We carried out an unannounced comprehensive inspection on 20 and 21 August 2018.

8 Restormel Terrace (known as Douglas House by the people who live there) 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.

The service is currently registered to accommodate and support a maximum of four people. At the time of the inspection four 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.

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 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.

At the last inspection, on 19 and 20 October 2015, the service was rated as outstanding in the domains of caring, responsive and well led. This meant that the service was rated as outstanding overall. At this inspection we found the service remained outstanding in those domains and therefore overall.

Why the service is rated outstanding.

People living at 8 Restormel Terrace had complex care needs and required a high level of support with daily care needs inside and outside the home. We met with all four people during our visit and observed some interactions between them and the staff. People had capacity and were able to verbalise their views and staff also used other methods of communication, for example visual choices and information sharing. The focus was on including people and seeking their involvement in every aspect of their lives.

When we arrived people were going about their day and following their planned routines. These planned routines helped provide reassurance to people who were living with autism. People were living a full life and there was a busy but relaxed atmosphere during the day. As the day went on people were either enjoying time on their own, with staff interaction when they needed it or going out on a planned activity. This was all based on people’s individual wishes.

People were encouraged to live active lives and were supported to participate in community life as much as possible using small, achievable goals that were obviously working. People were now able to attend community groups on their own, meet peers living nearby, attend social skills courses and practice independent shopping with less support. Activities were developed for people who perhaps had not tried certain activities before in order to increase the choices available to them. Other activities reflected people’s existing interests. The environment and the outside spaces had been designed for people living with autism to allow people to safely be on their own in the communal areas and courtyard in most weathers and to have support to choose what they wanted to do. There were quieter spaces where people could go if areas got too noisy or they wanted some quieter time.

The provider and registered manager had taken innovative steps to ensure people were at the heart of the service and involved in all aspects of the running of 8 Restormel Terrace, whilst encouraging and promoting independence. People’s opinions were regularly sought and valued. For example, people were enabled to achieve activities that had previously been a challe

We spoke with the deputy manager as the registered manager had been on leave and four staff members. We also spoke with and met people using the service.

People we spoke with told us they were very happy with the care they received from the service and they were enjoying their lives. One person told us "The staff are great and they are helping me to become more independent”. The deputy manager told us “The people we care for have an enormous amount of input based on their likes and dislikes. We are always encouraging their independence”.

We saw that people had specific and individualistic care plans. These had been completed daily in accordance to people's wishes. Care plans were easy read with pictures and colour coded charts. This demonstrated an awareness of the individual persons understanding and abilities to read and understand their own care plan.

Support staff worked at a level required by the individual and promotion of independence was evident. Staff had all received a thorough core training programme that included safeguarding and attended regular updates.

There were sufficient support workers to meet people's needs and appropriate background checks had been completed on all staff. Audits were in place to continually monitor and assess the quality of care and support provided.

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

Comments from people we spoke to included;

“The staff are nice, I like to go to the disco and swimming every week. The staff help me understand about healthy food so that I think about my diet and what I eat”

" I have a key worker, and we meet every month to discuss my care and the things I am doing”

During our visit we saw that staff treated people respectfully at all times, promoting choice and independence whenever possible. Staff were aware of when people may be anxious or upset and used their skills and knowledge to provide reassurance and support.

People were supported to develop their daily living skills. One person said “We have a rota so that we know when to clean our rooms, the staff help us when we ask them”

We found that people engaged in a range of age appropriate and meaningful activities inside and outside the home. Sufficient staffing levels were in place to support people when needed.

All of the staff we spoke to were aware of the systems in place to keep people safe. People using the service were provided with information about keeping safe and who they needed to speak to if they had any concerns. One person said, “I like living here, I feel 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 received.

The inspection took place on the 19 and 20 October 2015 and was unannounced.

Restormel Terrace (known as Douglas House by the people who live there) provides care and accommodation for up to four people. On the day of the inspection four people were living at the service. Restormel Terrace provides care for adults with a learning disability and associated conditions such as Asperger’s and autism.

The service had 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 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 service provided outstanding care and support to people enabling them to live fulfilled and meaningful lives. People told us they ‘loved’ living at Restormel Terrace. One person told us they had lived at Restormel Terrace for nearly 10 years and the staff had planned a party to celebrate all they had achieved. The interactions between people and staff were positive. We heard and saw people laughing and smiling. People looked comfortable, relaxed and happy in their home and with the people they lived with.

People were very proud of their home and spoke in a way that suggested a sense of belonging and contentment. One person told us “I love it here, it’s luxury”. All the relatives we spoke to without exception used words such as, “caring”, “excellent”, “brilliant”, and “kind”, Comments from relatives included, “I have nothing but praise, the staff are all wonderful”, and “The care is really excellent, I cannot believe how much […] has achieved, they are happy, positive and confident”. An advocate said, “Wonderful, the care is so person centred, the house is so vibrant, people are so involved” and “The staff are always so keen to get involved, always really positive, it is a joy”.

There was an extremely positive culture within the service, the management team provided strong leadership and led by example. The registered manager had clear visions, values and enthusiasm about how they wished the service to be provided and these values were shared with the whole staff team. Staff had clearly adopted the same ethos and enthusiasm and this showed in the way they cared for people. Individualised care was central to the home’s philosophy and staff demonstrated they understood and practiced this by talking to us about how they met people’s care and support needs. They spoke with commitment and used words like, “individual”, and “personalise”, when they talked about people they supported. 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 celebrated.

Throughout the inspection people were keen to tell us about their routines and their achievements We saw many examples of how staff had considered ways of helping people achieve their goals and aspirations. Staff helped people think about everyday risks, but did not allow this or other hurdles to get in the way of people progressing or achieving their goal. This contributed to the high levels of satisfaction expressed at the service. People were proud to tell us about how well they had done and how with the support of staff they had progressed and achieved goals such as obtaining work and travelling independently.

There were sufficient numbers of staff to meet people’s needs and keep them safe. The provider had effective recruitment and selection procedures in place and carried out checks when they employed staff to help ensure people were safe. People told us they were always involved in the recruitment process. They said they met staff before they worked in the home and also took part in the interview process. Staff were well trained and aspects of training were used regularly when planning care and supporting people with their lifestyle choices.

People had their medicines managed safely, and received their medicines in a way they chose and preferred. The registered manager and staff had given much consideration about how they could support and encourage people to manage their medicines independently and safely.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. The registered manager and staff demonstrated a good understanding of the Mental Capacity Act (MCA) and a wide range of learning material was available regarding assessing people’s capacity and making best interest decisions. At the time of the inspection all people using the service had been assessed as having capacity to make decisions and were not being deprived of their liberty. The registered manager was aware of the correct legal process to follow if these assessments of people’s needs changed.

People were able to express their opinions and views and were encouraged and supported to have their voice heard. People were fully involved in planning and reviewing their care and support needs. All of the files we looked at evidenced that people were involved in decisions about their care. People attended meetings and discussions that concerned them. People’s were supported to use their individualised communication methods during these discussions to ensure their views were noted and acted on. Information about the service and care arrangements had been translated into a format people could understand. During the inspection people were happy to show us their support plans and were clearly used to being involved in this process.

Due to people’s learning disability and associated conditions such as autism and Asperger’s support plans in most cases stated that people needed good, clear information to help them plan their time and understand what was going on. We saw a range of personalised communication methods and tools being used to support people. Communication aids were specific to people’s needs and were detailed as part of their support plan. We saw that people used this information and referred to these visual prompts to assist them when performing a certain activity or planning their day. We saw many examples of how the staff had really thought about people’s communication needs and ensured they were not a barrier to them achieving their goals and aspirations. We saw people being supported to use their individual communications methods and tools to help reduce anxiety and have greater control about their care and lifestyle.

People’s health and well-being needs were well- monitored. The registered manager and staff responded promptly to any concerns in relation to people’s health and also encouraged people to attend health checks recommended for their age group and gender. People were provided with information about diet and healthy eating and were fully involved in all aspects of shopping, menu planning and meal preparation.

All of the people who lived at Restormel Terrace were supported to lead a full and active lifestyle. Throughout the inspection we saw people coming and going from the home either independently or supported by staff. Some people went out for short trips to the shops or to visit friends and others went for a full day out either visiting family or partaking in other planned activities such as sport and voluntary work. Activities and people’s daily routines were personalised and dependent on people’s particular choices and interests. People were supported to develop their skills and pursue employment and educational opportunities A relative told us, “It’s brilliant, […] is learning to read and write, and they love their voluntary work”.

The registered manager took an active role within the home. There were clear lines of accountability and responsibility within the management structure and tasks were delegated to help ensure the smooth and efficient running of the service. Comments included, “The manager is really supportive, I have never experienced this level of organisation”, and “There is really good team work, good management and lots of opportunities for discussion”. The registered manager encouraged and promoted community involvement and joint agency working. This helped ensure people had their full range of health and social needs met.

The provider had a robust quality assurance system in place and gathered information about the quality of the service from a variety of sources including people who used the service, relatives and other agencies. Learning from incidents, feedback, concerns and complaints were used to help drive continuous improvement across the service.