No 36

Updated 11 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 3 February 2022 and was announced. We gave the service 24 hours' notice of the inspection.

Updated 11 February 2022

About the service

No 36 is a care home for up to nine adults with a learning disability. Some people also have autism. At the time of our inspection nine people were living at the service. The home is managed by LD Care Limited, a private organisation who also manage three other homes in the London Boroughs of Hounslow and Richmond upon Thames.

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

The culture of the service was one where the individual needs of people were central to how the service operated. The provider's representative explained, ''Our ethos is very much about being active and participating, we make sure that everyone understands there are no limits. [People] have also established a sense of responsibility, most take part in daily chores for themselves and the home. This has also helped give the sense of belonging and pride.'' This was very much evident within the service we saw, in everyday life there and in the feedback from others.

People received personalised care and support in an exceptional way. The staff were very responsive to their needs and wishes, planning care and activities to reflect these. People were an integral part of the local community. They took part in social and leisure activities which reflected their age and interests and were given opportunities to provide a service to others in need.

The atmosphere at the service was like a family home. There was no differentiation between the staff and people using the service in the way they were treated. They interacted with each other like friends or siblings would. There was an emphasis on having fun, respecting and valuing one another as equals. Staff and people who used the service were encouraged to invite their own families to special events, meaning there was an extensive community who shared successes and memories together.

Feedback from family members, staff and external professionals was very positive with one professional telling us, ''I honestly wish there were more services like this out there.'' Comments from the staff included, ''It is not like coming to work, this is my second home'' and ''There is a different feeling here, like a family we all care for each other so much.''

Whilst some people had communicated with aggression in the past, the way in which they were supported by the staff had reduced this so that people were able to live fulfilling and varied lives. Careful planning and coordination between the staff and other professionals meant they constantly reflected on what was best for the people who used the service. The medicines used to manage people's mental health needs had been reduced so that they were more active and aware. This allowed them to make informed choices about their lives with positive results.

There were numerous examples of care which exceeded people's and their families' expectations. These included thoughtful interventions by individual staff, as well as changes to the service and environment in response to a particular need or wish. The staff also acted as advocates for people, defending their rights when they had been challenged in the wider community.

The staff had the support, training and information they needed to care for people and also to develop their own skills and interests. People using the service, staff and other stakeholders felt able to discuss their ideas with the managers and felt these were listened to and valued.

There were appropriate systems for monitoring and improving the quality of the service. These had been implemented effectively and we saw how the service had developed and improved since the last inspection.

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 service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

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 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 some restrictive intervention practices 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 rating at the last inspection was outstanding (published 10 May 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.