Montrose Barn

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting underpinning principles of Right Support, Right Care, Right Culture.

Right Support:

The provider was exceptional in how they ensured that people were always kept safe from potential risks.

Care and support plans were holistic and reflected people’s individualised preferences and support needs. People were involved, with staff support in the development of individualised care and support plans.

Staff were exceptional in the way they supported people to learn new skills and maintain their independence. People had fulfilling days and meaningful goals they chose. Staff supported people exceptionally by focusing on their strengths and encouraging people with what they could do.

People were supported to have maximum choice and control of their life 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. We observed people making real choices in the structure of their day and the activities they took part in. They were consistently in control of how they spent their time; what they wanted to do and when.

People had control of their dignity and how personal care was provided. The service consistently met their needs based on their wishes, enhancing their quality of life and well-being.

Staff were exceptionally responsive and had excellent knowledge of the people they supported. The service had a strong emphasis on ensuring people felt empowered and valued.

Right Care:

Staff were extremely passionate about providing care that was compassionate and provided the best outcomes for people. Staff looked at ways to enrich people’s lives.

People were treated with kindness and were observed to be exceptionally well cared for. Staff were aware of the importance of the presentation for people and excelled in supporting people with this.

Staff understood people’s communication needs as they worked with them consistently and got to know them over time, developing trusting relationships and exploring how to best capture their wishes and views. Staff deeply respected the people they supported, each other and the home environment, providing care that was thoughtful and compassionate.

People were encouraged to take positive risks to enhance their wellbeing and the service communicated well around what risks people faced and how to support them to manage these risks positively. People's care, treatment and support plans reflected their individual needs, and this promoted their wellbeing and enjoyment of life.

The service promoted equality for the people they supported. The registered manager was passionate about supporting people to access services and activities. They supported people to overcome barriers and thought outside the box to achieve this.

Right Culture:

The registered manager and staff team were highly motivated and proud of the service they delivered to the people they supported. There was a visible person-centred culture at the service.

There were consistently high levels of engagement with people using the service and with health and social care professionals to ensure people received safe, effective and responsive care that met their individualised needs.

The service placed people's wishes and aspirations at the center of everything they did, driving a culture that was inclusive and empowering. The registered manager was passionate about supporting people to be able to access, experience and participate in activities inclusively. They promoted positive risk taking and innovative approaches to support them to achieve this and to provide people with meaningful outcomes.

The registered manager was passionate about ensuring staff were suitably skilled and trained to meet people’s complex and diverse needs. The ethos of the provider was that staff were guests in the people's home and this was reflected in how staff supported them.

There was clear leadership and visions and values for the service, that ensured people were at the heart of everything they did.

Last inspection

The service was rated Outstanding at our last inspection. (Published 21 November 2019) This was due to how responsive the provider was in meeting people’s individual needs and the excellent leadership of the service.

At this inspection the service remained Outstanding in Well Led and Responsive as the provider continued to improve and develop its service. We also rated Caring domains as outstanding due to the person centered care that the service was providing. It was evident that people’s quality of life and achievements had excelled since the last inspection.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Why we inspected

We were prompted to carry out this inspection due to concerns we received about recruitment of staff. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Montrose Barn is a care home that provides accommodation and personal care support for up to two adults with learning disabilities. The service specialises in the care of people who have a learning disability. At the time of our inspection two people were living at the service.

The service is in a rural location. People had their own rooms with en suite facilities.

The service had been open for some years and therefore had not been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. 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. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

The service was rated Outstanding in Well Led at our last inspection. At this inspection the service remained Outstanding in Well Led. We found the registered manager and staff team were highly motivated and proud of the service they delivered to people. There was a visible person-centred culture at the service. There were consistently high levels of engagement with people using the service, families and other professionals. There was a strong commitment to ensure the service was inclusive and that people had the opportunity to extend their lives in the community.

The service was also Outstanding, at responding to people’s needs. Staff were exceptional in the way they supported people to learn new skills and maintain their independence. People planned for activities that met their needs and preferences and they were supported to follow their interests. A social care professional told us the service excelled at the way it supported people in promoting their independence.

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 supported by staff who knew them well and were able to communicate with them in their chosen way. This ensured people could make choices about their day to day routines.

The service had safeguarding and whistleblowing policies and procedures in place and staff had a clear understanding of these procedures. Appropriate recruitment checks had taken place before staff started work and there were enough staff available to meet people's care and support needs. People's medicines were managed safely. Risks to people had been assessed to ensure their needs were safely met. The service had procedures in place to reduce the risk of infections.

People were cared for by staff who worked together to meet people's individual needs. Staff felt well supported and happy in their roles. This helped to create a relaxed and happy atmosphere for people to live in.

Where restrictions had been put in place to keep people safe this had been done in line with the requirements of the legislation as laid out in the Mental Capacity Act (2005) and associated Deprivation of Liberty Safeguards. Any restrictive practices were clearly recorded and regularly reviewed to check they were still necessary and proportionate.

People and their relatives (where appropriate) had been consulted about their care and support needs. The service had a complaints procedure in place. The service was exploring ways of identifying people’s wishes to support end of life care and support if it was required.

The registered manager had worked in partnership with health and social care providers to plan and deliver an effective service. The provider took people and their relatives views into account through satisfaction surveys. Staff enjoyed working at the home and said they received exceptional support from the registered manager.

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 7 April 2017).

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.

The service is situated in a quite rural position close to the north Cornish coast. Besides the accommodation there is a large outdoor area where there are animals including pigs and chickens. People using the service were involved in their care and wellbeing. One person told us they liked looking after the animals. The provider lived in an adjoining property meaning that people had the use of the house to themselves. The provider had recently added a sensory room to the house. They told us, “It’s been a successful project but it is taking a bit of time for (Person’s name) to get used to it.”

At the last inspection the service was rated overall good with an outstanding rating in the domain well led. At this inspection the rating remained overall good with the domain well led remaining outstanding.

The registered manager had systems in place to record safeguarding concerns, accidents and incidents and take appropriate action when required. Recruitment checks were carried out to ensure suitable people were employed to work at the home. Our observations and discussions with staff and people who lived at the service confirmed sufficient staff were on duty.

Support was provided by a consistent staff team who knew people well and understood their needs. There were sufficient numbers of suitably qualified staff on duty. People were supported to access the local community and take part in a range of activities of their choice.

People were able to do things they enjoyed and keep in touch with those people who were important to them. Risks to people's safety were understood by staff and people benefited from receiving care and support which took into account their health and welfare. Staff understood what actions to take if they had any concerns for people's wellbeing or safety. Where required people were supported to take their medicines so they would remain well.

People were being supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were supported by staff that used their skills and knowledge so they would enjoy a good quality of life. Staff worked with other organisations and relatives so people's right to make decisions and their freedom was protected. Staff ensured people received help from staff to enjoy a range of food and drinks so they would remain well. Staff assisted people to attend health appointments and followed the advice given by specialist health services so people would receive the care they needed as their health needs changed.

People and relatives knew how to raise any complaints they had and were confident staff would take action if this happened. There was clear and open communication between the registered manager and staff, so staff knew what was expected of them. Robust checks were undertaken on the quality of the care by the registered manager/provider and actions were taken where developments had been highlighted. The registered manager/provider made sure there was a focus on continuous development of the service.

We spoke with two members of staff who confirmed their understanding of people's care needs. During the inspection we saw clear and comprehensive records of people's health care in their care plans. The care plans reflected the needs, preferences and diversity of all the people who lived at Montrose Barn.

It was clear the practice at Montrose Barn was person centred. Throughout the inspection we observed that people who used the service received consistency of care. There was effective communication from those who delivered care and support.

There was evidence that newly employed staff received comprehensive induction and training. This ensured people who used the service were supported by staff who were properly trained, supervised and appraised.

When we inspected the home it was clean and odour free. Accommodation was homely and comfortable. At the time of the inspection staffing levels were satisfactory and there were satisfactory systems in place to ensure people received a good quality service.