Larkrise

We found the following examples of good practice.

The service had adapted areas around the home to accommodate visits from friends and relatives while reducing the risk of infection. This included an internal room with plastic screens that could be used flexibly to accommodate visits from family or health care professionals, in addition to a garden pod for use in warmer weather. People were encouraged to meet up with family members in the community and each person was given an infection protection pack with a mask, alcohol gel and wipes to take with them. When people were not able to meet with their relatives directly, staff supported them to use video calls to contact their family.

Staff used social stories to help people understand what the symptoms of COVID-19 were and how it may make them feel. There was clear pictorial and easy read guidance in place to explain to people why the use of personal protective equipment was so important to keep them safe.

Staff understood the importance of people’s routines and supported people to take part in alternative activities during COVID-19 when some community activities were restricted. When people were isolating staff came up with creative ways to support people including converting an office space into a lounge area for one person to watch television and spend their leisure time away from their room.

Heathcotes (Larkrise) is a care home which provides accommodation for up to seven people with autism, some of whom have additional learning disabilities. People also had particular needs in relation to communication. At the time of our inspection there were seven people using the service. At the rear of the home there was a large garden, this contained a separate supported living setting known as Garden Cottage. Garden Cottage was equipped to accommodate one person with private access and garden area. Both the care home and supported living service were looked at as part of this inspection.

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 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 service was a large home, bigger than most domestic style properties. Although this was larger than current best practice guidance, the building design fitted into the residential area and the other large domestic homes of a similar size. There were no identifying signs, intercom, cameras, or anything else outside to indicate it was a care home. Staff did not wear anything that suggested they were care staff when coming and going with people.

People’s experience of using this service and what we found

People were well supported and cared for at Heathcotes (Larkrise). Comments from relatives and professionals were, without exception, positive and praised the registered manager and staff team for the way they cared for people and supported people to live life to the full.

Staff put people at the centre of their care. Every decision made or action taken centred around people’s needs and how staff could improve the quality of life for people. People received exceptional person-centred care and support which truly focused on people as individuals. People were encouraged to maintain links with family, and staff and relatives told us they valued the support this gave to people.

Staff knew people well and were able to use a range of communication methods to fully involve and engage with people in their everyday life including people’s health and wellbeing; leading to excellent outcomes. 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.

People were valued as individuals and staff worked with people to learn new skills, increase their independence and become more confident in everyday life. This meant people were able to achieve their goals and have a fulfilled life.

The design and layout of the environment was unique and really helped to support people’s individual needs and preferences. Staff used the space available to its full potential so people could get the maximum enjoyment and benefits from communal areas.

The registered manager and staff were dedicated in providing a service that put people first. Relatives spoke highly of the registered manager and how committed they were to providing high-quality care. Relatives told us they would absolutely recommend the service to other people and gave examples of how the registered manager and staff had gone above and beyond to create an outstanding service.

Staff knew how to keep people safe. They knew how to care for people and the risks people faced and received training and support to do this. The service learned from accidents and incidents and worked hard to make sure there was continuous improvement. Staff recruitment continued to be safe and there were enough staff to meet the needs of people. Staff knew how to give people their medicines safely.

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 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 last rating for this service was good (published 26 May 2016).

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.

Larkrise is a care home in a large detached house which provides accommodation for up to seven people with autism, some of whom had additional learning disabilities. People also had particular needs in relation to communication. At the time of our inspection there were seven people living at the service. Each person had their own room with en-suite facilities. There was a large communal lounge, sensory room, kitchen, dining room and laundry room. At the rear of the home there was a large well maintained garden.

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.

People experienced positive outcomes in terms of managing behaviour which challenged others. Staff followed the techniques of a programme accredited by the British Institute of Learning Disabilities (BILD) to assist people to maintain self-control, and to support them with behaviour that challenged in a positive way. Staff worked closely with the local authority challenging behaviour team and mental health professionals to assess and monitor people’s behaviour which challenged to check people received the support they needed.

Staff were supported to understand people’s needs, such as needs relating to their autism, through a programme of training, supervision and annual appraisal. The registered manager and staff understood the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. People were supported in line with these.

People were offered a choice of food and drink. Staff were knowledgeable in supporting people with complex needs relating to eating and drinking. Staff supported people to access the healthcare services they needed to maintain their health and referred people to specialist support when necessary.

The provider supported people to establish routines and a weekly activity programme, as well as encouraging them to use their literacy skills which they had not done for some time, to improve their quality of life. All people had individual activity programmes in place based on their interests.

People’s care plans were regularly updated so contained reliable information for staff to follow in supporting them. People and their relatives were involved in forming and reviewing their care plans.

People were supported by staff who knew them well, including the best ways to support them in line with their complex needs. Staff understood the best ways to communicate with people and used a range of techniques including visual systems to help people communicate their needs. Staff treated people with dignity and respect and supported people to be as independent as they wanted to be.

People were supported by staff to maintain relationships with people who were important to them, encouraging visits and helping people to phone and video call their relatives regularly. Relatives were encouraged to join in activities together with people using the service. They took part in a Saturday walk each month with people and staff at the service.

Staff managed people’s medicines safely, storing, administering and recording medicines in line with best practice. Staff understood how to respond if they suspected people were being abused to keep them safe and had received training in safeguarding adults at risk. The registered manager managed risks to people and the premises well, ensuring people had accurate risk assessments in place with risk management plans to guide staff in caring for people safely. There were enough staff on shifts to support people. The provider followed robust recruitment procedures in checking staff were suitable to work with people. The provider maintained the premises and equipment safely through a system of checks carried out both internally by staff and by external contractors.

A suitable complaints procedure was in place and relatives were confident the registered manager would respond appropriately if they raised any concerns.

Leadership was visible across the home and the registered manager, area manager and staff had a good understanding of their roles and responsibilities. The provider had a range of audits in place to assess, monitor and improve the service and the service was highly rated in the provider’s internal auditing assessment procedures, which was in line with our findings. The registered manager involved people, relatives and staff in running the service and sought their feedback in various ways.