Restormel House is a residential Care Home, which provides accommodation and supports the needs of people with a learning disability and associated conditions such as autism and Asperger’s. In addition to a learning disability some people may also be living with mental health needs. The service is currently registered to accommodate and support a maximum of six people. At the time of the inspection five people were living at the home.

People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

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. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

People living at Restormel House had a range of complex care needs and required a high level of support with daily living inside and outside the home. Some people had previously lived in settings where they had been restricted from making everyday choices and others were experiencing change as they moved from being a child into adult services. Although people had capacity, some of their communication skills were limited. We met all five people during our visit and were able to observe interactions and talk to people about their daily routines and plans.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered person’s’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated regulations about how the service is run.

At the last inspection on the 20 January 2016, the service was rated as good in the domains of safe, effective, caring, responsive and well led. This meant the service was rated as good overall. At this inspection we found the service remained good in safe and effective, but had improved to outstanding in caring, responsive and well led. This means that at this inspection the service is rated as Outstanding overall.

Why the service is rated outstanding.

There was a very positive culture within the service. The management team provided strong leadership and led by example. Relatives, staff and other agencies were very positive about the leadership of the service. They described the registered manager as, “Excellent”, “Supportive, always available” and “Proactive, always thinking ahead”. We observed positive and compassionate interactions between staff and the people they supported. Staff said they loved their work and were passionate about providing high standards of care. The provider really inspired staff to provide an excellent quality service. Staff had been nominated and received awards to celebrate their contribution to care and a number of aspiring leadership opportunities were available to encourage progress and development.

There was a ‘can do’ approach to working with people. The registered manager and staff recognised that people they supported were young and despite their needs wanted to experience the same opportunities as other young people their age. Risks in relation to people’s care were assessed, understood and managed well. Staff worked very hard to manage risks, whilst not restricting people’s opportunities. For example, one person wanted to attend an event to see favourite film and TV characters. Staff supported the person to consider the risks involved in this activity and to plan the event safely. The person’s involvement, staff skills and determination resulted in the person having a wonderful experience, which we were able to see had been documented for them in photographs.

People were en

The inspection was unannounced and took place on the 19 and 20 January 2016. The inspection was undertaken by one adult social care inspector.

1A Restormel Terrace provides care and accommodation for up to six people. On the day of the inspection six people were living at the service. 1A Restormel provides care for adults with a learning disability and conditions such as Autism, Aspergers and other needs associated with their mental health.

The service had a Registered Manager. 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.

During the inspection people and staff were relaxed and happy. Staff had time to sit and talk to people and conversations we heard demonstrated staff knew people well and understood their needs and different personalities.

People, relatives and other agencies spoke highly of the service and the support people received. Comments included, “Staff are very passionate about the people they support”, “I think very highly of the staff team, they are really knowledgeable about people and are doing a really good job”. People confirmed staff were kind to them and they were happy living at 1A Restormel Terrace.

There was an open, transparent culture and good communication within the staff team. The registered manager was clear about the values of the service and these values were shared and understood by the staff team. Staff spoke in a compassionate and caring way about the people they supported. People were supported to fulfil their goals, wishes and aspirations and their achievements were recognised and celebrated. The registered manager said, “ We are a moving on service, we are constantly supporting people to develop their skills and be independent”

There were sufficient numbers of staff to meet people’s needs and to keep them safe. The provider had effective recruitment and selection procedures in place and people who lived in the home were involved in this process. People told us they felt safe, and were also supported to consider ways of keeping safe when they went out of the home.

People had their medicines managed safely. People were supported to maintain good health through regular visits with healthcare professionals, such as GPs, dentists and the specialists involved in their specific healthcare needs.

People were supported to take everyday risks and to make choices about their care and lifestyle. People’s risks were known, monitored and managed well. Management and staff understood their role with regards to ensuring people’s human rights and legal rights were respected. For example, the Mental Capacity Act (2005) (MCA) and the associated Deprivation of Liberty Safeguards (DoLS) were understood by staff. All staff had undertaken training on safeguarding adults from abuse and displayed a good knowledge on how to report any concerns.

Staff undertook a comprehensive induction programme specific to the service and supporting people within the care setting. Staff had opportunity for a wide range of training and the training programme was relevant to the specific needs of people they supported.

Staff said they felt well supported by the management team and their colleagues. Comments included, “The manager tells us never to be afraid to ask, we are able to suggest things, think outside the box, it makes us feel valued as part of a team”.

Support plans were focused on giving people control and encouraging people to maintain as much independence as possible. People were involved in planning their care and their particular preferences were sought and documented. People’s age, life histories, disabilities and abilities were taken into account in the planning and delivery of care.

People were encouraged to lead act

People told us that they were treated with respect and that their consent was always sought before care was undertaken. We observed that staff asked permission before entering people's rooms and that they recognised that people had the right to go out when they chose. People told us that were free to leave the home when they wished. We saw staff supporting people to go to the shops and attend a leisure facility.

Care plans were personalised, taking into account a person's strengths and weaknesses as well as their likes and dislikes. We saw that staff supported people to be as independent as possible, helping them to shop and cook and undertake activities they enjoyed. People told us that they would sit down with their key worker or another member of staff and discuss what they wanted to do. We observed staff sitting with people discussing activities.

People told us they 'liked the home' as they could decorate their rooms according to their personal preference. We saw that the home was well maintained and that repairs were carried out when required.

We reviewed staff records which showed they were supported to do training and also received regular supervision and appraisal.

There was a complaints procedure which was accessible to the people living in the home. We talked with people who said that they knew how to make a complaint but that 'they had never made a formal complaint as we tend to talk things through and get things sorted.'

At the time of our visit there were six people living at the home. We met and spoke to four of the people who used the service.

Comments from people we spoke to included;

“There are always staff available to speak to. If anything is bothering me, I can speak to staff and it will get resolved”

“Staff respect my privacy, they tell me about possible risks, but don’t stop me doing things” “Staff understand my problems and know the things I need support with”

During our visit we saw that staff treated people respectfully at all times, promoting choice and independence whenever possible. The interactions and relationships we observed helped to create a homely and age appropriate environment for people using the service.

People were supported to develop their daily living skills, and to consider options for the future. One person said “The staff tell us about possible risks, but they don’t stop us doing what we want to do.

We found that people engaged in a range of age appropriate and meaningful activities. Comments from people using the service included “I like to go to the local shops, the staff help me when I need it”

The three staff members we spoke to were able to tell us about different types of abuse, and they knew what to do to ensure that people using the service were kept safe.

The provider regularly reviewed the quality of the service and was able to demonstrate that changes had been made as a result of any feedback.