No. 18

No. 18 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.

No. 18 provides accommodation, support and personal care for up to three adults with learning disabilities and/or autism. The service is based in two separate houses. At the time of the inspection two people were living at the service, one in each house.

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.

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. No. 18 is part of Bowden Derra Park, a complex of residential accommodation. The registered manager was also responsible for the other Bowden Derra Park services. There was a deputy manager based in each house who oversaw the day to day running of the service.

We spent some time talking with people and staff and watching them spending time together. Staff were respectful and caring in their approach. They knew people well and had an understanding of their needs and preferences. People were clearly at ease and were able to decide if they met with us and how long for. They were able to express this to staff who respected their choices.

Risks to people’s safety and well-being were clearly identified and well managed. Staff used risk assessments to enable people to take part in activities. Staff were confident about providing support at any time including any period when people were distressed.

When staff identified people might benefit from additional support from external healthcare professionals they made appropriate referrals. Staff had encountered difficulties in this respect and were clearly frustrated by this but continued to make referrals. This showed they worked to improve people's experiences.

Staff were supported through a system of induction, training, supervision and staff meetings. This meant they developed the necessary skills to carry out their roles. There were opportunities for staff to raise any concerns or ideas about how the service could be developed. The deputy manager spoke of the importance of providing an open culture where staff were able to voice their opinions.

Care plans were detailed, informative and well organised. They covered a range of areas including details of people’s social needs as well as any health needs. Descriptions of routines that were important to people were comprehensive. Parts of the care plan were written using minimal text and pictures to support the information to make them more accessible for people. Health care passports had been developed to share with other healthcare professionals if people needed to access health services.

Staff understood the Mental Capacity Act and associated Deprivation of Liberty safeguards. Any conditions attached to DoLS were complied with. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

There were clear lines of accountability within the staff team. The management team were supported by experienced senior care workers who had well defined responsibilities. Staff told us the team worked well together and communicated effectively on a daily basis and with regular staff meetings.

There were effective quality assurance systems in place to monitor the standards of the care provided. Audits were carried out regularly both within the service and at organisational level.

Further information is in the detailed findings below.

We spent time talking to people who lived at No. 18 and observing the interactions between them and staff. A comment included: 'It's nice here.' During our visit, we saw that people appeared relaxed and contented. For example, we saw staff reading a favourite book with a person.

Staff demonstrated a good understanding of what kinds of things might constitute abuse, and knew where they should go to report any suspicions they may have. Staff we spoke with felt confident about responding to changing needs and knew what signs of abuse to look out for during their daily practice.

Staff were able to speak confidently about the care practices they delivered and understood how they contributed to people's health and wellbeing.

Staff at No. 18 recognised the importance of people's personal details being protected to preserve confidentiality.