Cascade (Charlton House)

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.

The inspection took place on 1 and 2 March 2017 and was announced.

Cascade is registered to provide care for up to 8 people. At the time of the inspection 6 people were living at the home. The home supports young adults who have a range of different learning disabilities and mental health needs. The accommodation comprised of a refurbished building over two floors. This was the services first inspection.

There was a registered manager in place. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. For the purposes of this report the registered manager will be referred to as the manager. On the day we visited the management structure had changed. A new deputy manager and daily manager had been appointed. The registered manager remained the registered manager.

People had robust risk assessments and reviews of their needs. These records were detailed accounts of people’s needs and the risks they faced. These records gave clear guidance to staff about how to manage people’s needs. The manager responded effectively to accidents and incidents and took appropriate action to try and reduce the re-occurrence of these. The service had emergency plans in place and carried out various tests to ensure the building and equipment used was safe.

The manager and staff knew how to keep people safe and how to protect people from potential harm and abuse. There were systems for staff to report their concerns to the manager. The manager knew of external agencies they must report such concerns to. Staff knowledge about these agencies was variable but the manager said they would address this issue.

People benefited from being supported by staff who were safely recruited. There was consistently enough staff to safely meet people’s needs at the time of this inspection.

People received their medicines in a safe way. People’s medicines were stored securely. The administration of people’s medicines was audited and checked. The manager and staff were proactive in responding to a change in people’s health needs. The service promoted and encouraged healthy lifestyles.

Staff received regular training and the service was making plans for future training for staff to complete. Staff felt their induction to their work was effective. Staff received regular supervisions. The manager was not always testing staff knowledge about certain areas of their work. However, following this visit we received confirmation that these systems had been put in place.

The Care Quality Commission (CQC) is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. The service was working within the principles of the MCA. Staff had a good understanding about the need to seek consent from the people they were supporting.

People told us that staff treated them in a caring and kind way. People and staff had formed positive relationships with one another. The service supported people with their diverse needs. The staff and the manager supported people in a way which promoted their independence.

People received care which was person centred, relevant and responsive to their individual needs. People engaged with a range of social activities and educational causes aimed at enabling independence for their futures.

The manager had created a positive, open, culture at the home with a clear vision for the service and the people who lived at the home. This vision was shared by staff and people alike and put into practice.

The manager took quick action to resolve the areas which we had identified that needed improvement.