Reach Ivy Cottage

Reach Ivy Cottage provides care for up to eight adults in one building, close to the town centre In Aylesbury. At the time of the inspection it was providing support to seven younger adults with a range of learning disabilities, autism spectrum disorder, physical disabilities and mental health problems.

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. There were deliberately no identifying signs, intercom, cameras 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.

People’s experience of using this service and what we found

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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.

People were relaxed around staff and said they received the support they needed. Relatives and friends spoke positively about the home. Comments included “The quality of his care is very good and his needs are well met at Ivy Cottage” and "The care offered at Ivy Cottage is exceptional; it totally fulfils (name of person)'s needs."

A community professional told us “The service is of a good standard and well organised in my experience…feedback requested from them has been very efficient and the staff manage some complex residents very well.”

There were enough staff to provide the support people needed. Staff were trained and supervised to make sure they met people’s needs effectively. They had been recruited using robust procedures.

People were supported to access healthcare services and their medicines were managed well. People were treated with dignity and respect. Their care plans were detailed and outlined the support they needed. These records were regularly reviewed to make sure they reflected changes to people’s circumstances. Written risk assessments were in place to identify and help reduce the likelihood of people experiencing injury or harm.

The service was managed well. Staff understood their responsibilities and worked together as a team. There were systems to monitor the quality of people’s care to make sure it was effective and safe.

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 provider 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. Some minor restrictive intervention practice was used as a last resort, in a person-centred way, in line with positive behaviour support principles.

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 Good (report published 25 January 2017).

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Reach Ivy Cottage on our website at www.cqc.org.uk.

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.

Ivy Cottage is a care home which provides accommodation and personal care for up to eight people with a learning disability. At the time of our inspection there were seven people living in the home.

There was a registered manager in post. 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 home was previously inspected in December 2013. It was compliant in the areas assessed at that time.

At this inspection we found the service provided safe, effective, caring, responsive and well-led care to people. People and their relatives were happy with the care provided. They described staff as caring, welcoming and friendly. A relative felt very grateful that their family member had got a place at the home. They commented “This is the best place “X” has been in, we feel very fortunate “X” is there”.

Systems were in place to safeguard people. Risks to people were identified and managed which promoted people’s independence. People had care plans in place which provided clear guidance to staff on the support individuals required. Care plans were updated and reviewed as people’s needs changed.

Medicines were safely managed and people’s health and nutritional needs were met. People had access to community activities, college and work placements.

People’s privacy and dignity was promoted. Staff were kind, caring and had a good knowledge of the people they were supporting. They knew how to communicate with people. Staff were aware of people’s needs, risks and the support required to promote their safety.

Staff were suitably recruited, inducted, trained, supervised and supported. They were able to relate their training to their practice to support people effectively. People were supported by a mix of experienced and new staff who worked well together as a team to benefit people.

People and their relatives knew who to contact to raise a concern or complaint. Resident meetings took place. This provided another opportunity for people to discuss issues that impacted on the resident group.

The registered manager was experienced in their role. They had developed systems to audit the service to ensure the service was being effectively monitored. They were organised and this was reflected in the way records were managed and presented. They had developed a committed staff team who were clear of their roles and responsibilities. Staff were motivated, enthusiastic and passionate about the work they did and were keen to promote people’s independence and life skills.

People who used the service, relatives and professionals were happy with the way the home was managed and described the registered manager as experienced, professional, accessible and approachable.

The provider had an effective system in place to ensure pre-employment checks were undertaken. This demonstrated staff suitability to work within the service was assessed and monitored. We saw staff received regular supervision and appraisals in line with the provider's policy. Staff received regular training and were enabled to undertake further training to enhance their professional development.

Regular audits were undertaken which identified any issues or actions within the service. Evidence of learning from accident and incidents were recorded and actioned appropriately. We saw people's complaints and comments were actioned and fed back into the service. This demonstrated the quality of service was monitored.

When we spoke to staff they all had a very positive attitude to the people they supported and understood about working in a person-centred way. We observed staff were consistent in their approach to people and treated them with respect and in a dignified manner.

People were supported by staff to take part in a range of activities, both within their home and in the wider community. People's methods of communication were documented in their care plans.

We found people were not cared for by suitably qualified, skilled and experienced staff. We saw the provider had a number of gaps on updating their staff training. Most notably in moving and handling, food hygiene, fire safety, health and safety, safeguarding and working with people with autism.