Ruskin Mill College

Ruskin Mill College is a specialist residential college and a shared lives service for young people with learning disabilities, autism and/or mental health needs. The shared lives scheme provides people with long-term placements, short breaks and respite care, within shared lives providers (SLP) own homes. The service can support up to 45 people. 23 people were receiving personal care at the time of the inspection. The service has been developed and designed 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.

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

The service was outstandingly responsive to people’s individual belief’s, preferences and needs. Therapeutic care was delivered in line with their Practical Skills Therapeutic Education (PSTE) method, and we found that staff worked creatively to incorporate people’s individual needs with their therapeutic programme. This supported people to achieve support in a way that met their individual needs and promoted their equality.

Staff understood the needs of people and treated them with dignity and kindness to ensure their individual preferences were met. Staff were aware of what actions they would need to take if they had any concerns about peoples' safety.

People's individual needs were assessed, and comprehensive care plans and risk assessments were in place to help staff support people in accordance with their preferences.

We were told that the registered manager was very approachable, and staff told us they were supported well and encouraged to share ideas to achieve the best outcomes for the people they supported.

Positive risk taking was encouraged to provide people with as rewarding life as possible. Staff demonstrated a high level of understanding of the people they supported.

The registered manager was keen to continually improve and develop the service and ensured this through an extensive series of audits and regular monitoring of the quality of support delivered. A positive culture was promoted within the service whereby staff felt empowered to speak up and contribute to peoples' plans of care.

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.

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 the underpinning principles of Right support, right care, right culture. We saw that the care people received helped them to thrive in a learning environment among their peers, to reach their full potential, and to have maximum choice and control over their lives

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

Rating at last inspection

This service was registered with us on 18 August 2020 due to a change in registration. This is the first inspection.

The last rating for the service under the provider; Transform Residential Limited was Outstanding, published on 10 December 2019.

Why we inspected

The inspection was prompted in part due to concerns received about the management of risk. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe section of this full report.

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.

You can read the report from our last inspection, by selecting the ‘all reports’ link for Ruskin Mill College on our website at www.cqc.org.uk.

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 has been developed and designed 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.

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

Ruskin Mill College provides care to young people commissioned by Clinical Commissioning Groups from across the country. Some young people required significant emotional, mental health and behavioural support to keep them safe. Ongoing support from local specialist multi-disciplinary services was routinely needed to ensure people’s needs could be met safely. This included support with risk assessment and implementing and reviewing management strategies. This ensured support plans and other management strategies remained effective in reducing the likelihood of the person experiencing a ‘crisis’.

The local clinical commissioning group raised concerns that local mental health services were often not informed a new person had moved to Ruskin Mill, until the person was in crisis and needed emergency support. There were concerns there may be limited opportunities for local specialists to establish a relationship, develop understanding and provide pro-active support, before being required to support people in crisis.

As part of this inspection we discussed the support pathway for young people, including where wider health and social care support was required as part of their care.

We found Ruskin Mill College followed national good practice guidance when supporting people with anxiety related behaviour to stay safe. The service responded appropriately when incidents occurred, and young people experienced a crisis. People and their relatives felt the service was safe.

Staff knew young people well and could describe how they would support them to reduce their anxiety and prevent their behaviour from escalating. Staff had received training in how to manage anxiety related behaviour.

Staff understood the Mental Capacity Act definition of restraint and worked within it. Staff assessed and managed risks to young people and others well. They followed best practice in anticipating, de-escalating and managing challenging behaviour. Staff could describe how they used de-escalation techniques to avoid the use of restraint. As a result, they used restraint only after attempts at de-escalation had failed. The service continued to work on reducing restrictive interventions and use of restrictive interventions were low; staff worked well to limit them.

We did, however, find effective links between Ruskin Mill College and local specialist multi-disciplinary support services were not always well established. This was essential to ensure a coordinated and seamless transition of support for young people with mental health needs. This meant pro-active plans had not always been put in place in agreement with all relevant local specialist multi-disciplinary services. This was needed to ensure local mental health services could get to know people’s needs and effectively plan and provide early interventions including preventative support.

Prior to our inspection, Ruskin Mill College had identified work was needed to agree a clear referral and treatment pathway with local services. They arranged to meet with the local clinical commissioning group to discuss future joint working and update us with the outcome of these discussions. We will look at what progress had been made at our next inspection.

The service had appropriate infection control policies and procedures in place. These were developed in line with current government guidance. We were assured the service were following safe infection prevention and control procedures to keep people safe. We were assured the service were following safe infection prevention and control procedures to keep people safe.

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

Rating at last inspection and update:

This is the first time we have inspected this service under its current registration. As this is a targeted inspection the service remains unrated.

Why we inspected

We undertook this targeted inspection to follow up on concerns we had received about people’s care and how the service assessed and managed people’s individual risks. A decision was made for us to inspect and examine those risks.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

Following this inspection we will arrange a meeting with a representative of the provider and the registered manager as part of our regulatory duties. We plan to carry out a comprehensive inspection, where we will assess and rate the service.