We carried out this inspection of 8-8A The Cedars on 19 and 26 April 2016. The last inspection of this service was carried out on 3 December 2013. The service met the regulations we inspected against at that time.
8 The Cedars is registered to provide care and support for up to 10 people with autism spectrum condition and associated complex needs. There were eight people living at the service at the time of this inspection, six in the main house and two people in adjacent coach house. This home does not provide nursing care.
The service had a registered manager who had been in post at this home for five years. 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 people who lived at this home were subject to deprivation of liberty safeguards (DoLS) which meant they needed supervision both inside and outside the home for their safety. It is a legal requirement that services tell us about the outcome of DoLS. During this inspection we found that the service had not told us the outcomes of applications that had been made during 2015-2016 about the DoLS. This had been an oversight, as DoLS notifications from the previous year had been submitted to the Care Quality Commission (CQC). We have written to the provider about this outside of the inspection process.
The people who lived at the home had complex needs that meant they were unable to fully express their views. Relatives said people were “safe and well looked after”. One relative told us, “I have always found [my family member’s] needs to be safely managed to a high level.”
Staff were clear about how to recognise and report any suspicions of abuse. There were good systems for staff to be able to raise concerns with senior managers at any time of day or night. Relatives and staff felt there were enough staff on duty at all times to make sure people were safe.
Staff were vetted before they started work at the service to make sure they were suitable to work with vulnerable adults. Staff managed people’s medicines in a safe way for them.
Relatives felt staff were competent and experienced at caring for people with the complex needs associated with autism. Staff said they felt well trained and supported in their roles. Staff understood the Mental Capacity Act 2005 for people who lacked capacity to make a decision and Deprivation of Liberty Safeguards to make sure they were not restricted unnecessarily.
People were supported to have as independent a lifestyle as possible. They were encouraged to enjoy a healthy lifestyle and balanced diet. A relative commented, “Nutrition is always high on the agenda and a good variety of meals are provided.”
People who were able to express a view said they “liked” the home. Relatives made positive comments about how people reacted to the home and the support they received from staff. One relative told us, “I know [my family member] is very happy there and is always ready to go back after home visits.”
A relative commented, “I believe my family member is well looked after by some genuinely caring, enthusiastic staff.” Staff felt there was a “caring culture” at the home and they promoted this with new staff coming to work there.
The records about how to support people were personalised, individual and detailed. People had a range of social and vocational activities that were tailored to their preferences and choices.
People and their relatives were asked for their views about the home and their suggestions were used to improve the service. People and relatives had clear information about how to make a complaint or comment.
The provider involved people and their relatives in reviews about the individual care service people received. Staff felt there was an “open” and “approachable” culture within the home and in the organisation. Staff said they felt valued and fulfilled in their roles.
Relatives felt the service was well run and felt able to discuss any issues with the registered manager or assistant manager. The registered manager and staff carried out checks of the safety of the service. The provider had a quality assurance system that included audits by managers of other services and a general manager.