Linsell House

People’s experience of using this service:

• People received safe care. Staff understood safeguarding procedures.

• Risk assessments were in place to manage risks within people’s lives.

• Staff recruitment procedures ensured that appropriate pre-employment checks were carried out.

• Medicines were stored and administered safely.

• Staffing support matched the level of assessed needs within the service during our inspection.

• Staff were trained to support people effectively.

• Staff were supervised well and felt confident in their roles.

• People were supported to have a varied diet.

• Healthcare needs were met, and people had access to health professionals as required.

• People's consent was gained before any care was provided, and they were supported to have maximum choice and control of their lives.

• Staff treated people with kindness, dignity and respect and spent time getting to know them.

• People were supported in the least restrictive way possible.

• Care plans reflected people likes dislikes and preferences.

• People were able to take part in a range of activities and outings.

• People and their families were involved in care planning as much as was possible.

• A complaints system was in place and was used effectively.

• The registered manager was open and honest, and worked in partnership with outside agencies to improve people’s support when required.

• Audits of the service were detailed and robust, and any issues found were addressed promptly.

• The service had a registered manager in place, and staff felt well supported by them.

Rating at last inspection: Good (report published 18/08/2016).`

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service remained rated Good overall.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Linsell House provides accommodation and support to up to 12 people with profound and multiple learning disabilities (PMLD) and provides a respite service to up to four people at a time. There are 40 people who use this service. At the time of the inspection there were 12 people living at the home and four people being provided with respite care.

The service has 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.

Linsell House is a purpose built single storey home arranged over three units connected to the management offices by corridors that allow people free access to the whole of the building and the enclosed garden, in which people are supported to grow fruit and flowers during the summer months. The corridors were decorated to reflect the changing seasons and provide a stimulus for people throughout the year. The building had undergone some refurbishment to ensure that the facilities provided best met the complex needs of the people who lived there or used the respite service. This had included refurbishment of the bathrooms to include custom built Jacuzzi baths that enabled all the people to have an enjoyable and relaxing bathing experience. The rooms of the people who lived at the home had been furnished to reflect their tastes and included sensory equipment that they could operate themselves when spending time in their beds. The rooms in which people that used the respite service stayed had plain walls that were decorated with pictures and items in a way to suit the individual who was to occupy it, even if this was for only one or two nights. This gave people with complex needs a familiar setting in which they felt comfortable away from their family carers.

People were protected by exceptional systems to recognise and report suspected abuse. There were easy to use telephones in a prominent position on each of the three units connected directly to the local safeguarding team and the registered manager with easy to read instructions on how to use them in plain sight. Staff had completed training in the protection of adults and had an excellent understanding of their roles and responsibilities in this. There were very detailed, person centred risk management plans for each person who used the service, including personalised assessments for each and every activity that they undertook and support strategies to reduce the risk of harm to them or other people. When new ways of working were to be introduced these were discussed with the local safeguarding team and approval for the policies and processes sought where this was appropriate before the new way of working was implemented.

The registered manager, the management team and the staff were passionate about providing people with support that would enable them to lead happy and fulfilling lives. They sought to provide a service that reflected the most up to date research in the support and development of people with PMLD and a specific diagnosis. This had included the introduction of intensive interaction to support people and increase their communication skills. Intensive Interaction supported staff to engage in quality interaction with people on a one to one basis, using their preferred method of communication. Staff worked with other services that supported people, such as day centres and family carers to ensure that people received continuity in this approach to their support. Relatives of people who had taken part in the pilot scheme told us of the improvement they had seen in people’s communication skills; they had learned how to take turns and were developing listening skills. This had considerably enhanced people’s life experiences.

The whole staff team were committed to providing systems, including new technology that would enhance people's lives. We saw evidence of how this had been achieved in a number of areas, such as touch telephones on each unit that connected directly to the registered manager, the walkie-talkie phones used to support people and the custom built baths in the residential units that had light displays. These had enhanced people’s independence and experiences.

People were very happy living at the home and using the respite service. They had formed very close relationships with other people and the staff who supported them. Staff viewed them as members of their extended family. The service operated a key worker system where one member of staff was responsible for working with an individual to develop and review their care and support plans in both the residential and respite services. People knew who their key worker was and had formed very close bonds with them. Key workers identified people’s interests and explored activities that could support them with these and others that would expand their life experiences. These had including flying an aircraft, attending concerts at the Royal Albert Hall in London, riding in a horse and cart and attending an exhibition of Elvis memorabilia in Greenwich. People had a full calendar of activities available to them and friends and family were encouraged to participate in events to increase the family feeling. People who had moved on from the service were invited to and attended many of the social events that were arranged to maintain their relationships with the people who used the service. The registered manager used these events as an opportunity to talk with families and obtain informal feedback on the service and how it could be improved. This supplemented the regular methods of obtaining feedback such as annual surveys and meetings. People were also encouraged to spend time talking with staff in the office when they were able to express their views and make comments about the service provided. The registered manager operated an open door policy and people and relatives stopped to talk with them The registered manager knew every relative of people who used the service by name. It was clear that the registered manager listened to the feedback received from people and relatives and, wherever possible, had implemented improvements that had been requested.

Linsell House, in partnership with a community based company had set up a peer advocacy group to support people who lived there and to speak up for them. Young people with a learning disability had been recruited and trained at Linsell House by the registered manager to become advocates for the people who used the service. They visited the service at least monthly and provided feedback to the registered manager on people’s views and experiences. The peer advocates had provided insight and understanding of the people they supported which the staff had used to improve their understanding of the people they cared for.

Staff had an excellent understanding of the complex needs of the people who lived at the home and those who used the respite services. They had received specialised training to meet people’s physical needs, such as stoma care. They had also received training to support people’s mental and emotional needs and to understand the challenges that they and the families who support them faced. Individual members of staff had been nominated as champions to ensure that people with a specific diagnosis received care and support that reflected the most up to date research and recommendations.

Staff used various ways to communicate with people, such as talking schedules, symbol cards and sign language as well as easy to read documents and objects of reference. They had developed ways of interacting with people that they shared with others that supported them to ensure continuity in the way that support was given to them when they were away from the service. Staff were passionate about the rights of people to be consulted and to make their own choices. This was reflected in the way the care and support plans were written and the way in which staff supported and encouraged people to make decisions when delivering care and support.

Staff were very clear about their roles and responsibilities toward the people they supported to enable them to maintain the maximum possible level of independence, choice and control. As well as following the provider’s visions and values the staff had introduced their own charter to further endorse respect for people and colleagues. As the staff were aware of almost every aspect of people’s lives, people and their relatives were provided with information about the staff who cared for them so that they were in a more equal position.

The service had introduced a quality assurance system that reflected methods used by CQC in our inspections. These had included the use of observations based on CQC’s short observational framework for inspections and quality audits that reflected across the five areas of safe, effective, caring, responsive and well led. In addition the service had appointed a number of champions to ensure that the most up to date and best practice was followed in the delivery of care and support for people with PMLD. There was a CQC champion who reviewed reports published by CQC on a weekly basis to identify areas of excellence that could be incorporated into the service delivery.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

We always ask the following five questions of services.

Is the service safe?

We observed people were treated with respect and dignity. For example, when assisting people with their care needs staff informed them what they were going to do before undertaking the task.

The home had a system in place to ensure that people's risk assessments were kept under regular review. Accidents sustained by people were monitored. Any trends identified were dealt with to minimise risks relating to people's health, welfare and safety.

Staff spoken with said that there was no one in the home on the day of our visit whose liberty was being deprived. We saw evidence which confirmed that staff had been provided with training on the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff were able to describe what measures the home had in place to promote people's safety and how they would protect people if they felt their human rights were being breached.

We found that the home had systems in place to ensure that the equipment used to support people was appropriately maintained and suitable for its purpose.

The home had infection control processes in place to ensure that it was clean and hygienic. People were protected against the risk of acquiring infections.

Is the service effective?

Staff told us that none of the people currently living at Linsell House were using the services of an advocate. This was because some people family members were advocating for them. Staff said if people needed the services of an independent advocate they would support people to obtain one. This meant that when required people could access additional support.

We found that people's care plans provided detailed information on how they wished to be supported with their care needs. Communication and health action plans had been developed for people. These were appropriately maintained to ensure if required a new member of staff or agency worker would be able to deliver care safely and effectively.

We found that people's health care needs were kept under regular review. They had access to health care professionals such as the GP, dentist, optician and district nurse. This meant that people were supported to keep healthy and well.

Is the service caring?

We observed staff talking to people in a kind and respectful manner. Staff demonstrated genuine affection, care and concern to people. Staff spoken with were knowledgeable about people's care needs including their preferences and personal histories. It was evident that people were listened to and staff responded to them in a caring way.

Is the service responsive?

We found that people were supported to express their views and be actively involved in making decisions about their care treatment and support. In the care plans we looked at we saw evidence which reflected that people and their relatives were involved in making their views known about how they wished to be cared for and supported. If people were not able to sign their care plans these were signed by family members or their key workers. We saw evidence that regular care plan reviews took place. This meant that people's care needs were current and kept under regular review.

We found that where appropriate staff enabled people to have access to activities that were important and relevant to them. It was evident that people were protected from becoming isolated and were provided with activities to meet their diverse needs.

During our visit we spoke with a social worker who told us that the home had been very responsive and accommodating to their client's needs. Staff were fully aware of people's care needs. This demonstrated that the home ensured that staff were allocated enough time to understand and accommodate people's changing needs.

Is the service well led?

Staff spoken with said that they felt supported by the management team and were provided with regular staff meetings and one to one supervisions. At these meetings they were able to raise questions relating to the delivery and implementation of best practice. This meant that staff felt supported and well-led.

We found that the home had quality assurance systems in place. Staff practice was regularly observed. The outcomes from these were discussed and used to improve the care provision. Staff spoken with said that they were provided with adequate training. This enabled them to perform their roles and to be accountable for their actions.

The home had arrangements in place to monitor complaints, accidents and incidents. This meant that lessons were learnt from mistakes, incidents and complaints investigations to ensure improvements with the service delivery.

We observed that people who used the service were offered support at a level which encouraged independence and ensured that their individual needs were met safely. There was a relaxed atmosphere in the home and peoples' body language, facial expressions and gestures indicated they were comfortable and at ease in the company of the staff who supported them.

We noted staff were caring and respectful in their approach and interacted confidently and effectively with people, using both verbal communication and sign language where appropriate. People were encouraged to express their views and were involved in planning their care and making decisions about all aspects of their life. At the time of this inspection some people were out at day centres, and those who were at home were involved in one to one activities of their choice.

We found that the care and support people required was clearly documented in their care plans, and medication was safely managed to ensure people received it as it was prescribed.

The provider had quality monitoring systems in place, however records of these processes were incomplete, so we could not be assured that people were always safe, or satisfied with the service they received.

We observed that people were offered support that ensured their individual needs were met and independence encouraged. Staff were friendly and respectful in their approach to people and interacted confidently with them, respecting the individual's dignity and knowing how to communicate effectively with them. There were numerous examples around Linsell House of how diversity was recognised and respected, including booklets on different religions and pictures of how the home had celebrated various festivals including Diwali and Christmas.