The inspection took place on 29 March, 4 and 5 April 2017. The first day of the inspection was unannounced, which meant the staff and provider did not know that we would be visiting. We informed the registered manager when we would visit for the second and third day of our inspection in order to meet a wide range of people who used the service and join a relatives meeting.1 Lanark Close is registered to accommodate up to 16 people but the provider is operating the service as a 12 bedded care home providing short-breaks, a transitional service and a crisis bed for approximately 77 people per year who have a learning disability. Some of the people who used the service may have in addition to a learning disability a physical disability or mental health need. People normally arrive for their stay in the afternoon and depart on the morning their break finishes. But when people were in a crisis situation they could immediately access a stay at the service and were fully supported by staff to deal with any emotional distress as well as, with their consent, access to other organisations and services that could assist them during this stressful period. During their stay at the service people had access to hotel style accommodation, a gym, sensory room, games room, internal and external activities such as going to discos, the cinema and making crafts, as well as access to advocacy and mental health services.
There was a registered manager in post at the time of our inspection who had worked at the service since April 2014 and became the registered with CQC in October 2014. 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.
The most striking aspect of this dynamic service was the strong sense of leadership, commitment and drive to deliver a service which improves the lives of the people who use the service and their relatives in a fulfilling and creative way. The culture embedded in the service was an absolute commitment to deliver a person-centred and responsive short-break service, which relatives described as a lifeline for them as well as a fantastic place for people to use. We found that the registered manager had encouraged staff to constantly think about improvements. Staff told us that prior to and following people’s visits to the service they looked at what went well and how they could make the next stay even more special for each individual. We found that the management style had led to staff, people who use the service and relatives feeling they were an integral to and an essential partner in assisting to develop and enhance the service.
Although over 77 people use the service each year staff were devoted to ensuring each individual found their lives were enriched by they experience that they kept very up to date with each person’s life. Staff could readily discuss at length and in great detail each and every person who came to 1 Lanark Close, what they liked and their support needs. We found the staff empowered people to voice their wants and aspirations for their lives and then supported them to achieve these goals. It was evident that people’s voice was heard as following people and relatives giving feedback that the environment needed to be updated the provider had completed major refurbishment work and installed high quality baths, showers and furnishings. They had created more space for people to use by converting an office on the upstairs floor into a pool room as well as enhancing the gym, games room and sensory room. The standard of décor within the home was of a very high quality.
During their short breaks people were encouraged and supported to establish new friendships, to learn new skills and transfer these into their everyday lives. A number of the people enthusiastically told us about the skills book they completed, which encouraged the development of a new skill each time they visited such as using a computer or cooking and to practice the ones they had already learnt. Relatives told us that the availability of staff support for people to develop their skills was invaluable and gave them confidence that over time individuals would become more self-reliant.
We heard how staff explored with people all of their interests and celebrated every achievement and each of the steps they took to move towards their ultimate goal. Staff believed that by celebrating each step people would gain confidence and increase their desire to reach an ultimate goal, whatever that was, such as continuing to have a happy life with their parents for longer, seeking employment or moving into their own accommodation. We found this drive to support people to grow and develop was exceptional and rarely seen within short-break services.
The service was making a difference to people’s wellbeing by working well as a team, in harmony with one another sharing the same values and principles. The service was proactive in providing people with a range of information to assist them to make decisions about their health and wellbeing. Staff worked with health and social care professionals in ways that benefited people. They were actively contributing to supporting people to understand how to manage mental and physical well-being. Staff recorded clearly in the records the advice provided by the professional whilst at the service or, if appropriate, when at home in order to support the person to follow the advice given.
The service provided outstanding care to people. Staff were exceptionally caring and inspired people to do well in achieving their goals. People were cared for by staff who knew them well and understood how to support them and maximise their potential. The service's visions and values promoted people's rights to make choices and live a dignified and fulfilled life, this was reflected in the care and support that people received. People were listened to and their voice was heard in a variety of creative ways such as by people taking part in surveys each time they visited.
Staff understood people's different ways of communicating and how to make people feel valued. They supported people to make decisions for themselves and spoke with people about their wishes and preferences. Staff were observant and reported any changes in people’s needs. They were flexible in adapting the way they provided care ensuring they were person centred. The system for booking at the short-stay service was extremely efficient and we heard that 99% of the time people got the days they picked. Also if plans changed or emergencies occurred, relatives told us that the service would readily try to accommodate any requests for different days.
The benefits of this service were illustrated within a short film which the people who used the service compiled to raise awareness of the resources available at 1 Lanark Close. In the short film, people were seen laughing, conversing, going out and about in the community and completing activities in the service. People told us that the involvement with 1 Lanark Close was contributing to their mental health wellbeing and providing social interaction which was meaningful and person centred.
Relatives were also able to attend a monthly meeting, run by an independent carers service who the provider had commissioned. These meetings provided relatives with access to a wide range of information about practical matters such as making benefit claims as well as speakers coming to each event and a support network. It also gave relatives access to a space with an independent person where they could discuss all of the everyday stresses of being a carer.
At each visit people actively chose what they wanted to do that day and for the duration of their stay. People had formed great friendships with each other whilst at the service, which had extended out to their everyday lives. We heard how people got together to work out when they would all go to the service to stay. Thus at times there could be groups of people who wanted to go somewhere together and individuals or a couple of people wanting to go out to a different place or event. Previously the provider had bought a people carrier for the service but the registered manager and staff found this inhibited them when organising the activities. In response the provider had organised access to various minibuses and community drivers to take people where they wanted to go on an evening and also purchased a car so people could go out on a one-to-one basis.
People also enjoyed a wide range of activities whilst at the service, which included craft work and access to a games room, pool room, sensory room and gym holding static bicycles, rowing machines and a treadmill. All of the staff had completed training to enable them to support people to use the gym equipment. At each visit people actively chose what they wanted to do that day and for the duration of their stay. The staff promoted healthy eating and discussed all aspects of physical care with people and the registered manager was trained in mental health first aid.
Since the last inspection the provider had redesigned the catering arrangements and replaced the cook/chill equipment. Health and nutritional technicians now prepared freshly cooked food and worked with the people to assist them to develop their cooking skills. We enjoyed a meal with people and saw that this was very much a combined effort with people assisting each other to get plates, drinks and so forth as well as an opportunity for all to catch up with what had been happening in each other lives since they last met.
Staff told us they received supervision on a monthly basis and they received annual appraisals. Staff were well respected within the organisation