a day to day basis. An appraisal system was being developed. Staff had identified additional training that would be beneficial and the home were responding to this.