Background to this inspection
Updated
7 April 2021
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 coronavirus pandemic we are looking at the preparedness of care homes in relation to infection prevention and control. This was a targeted inspection looking at the infection control and prevention measures the provider has in place.
This inspection took place on 3 March 2021 and was announced.
Updated
7 April 2021
We carried out an unannounced comprehensive inspection on 20 and 21 August 2018.
8 Restormel Terrace (known as Douglas House by the people who live there) is a residential care home, which provides accommodation and supports the needs of people with a learning disability and associated conditions such as autism and Asperger’s.
The service is currently registered to accommodate and support a maximum of four people. At the time of the inspection four people were living at the home.
People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
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.
At the last inspection, on 19 and 20 October 2015, the service was rated as outstanding in the domains of caring, responsive and well led. This meant that the service was rated as outstanding overall. At this inspection we found the service remained outstanding in those domains and therefore overall.
Why the service is rated outstanding.
People living at 8 Restormel Terrace had complex care needs and required a high level of support with daily care needs inside and outside the home. We met with all four people during our visit and observed some interactions between them and the staff. People had capacity and were able to verbalise their views and staff also used other methods of communication, for example visual choices and information sharing. The focus was on including people and seeking their involvement in every aspect of their lives.
When we arrived people were going about their day and following their planned routines. These planned routines helped provide reassurance to people who were living with autism. People were living a full life and there was a busy but relaxed atmosphere during the day. As the day went on people were either enjoying time on their own, with staff interaction when they needed it or going out on a planned activity. This was all based on people’s individual wishes.
People were encouraged to live active lives and were supported to participate in community life as much as possible using small, achievable goals that were obviously working. People were now able to attend community groups on their own, meet peers living nearby, attend social skills courses and practice independent shopping with less support. Activities were developed for people who perhaps had not tried certain activities before in order to increase the choices available to them. Other activities reflected people’s existing interests. The environment and the outside spaces had been designed for people living with autism to allow people to safely be on their own in the communal areas and courtyard in most weathers and to have support to choose what they wanted to do. There were quieter spaces where people could go if areas got too noisy or they wanted some quieter time.
The provider and registered manager had taken innovative steps to ensure people were at the heart of the service and involved in all aspects of the running of 8 Restormel Terrace, whilst encouraging and promoting independence. People’s opinions were regularly sought and valued. For example, people were enabled to achieve activities that had previously been a challenge for them and these were celebrated with consent in a ‘Douglas House achievements folder’ and visually with a digital photo frame. This all promoted a positive focus in people’s lives and celebrated success. Careful planning and involvement of those living at 8 Restormel Terrace clearly showed that the service was person centred and promoted a high quality of life. Family contact, holidays and people’s management of their own health, activities and work was important. A gentle, encouraging approach had resulted in an increase in positive behaviours and inclusion within the community. People and staff also knew each other well and were supported to live together in harmony, understanding each others needs.
People had their health needs met. People received visits from healthcare professionals, for example speech and language therapist and GPs to ensure they received appropriate care and treatment to meet their health care needs. Professionals confirmed staff followed the guidance they provided. The provider and registered manager also pro-actively sought advice from external agencies to further enhance people’s lives and enable them to move forward and grow. For example, people’s behaviours related to anxiety, alcohol abuse and repetitive negative behaviours had very much positively improved since living at the service. People, as well as staff, took on champion roles in a meaningful way and ensured their subsequent specialist knowledge was used to benefit everyone at 8 Restormel Terrace. For example, people had been trained to meaningfully become health and safety and first aid champions, as well as attending training with staff in topics that benefitted everyone. For example, in men’s health and oral care. This meant that when one person needed additional support, this was addressed in a general way involving everyone living at the home so they could all work together and understand each other without one person being singled out.
Some people had more complex communication needs and these were individually assessed and met. People were encouraged and supported to make as many decisions and choices whenever possible in their day to day lives, this was often through visual images, patient encouragement and information sharing and through social stories. This had enabled people to prepare fully for holidays, trip out and health appointments to reduce negative behaviours and anxiety with success. People were supported to access the community and promote their independence. For example, people who had previously been reluctant to go into the community independently for a long time, now had a programme developed and encouraged by staff to support them and regularly discussed people’s feelings about their progress. Other people had been able to take foreign holidays or take a trip to visit a relative. Staff and relatives worked together to support people in their own home. Families and staff were very involved in care and risk planning and sourced different ways for people to access the community safely.
People were now able to access many areas in the community due to the support they had received from staff to further enhance their quality of life within their community. This included support to seek voluntary work experiences, be involved in relevant charities and spend time with peers living in the provider’s other services nearby.
Staff were observed supporting people with great understanding about how individuals living with autism saw the world and displayed patience and kindness. Compassionate care was really important to the values of the service and was clearly reflected in how staff cared for people. People were matched with staff who they particularly got on well with and all had a named key worker whom they spoke of. One person said, “He’s [staff member’s name] my friend really.” Valuing people and enabling them to feel they mattered was important and staff enabled people to help in the running of the home. For example, a cooking club enabled people to plan meals and do the shopping on a regular basis. People used their chosen easy read recipes which enabled them to eat together when they wanted to and people took it in turns to choose the meat for the Sunday roast. The staff had built strong relationships with the people they cared for and respected people’s privacy. People or their representatives, were very involved in decisions about the care and support people received. People were able to voice their opinions and aspirations knowing they would be listened to. For example, one person had expressed a desire to move nearer their family and this was being looked at with the person, including discussing the reality of moving and visiting possible services.
People, relatives and staff felt the service was extremely well led. Relatives and staff described the registered manager as very approachable, available and supportive. Staff talked very positively about their jobs and took pride in their work, all telling us how much they found their work enjoyable and rewarding. Comments included, “I like working a Douglas house because everyday is different, the team are really good and I class them all as friends. I like seeing people progress and learn new things.”
People lived in a service where the provider’s values and vision were embedded into the service, staff and culture. The registered manager and staff were very passionate about the service. They had very robust quality assurance processes in place with the support of a head office. Audits were conducted to ensure any issues in the quality of care and environment were identified promptly. Accidents were investigated and, where there were areas for improvement, these were shared for learning with people, staff, other services and health professionals.
The provider had a complaints policy in place and the registered manager said any complaints received would be fully investigated and responded to in line with the co