Cambian Asperger Syndrome Services Limited - 30 Milton Road

30 Milton Road is a care home registered to provide accommodation and personal care for up to eight people diagnosed with autistic spectrum disorders and learning disabilities. At the time of this inspection there were eight people living at the home.

30 Milton Road had not originally been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. This was because the service was registered for eight people and the current guidance implemented in 2017 reflects that smaller numbers of people living together have much better experiences and achieve better outcomes. However, the registered manager and staff demonstrated they understood the values that underpin Registering the Right Support. 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 of them.

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

People told us they were happy and comfortable living at 30 Milton Road. They told us they liked the staff who knew them well and provided their support and care with kindness, patience, respect and dignity.

We received positive feedback from relatives about the kindness, compassion and professionalism of staff. Staff understood how to identify and report abuse and were well supported in their roles. Staff received regular supervision meetings and a variety of training courses to enable them to carry out their roles competently.

Risks to people’s health, safety and well being were assessed and management plans put in place to ensure risks were reduced as much as possible.

People were supported by safely recruited staff and there were enough appropriately trained and experienced staff to support people in ways that suited them. Communication styles and methods were tailored to individual people and staff supported people to understand the choices available to them.

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 enabled to have choice and control of their lives and staff supported them in the least restrictive way possible.

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 worked collaboratively and closely with health care professionals to ensure people received the best care and support at all times.

People’s health care needs were met and staff supported them to see healthcare professionals when appropriate. Medicines were managed, stored and administered safely. People were supported to take their medicines safely by staff who had received the appropriate levels of training.

Staff were responsive to people’s changing support needs and adapted care and support according to their health needs.

There was a clear complaints policy and relatives told us they knew how to make a complaint if the needed to and felt any concerns would be taken seriously and action taken straight away.

There was a clear management structure and people, relatives and staff spoke highly of the registered manager who ensured there was an open, supportive, friendly culture at the home.

There were robust quality assurance systems in place to drive improvement and ensure the home offered a safe, effective, caring and responsive service.

Rating at last inspection

The last rating for this service was good, (published December 2016).

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cambian Asperger Syndrome Services Limited- 30 Milton Road on our website at www.cqc.org.uk

The service had a registered manager in place. 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.

30 Milton Road is a care home registered to provide accommodation and personal care for up to eight people diagnosed with autistic spectrum disorders and learning disabilities. The registered manager explained that the home is a 38 week service meaning people who live there go back to their families during school holidays as the home closes during these times.

There was one ensuite bedroom on the ground floor and seven additional bedrooms split across the first and second floor. Five of these rooms were ensuite and the remaining two bedrooms shared a bathroom. There was an open plan kitchen dining room and a communal living area. Staff had their own office and there was a separate medicines room. Outside the management shared an office space which had a laundry room on one side and a relaxation room for people on the other. There was an enclosed rear garden and patio which led from the dining area.

People were given regular quality assurance questionnaires to complete. We saw that feedback from these was used to improve and develop the service further. We noted one comment from a person who lived at Milton Road which read; “Amazing staff day and night. Just an awesome house”.

People, relatives and staff told us that the service was safe. Staff were able to tell us how they would report and recognise signs of abuse and had received safeguarding training.

Milton Road had comprehensive risk management systems in place. There was a signing in and out book for people which referenced risk assessments relevant to the activity taking place.

Care files were in place which detailed the care and support people needed to remain safe whilst having control and making choices about how they chose to live their lives. Each person had an individual risk assessment in place which linked to their behaviour support plans. These ensured risks to people were managed and that people were protected.

Medicines were managed safely, securely stored, correctly recorded and only administered by staff that were trained to give medicines. Medicine administration records reviewed showed no gaps in the recording of medicines administered. People were being supported to manage their own medicines safely.

Staff had a good knowledge of people’s support needs and received regular mandatory training as well as training specific to their roles for example, autism, positive behaviour support and incident report writing.

Staff told us they received regular supervisions which were carried out by management. We reviewed records which confirmed this. A staff member told us, “I receive regular supervisions and find them useful”.

Staff were aware of the Mental Capacity Act and training records showed that they had received training in this. Capacity assessments were completed and best interest decisions recorded.

People were supported to access healthcare appointments as and when required and staff followed professional’s advice when supporting people with ongoing care needs. An advocate visited the service on a regular basis.

People told us that staff were caring. We observed positive interactions between staff and people. This showed us that people felt comfortable with staff supporting them.

People had their care and support needs assessed before using the service and care packages reflected needs identified in these. Outcomes were set by people and outcome focused reviews took place. These evidenced that people were actively supported to work towards their individual goals and outcome areas. We saw that these were reviewed annually by the service with people, families and health professionals when available.

People, staff and relatives were encouraged to feedback through house meetings, one to one time away from the home with their keyworker and annual quality surveys. We found that feedback from people was listened to and improvements made in response. This told us that the service listened to people’s experiences and concerns.

There was a system in place for recording complaints which captured the detail and evidenced steps taken to address them. We saw that there were no outstanding complaints. This demonstrated that the service was open to people’s comments and acted promptly when concerns were raised.

People, their families, staff and other professionals all told us they felt the service was well managed. They told us the registered manager and management team were all approachable, knowledgeable, that there was good communication and they were efficient. Staff and people were empowered to take part in the running of the service. They were supported and encouraged to share ideas about how the service could be improved and had been pro-active in supporting changes. They spoke enthusiastically about the positive teamwork and support they received.

The registered manager had a good understanding of their responsibilities for sharing information with CQC and our records told us this was done in a timely manner.

Staff had a good understanding of their roles and responsibilities and in addition to these had lead roles within the home. Information was shared with staff so that they had a good understanding of what was expected from them.

The service understood its reporting responsibilities to CQC and other regulatory bodies and provided information in a timely way.

Quality monitoring visits and audits were completed by the management team. These included environment, medicines and safeguarding. There were also spot checks carried out by the management and additional audits completed by other registered managers from the other local Cambian services. In addition quality meetings took place. This showed that there were a number of good monitoring systems in place to ensure safe quality care and support was provided to people.

People we spoke with told us they were happy living at Milton Road.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. One person we spoke with told us, 'Staff are really nice and supportive with most things'. People had been fully involved in planning the care or support they wanted or needed.

One care worker we spoke with said, 'The guys seem very at home here'. Another care worker described the strengths of the home as, 'Life skills are superb, good location, quite a lot of activities' and, 'What we provide is good'.

We found there were enough staff to meet people's needs.

Milton Road ensured people were able to express their views about the home, and acted on suggestions made by individuals or staff working at the home.

Milton Road regularly checked the quality and safety of the service people experienced.

There was an effective complaints system and information about making a complaint was provided in a suitable format.