About the service:

Outreach Community & Residential Services – 86 Meade Hill Road is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both premises and the care provided, and both were looked at during this inspection. The home provides care and accommodation for up to five people who have learning disabilities or who have autistic spectrum conditions. At the time of the inspection there were five people living at the home.

People’s experience of using this service:

At this inspection we found the evidence continued to support the overall rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. The outcomes for people using the service reflected the principles and values of registering the right support. This was because peoples support focused on them having choice and control and as many opportunities as possible for them to gain new skills and become more independent.

Care records were person centred. Care and support was organised around each individual and their needs and wishes.

People’s life history and preferences were respected. People told us their individual beliefs, as well as their Jewish religion and culture, were respected.

Staff interacted with people in a kind, friendly and respectful manner. The atmosphere was relaxed and there was lots of laughter and gentle banter. Staff and managers knew people really well and showed genuine fondness, compassion and understanding for the people who lived at the home.

Staff received the training and support they needed to carry out their roles effectively. Staff members had been safely recruited and there were sufficient numbers of staff to provide people with the person-centred support they needed.

Risks were well managed. Medicines were managed safely. Staff helped people to stay healthy and promoted their wellbeing.

People had access to a wide range of community based activities which met their social, recreational and cultural needs.

The registered manager had a clear vision of what the service should be. They were committed to ensuring people were respected as individuals, had opportunity for ordinary life experiences and that their independence was encouraged. Staff we spoke with shared this commitment.

Everyone was very positive about the registered manager and the way the service was organised and run.

Audits of the service, company policies and procedures and staff practice all helped to evidence how the service was meeting the regulations. The quality assurance records that we saw demonstrated how the registered manager maintained good oversight of the service.

Rating at last inspection:

At our last inspection, published in August 2016, we rated the service as good.

Why we inspected:

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

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit in line with our re-inspection programme. If any concerning information is received we may inspect sooner.

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

This was an announced inspection, which took place on 22 and 27 June 2016. We had previously carried out an inspection on 4 August 2014 when we found the service to be compliant with all the regulations that were in force at the time.

86 Meade Hill Road is a care home registered to provide accommodation and personal care for up to five people who have a learning disability or mental health needs. At the time of this inspection, five people were using the service.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

People who lived at the home who were able to speak with us told us they felt safe at the home. They said they could approach the registered manager, the staff or a relative if they had any worries or concerns. They were confident they would be listened to and that any problems would be sorted out.

Recruitment processes were sufficiently robust and should help protect people who used the service from the risk of staff who were unsuitable to work with vulnerable adults. We saw that there were sufficient staff available to meet people’s needs. No outside agency staff were used by the services. This meant that people who used the service received consistent support from a staff team who knew them well.

There were systems in place to ensure the safe administration of medicines and effective infection control practices. Staff had received the training they needed to support people safely and effectively.

Where a person who lacked mental capacity was not allowed to leave the house unaccompanied, we saw that an application for a standard deprivation of liberty safeguard had been made.

People had the access they needed to health and social care professionals.

We were told by people we spoke with that their Jewish faith and culture was observed, for example, attending Shule, celebrating Shabbos and buying kosher food.

The atmosphere in the services was relaxed and friendly and there was a good rapport between people who used the service and the staff supporting them.

We saw that those who used the services had person centred care records, which included easy read formats and photographs that helped people to be involved.

People had access to a range of activities that met their individual needs and were encouraged to be as an independent as possible.

Wherever possible people who lived at the home were encouraged to maintain contact with their family and friends.

We saw records that showed that the registered manager carried out regular audits of the home’s records and health and safety checks.

All the people we spoke with told us the registered manager and all the staff were approachable and would always listen and respond if they raised any concerns.

During this inspection, we contacted the commissioner and safeguarding teams at the local authority. They raised no concerns about the service with us.

We saw that the service asked people for feedback about the service and what they thought about the quality of service they received.

We considered all the evidence we gathered under the outcomes we inspected. We used the information to answer the five questions we always ask: Is the service safe? Is the service caring? Is the service effective? Is the service responsive to people’s needs? Is the service well led?

Below is a summary of what we found. The summary is based on speaking with two people who used the service and two staff members who supported them, observation and looking at records.

Is the service safe?

People we spoke with who lived at the home told us they felt safe at the home. They said they could approach the registered manager if they had any worries or concerns. They were confident they would be listened to and that the problem would be sorted out.

A person who lacked capacity to make decisions was not allowed to leave the house unaccompanied to ensure they stated safe from harm, for example, from traffic or getting lost. We saw that an application for a standard deprivation of liberty safeguard had been made to ensure that the home was acting in line with the law.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

Is the service effective?

People told us that their individual needs, choices and preferences were acted upon and were respected by the staff supporting them. In the section of the person’s care records ‘How best to support me’ it stated, “Read my pen picture (one page profile) and ask me if there is anything else you want to know.”

The deputy manager told us about what action had been taken when the physical health needs of a person had changed. They also gave us examples of how people’s health needs were monitored, for example, a dementia assessment.

Is the service caring?

Interactions between people and the staff supporting them were seen to be frequent, friendly and the atmosphere was calm and relaxed.

People were supported by support workers who knew them well.

Is the service responsive to people’s needs?

Wherever possible people who lived at the home were encouraged to maintain contact with their family and friends.

We were told by people we spoke with that their Jewish faith and culture was observed, for example, attending Shule, celebrating Shabbos and buying kosher food.

People were involved in activities within the community. We saw in the ‘Dreams and Aspirations’ section of their support records that the person had said they wanted to go out and play pool. We saw that with the help of a befriender this goal had been achieved.

Is the service well-led?

The manager of the home was registered with the Care Quality Commission (CQC). We saw records that showed that the registered manager carried out regular audits of the home’s records and health and safety checks.

To ensure their continuous professional development the deputy manager was undertaking a leadership and management course.

A person who lived at the home was a representative on the organisation’s management committee. This gave them the opportunity to have a say in how the service was run.

People we spoke with told us that they could make their own decisions about what they did on a day to day basis. For example one person had chosen to go out for lunch with a member of staff to celebrate their birthday. They told us they were able to pursue their own interests for example watching world cricket on television and buying magazines that interested them.

People’s care and support was planned and delivered in line with their individual care plan.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

People we spoke with told us that they could speak to the senior staff member if they had any problems or concerns. They said that they were confident that they would be taken seriously and they would do their best to sort the problem out.

Prior to our visit we contacted the local commissioning team about the service. They informed us that they had no concerns about 86 Meade Hill Road.

People were supported in promoting their independence and community involvement. People enjoyed different activities for example some people went out to day centres whilst others preferred to stay at home and watch sport on the television or read the newspaper.

Staff were seen to knock on doors before entering people’s bedrooms. The atmosphere was relaxed and friendly. There were frequent and friendly interactions between people living at the home and support workers. People told us "the staff are good they are great" and "she's the best".

People’s food and drink met their religious or cultural needs. Meat was sourced from a kosher butcher and some had been purchased that day. We saw that people had access to the kitchen and were able to prepare meals and make drinks in line with their individual needs. Some people confirmed they did their own cooking and shopping and they enjoyed being able to do this.

There were systems in place to reduce the risk and spread of infection. People told us they helped to keep the house clean and tidy. They took responsibility to clean their rooms and some communal areas with the support of staff.

People who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

Appropriate checks were undertaken before staff began work. There were effective recruitment and selection processes in place