Cascade (Charlton House)

Updated 11 December 2019

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

This inspection was carried out by one inspector.

Service and service type

Cascade (Charlton House) Ltd 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.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was announced. We announced the inspection the day before we visited. This was because the service supported a small group of people who often went out and we wanted to ensure we could gain access to the home during the day.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make.

During the inspection

We spoke with four people who used the service and three relatives about their experience of the care provided. We spoke with nine members of staff including group (provider) managers, the registered manager, the deputy manager, a team leader and care support workers. We also spoke with a professional from another agency who was visiting the home on the day of inspection.

We reviewed a range of records. This included four people’s care records and multiple medication records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures and auditing systems were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We gained feedback from two professionals who regularly visit the service.

Updated 11 December 2019

About the service

Cascade (Charlton House) Ltd is a residential care home providing personal and nursing care to younger adults with learning disabilities and mental health needs. At the time of the inspection the home was fully occupied and there were eight people living in the home.

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, similar to other residential buildings in the area. There were five ensuite rooms within the main house and three self-contained flats to the rear of the property adjacent to the garden. The building had been refurbished to adapt it to the needs of people living there. It was registered for the support of up to eight people. The building design fitted into the residential area and the other domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins 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

This was an outstanding service with a clear ethos to promote “independent living and social skills, aiming to instil confidence and enable them to participate in a meaningful life.” The ethos was evident throughout the service and there were numerous examples of people who had been supported to develop their confidence which enabled them to become more independent and access meaningful activities.

People’s safety, health and wellbeing were at the heart of the service. Leaders were consistent in their approach and staff felt supported and involved in the development of the service. The service worked well with family members to understand and enhance the care that people received. Relatives told us the manager was very responsive and went above and beyond in supporting people.

The service understood people’s needs and anxieties and were skilled in supporting people to manage their behaviours. This meant they were able to keep people safe who had not been safe in previous services. Their holistic approach focussed on health and wellbeing and resulted in a reduction in the number of serious incidents involving behaviours that could present a risk to individuals themselves or others. The service successfully reduced people’s use of medicines to manage behaviours and anxieties through their holistic approach. Positive risk-taking and realistic goal-setting was promoted, which ensured people achieved very good outcomes, whilst remaining safe.

The service was exceptionally responsive to people’s needs. Individualised care plans were regularly reviewed, and people were supported with positive behavioural support plans. The expertise of the staff had enabled people living in the service to reduce their anxieties and manage behaviours which previously had prevented them from staying in services or had impacted on their ability to be independent. People were supported with hobbies and interests as well as to develop work-based skills. Some people had started voluntary work and were working towards paid work.

The service had an innovative approach to end of life care. As a service aimed primarily at young people this was not a big feature of the support provided. However, they had developed a ‘Just in Case’ workbook to work through with individuals for them to understand how people would want to be cared for if anything did happen resulting in them needing end of life care. This was an innovative and original approach using a tool that had been developed by the provider.

People’s needs were understood and assessed holistically before people moved into the service. Staff were well trained to understand and anticipate people’s needs. People were supported to maintain a healthy diet through a holistic approach to health and wellbeing which included physical activities. The service was proactive in seeking support from other professionals to maintain people’s health and wellbeing and advice from professionals was used to enhance the support people received.

The service was focussed on people’s consent, which meant that support was very personalised. 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. Staff understood the Mental Capacity Act and care plans gave clear guidance in this area. The home had recently had a ‘consent’ week where they had discussed different scenarios with people to help them understand the concept of consent and when it is appropriate to say ‘yes’ or ‘no’ in different situations.

Staff knew people well and developed trusting relationships with them. The service was focussed on supporting people to become more independent and we saw staff encouraging people to carry out daily living tasks independently during our inspection. People were also supported to progress towards independence within the community and in education and work.

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 (published 26 April 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 Cascade (Charlton House) Ltd on our website at www.cqc.org.uk.