Bigwig House

Updated 9 October 2019

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection was carried out by one inspector.

Service and service type

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

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We also reviewed information that we held about the service such as notifications. These are events that happen in the service that the provider is required to tell us about. We used all of this information to plan our inspection.

During the inspection

We met and spoke with everyone living at the service. We spoke with three care staff and the registered and deputy managers.

We reviewed people’s care and medication records. We looked at staff records in relation to recruitment, training and supervision. We also looked at a variety of records relating to the management of the service and quality monitoring systems.

After the inspection

We looked at staff training data and spoke with another four staff. We also spoke with four relatives and two healthcare professionals to hear their views of the service.

Updated 9 October 2019

About the service

Bigwig house provides care and accommodation for up to three people who have autistic spectrum disorders. At the time of the inspection three people were living at the service. The service is part of the Green Light group who run several similar services throughout Cornwall, for people living on the autistic spectrum.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service and what we found

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion.

Staff enabled people to live as fulfilling live as possible and achieve the best possible outcomes. Staff knew people exceedingly well and worked together as a team. They set high standards for people to achieve and strived to support people to reach their full potential. The care and support people received was exceptionally compassionate and kind.

People were supported to try new experiences while any related risks were identified and action taken to help reduce the risks. Staff were exceptionally skilled at understanding and managing people’s complex needs and behaviour. This knowledge, and the strategies put in place, had enabled people to exceed expectations in the skills they had learnt and how their independence and well-being had been enhanced.

People received care and support that was individual to their needs and wishes. Care plans were regularly reviewed and updated and were an accurate reflection of people’s needs. Staff actively supported people to maintain links with the local community, their friends and family.

People were supported to pursue their interests, hobbies and gain new skills. Staff were flexible and responded to people’s needs and wishes, adjusting activities accordingly, as well as exploring and trying new ideas with people.

People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately. Staff helped people to plan meals and shop as well as preparing and cooking meals. Staff encouraged people to eat a well-balanced diet and make healthy eating choices.

Staff were recruited safely and there were sufficient numbers to ensure people’s care and social needs were met. Staff received induction, training and supervision to assist them to carry out their work.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported/ did not support this practice. Any restrictive practices were regularly reviewed to ensure they remained the least restrictive option and were proportionate and necessary.

There was a clearly defined management structure and regular oversight and input from senior management. Staff were positive about the management of the service and told us the registered manager was supportive and approachable.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people. The service used positive behaviour support principles to support people in the least restrictive way. The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.

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

Rating at last inspection

The last rating for this service was good (report published 22 February 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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