Ormesby House

Ormesby House is a residential care home providing personal care to ten people with learning disabilities and/ or Autistic spectrum needs primarily under aged 65 years of age in one adapted building. The service can support up to ten people.

The service operated 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, bigger than most domestic style properties. It was registered for the support of up to ten people. Ten people were using the service. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large 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

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 service had suitable safeguarding systems in place, and staff had received training about recognising abuse.

Appropriate risk assessment procedures were in place so any risks to people, staff or visitors were minimised.

Staff were recruited appropriately. Staffing levels were satisfactory, and people received timely support from staff when this was required.

The medicines system was well organised and staff received suitable training. People received their medicines on time.

The building was clean, and there were appropriate procedures to ensure any infection control risks were minimised.

The service had suitable assessment and care planning systems to assist in ensuring people received effective and responsive care.

Staff received induction, training and supervision to assist them to carry out their work.

People received enough to eat and drink. Some people were involved in food shopping and cooking for the household.

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 received support from external health professionals and were encouraged to live healthier lives.

People said they received support from staff which was caring and respectful. Care promoted people’s dignity and independence. People were involved in decisions about their care.

People had the opportunity to participate in activities and to spend time with the wider community.

People felt confident raising any concerns or complaints. Records showed these had been responded to appropriately.

The service was managed effectively. People and staff had confidence in the registered manager.

The manager was able to demonstrate the service learned from mistakes to minimise them happening again.

The service had suitable systems to monitor service delivery and bring about improvement when necessary.

The team worked well together and had the shared goal of providing a good service to people who lived at the home.

The service worked well with external professionals, and other organisations to provide good quality care.

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 Outstanding (published 17 October 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.

This was an unannounced inspection which took place on 23 August 2016.

During our inspection the registered manager was present. 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 and associated Regulations about how the service is run.

Everyone spoke very highly of the registered manager. Staff were highly motivated and told us that management at the home was very good. The registered manager was aware of the attitudes, values and behaviours of staff. She took responsibility for maintaining her own knowledge and shared this with staff at the home. The provider’s values were embedded at the home and known by all.

A range of quality assurance audits were completed by the registered manager and representatives of the provider that helped ensure quality standards were maintained and legislation complied with. Quality assurance processes included obtaining and acting on the views of people in order that their views could be used to drive improvements at the home.

People were routinely involved in the review of their care packages, making decisions about the service provided and supported to express their views. A range of aids were used which helped ensure everyone, regardless of their abilities were routinely involved. These included pictorial aids, the use of I-Pads, Skype and communication books.

Medicines were managed safely and staff training in this area included observations of their practice to ensure medicines were given appropriately and with consideration for the person concerned. People were supported to be as independent as possible with their medicines.

People appeared very happy and at ease in the presence of staff. Staff were aware of their responsibilities in relation to protecting people from harm and abuse.

People were supported to take control of their lives in a safe way. Risks were identified and managed that supported this. Systems were in place for continually reviewing incidents and accidents that happened within the home in order that actions were taken to reduce, where possible reoccurrence. Checks on the environment and equipment had been completed to ensure it was safe for people to use. The home had suitable equipment to meet people’s needs and promote their independence.

Staff were available for people when they needed support in the home and in the community. Staff told us that they had enough time to support people in a safe and timely way. Staff recruitment records contained information that demonstrated that the provider took the necessary steps to ensure they employed people who were suitable to work at the home. Staff were sufficiently skilled and experienced to care and support people to have a good quality of life. Training was provided during induction and then on an on-going basis.

Ormesby House was meeting the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). These safeguards protect the rights of people by ensuring if there are any restrictions to their freedom and liberty these have been authorised by the local authority as being required to protect the person from harm.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Records included the use of photographs and symbols which supported people's involvement and understanding in the care planning process. Capacity to make decisions had been assumed by staff unless there was a professional assessment to show otherwise. People were supported to access healthcare services and to maintain good health. People played an active role in planning their meals and had enough to eat and drink throughout the day.

Positive, caring relationships had been developed with people. We observed people smiling and choosing to spend time with staff who always gave people time and attention. Staff knew what people could do for themselves and areas where support was needed. Staff appeared very dedicated and committed.

Staff understood the importance of supporting people to raise concerns who could not verbalise their concerns. Pictorial information of what to do in the event of needing to make a complaint was displayed in the home.

We spoke with two people who use the service and four relatives of people using the service. One relative told us they were "extremely happy with the service, the staff were friendly and dedicated". Another relative told us that "when issues cropped up, the staff sorted it out and they were happy with the service".

We looked at care records of four people who use the service and saw evidence that risk assessments and care plans were regularly reviewed, that people were involved in the decisions about their care and people were treated with dignity and respect.

We saw the provider had robust systems to regularly monitor the quality, safety of care and support provided at the service and the records of their findings were detailed and comprehensive. We found that if the provider identified areas for improvement, an action plan was implemented with a timescale for completion.

We looked at care records of people who used the service and saw evidence that the care needs had been assessed and regularly reviewed.

People's values and human rights have been respected.

We saw a exceptionally high level of engagement between people who used the service and staff.

We saw that the provider minimised risk of abuse all policies and procedures to promote safeguarding were in place.

The provider had robust systems in place to monitor the quality and safety of care and support provided at the service. One relative said that they "certainly have no worries" with respect to the wellbeing of their family member. They continued to state that the service is keep them in contact at all time regarding the health of their family member. Another relative stated that they "always feel listened to and that their family member "enjoys living at Ormesby House". They also said if they raised any issues with the these were acted upon.

We saw that the provider carried out regular visits at the home to monitor the quality of service that people received. We found these to be detailed and comprehensive. We found that where areas for improvement had been identified an action plan had been implemented and a time scale for completion had been recorded.