Ebbsfleet House

Ebbsfleet House is a residential care home that provides personal care for up to five people who may have autism or a learning disability. It is a specialist service for people that have anxious or emotional behaviour that has limited their quality of life and experiences. At the time of our inspection there were five people living there.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

People’s experience of using this service:

The home applied the principles and values of Registering the Right Support and other best practice guidance. These ensured people who live at the home can live as full a life as possible and achieve the best possible outcomes that include control, choice, inclusion and independence.

Since our last inspection people had been supported to achieve goals that were previously considered out of reach. For example, one person had been supported to go shopping, an activity which previously caused a lot of anxiety, and resulted in the person displaying behaviour that could challenge. People were very active, and part of the local community, involved in the local sports centre, and horse-riding stables.

Incidents of behaviour that could challenge had reduced since our last inspection, leading to a decrease in restrictions in place for people. Alongside this, incidents of physical restraint had reduced, and staff worked with external healthcare professionals to reduce the levels of restraint used, which has a positive impact on people. People had been supported to take positive risks, including re visiting activities which previously caused increased levels of anxiety. Staff worked with people, providing picture references to increase understanding of activities, and food choices, as well as to support understanding of healthcare appointments. People had been supported to safely reduce the medicines they were taking.

There was a positive culture within the service, with mutual respect between people and the staff supporting them. Staff were passionate about providing positive outcomes for people and has formed excellent relationships with people. People were supported to express their views and be involved in their care.

The service continued to meet the characterises of Good in all domains.

Rating at last inspection:

At the last inspection the service was rated Good. (28 September 2016)

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as

per our re-inspection programme. If any concerning information is received, we may inspect sooner.

Ebbsfleet House is a service for five people who have Autism and learning disabilities. It is a specialist service for people that have anxious or emotional behaviour that has limited their quality of life and experiences. Accommodation for four people is in the main house and there is a separate flat for one person. The home is set in a rural area in a small street with a few other houses nearby. There is a good size garden behind the house and a separate garden alongside the flat. Both are secure. There is a small car park to the side of the property and further parking on the street.

A registered manager and deputy manager were based at the service. 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.

There was a culture of warmth and openness. People were cared for and supported to develop their independence in a secure environment so that their confidence could grow. There were plenty of staff who were well organised to support people’s needs and interests. Staff were committed and worked hard to get to know people so that they could provide a service that suited each person and increased their quality of lifestyle.

The home was run in a family style. It was warm, friendly and everyone’s individuality was respected and nurtured. Staff were trained and competent to carry out their roles. Staff were supervised and had yearly appraisals. All staff were checked before they started work at the service to make sure they were of good character and safe to work with people. People said or expressed that they felt safe in the service and staff had a clear understanding of what could be abuse and how to report it.

There was a clear system of risk assessment to protect people as much as possible without limiting their experiences. Each situation and opportunity was assessed for how it would enhance the person’s quality of life and what the potential risks were. Positive risks taken to help people develop their independence.

Mealtimes were social occasions and were organised around people’s preferences and lifestyle. The kitchen was designed so that it was an open space that was practical for people to use. Everything was accessible and only high risk items such as sharp knives were kept securely out of the way when not being used. People were supported to make their own meals.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Mental capacity assessments had been carried out to determine people’s level of capacity to make decisions in their day to day lives and for more complex decisions when needed. DoLS authorisations were in place, and applications had been made for renewal, for people who needed constant supervision because of their disabilities. There were no unnecessary restrictions to people’s lifestyles.

Staff found ways to help people overcome the barriers to their relationships with other people, and that had limited their opportunities to go out and about and live an ordinary lifestyle. Each person had a key worker and co-key worker. Key workers were members of staff who took a key role in co-ordinating a person’s care and promoted continuity of support between the staff team. People were making progress with their social skills and awareness, managing their health and wellbeing and developing their daily living skills.

People were able to express what they wanted using gestures, objects, pictures and photos and had the support of community professionals to develop these. Noticeboards and planners were used to assist people to plan activities and events. The communication methods and aids were being developed for each individual. People were encouraged and supported to have their voices heard through ‘My Voice’ meetings within the organisation.

People were encouraged to try new experiences and develop new interests to enrich their lifestyle. Meetings were held with each person so they could decide what activities they would like to try and develop their goals. People were going out more often and doing different things. A variety of day to day activities were ongoing inside and outside the home and there were plans for holidays and trips further afield. An outside sensory room had been designed and equipped and was almost ready to use.

People were supported to maintain a healthy, active lifestyle. People’s days included plenty of exercise and activities. Health and social care professionals were involved as much as needed and all gave us good feedback of the service provided. People were encouraged to eat healthily and all were involved in deciding what to eat and helped at mealtimes. Each person had clear guidelines and support to manage health conditions like epilepsy or food allergies and to take prescribed medicines safely.

A health and social care professional commented, “During visits, carers always spoke in a respectful way to people. On a day to day basis they appeared to have good understanding of people’s needs and wants.”

The registered manager used effective systems to continually monitor the quality of the service and had on-going plans for improving the service people received. There was a clear complaints procedure and process that was designed to enable people to express their views and were responded to in a way they could understand. The registered manager welcomed complaints and used the opportunity to improve the service. Several improvements had been made following feedback and complaints including new fencing, internal alterations to stairs and doorways and improvements to the garden.

Emergency plans were in place so if an emergency happened, like a fire, the staff knew what to do. There were regular fire drills so people knew how to leave the building safely. Safety checks were carried out regularly throughout the building and the equipment to make sure they were safe to use.

Through direct observation, discussions with staff and records we viewed, we saw that the service actively encouraged people to be members of the wider community. The service provided imaginative and varied opportunities for people to develop and maintain social, emotional, communication and independent living skills.

We were able to observe people who used the service being supported with their hobbies and interests. People also took part in many every day activities. These included going for a walk and shopping. People were also supported to carry out household chores such as cooking and laundry.

Through observation however during the site visit we were able to observe staff supporting people who use the service in a respectful way and that staff took time to explain where possible the options available and involved them in many activities.

We were also able to speak with a visiting parent during the inspection who expressed her opinions of the service. She felt that the service provided good care, that her son was happy living there and that she had an active say in his care and that the manager and staff team were very good in supporting her son with his needs.

Through direct observation, discussions with staff and records viewed we could see that the service actively encouraged people to be members of the wider community. The service provided imaginative and varied opportunities for people to develop and maintain social, emotional, communication and independent living skills. The staff had a strong ethos and focused on involving people in all areas of their lives.