Abbeymead Lodge is a ‘care home’. People in care homes receive accommodation and 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. There were eight people living at the home at the time of our 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.

At our last inspection we rated the service good. At this inspection we found the evidence that the service had progressed in developing people’s personal growth and empowerment. The management continually demonstrated how they reviewed their systems and care practices to ensure people received high quality care. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. At this inspection we found the service improved to outstanding.

Why the service is rated Outstanding:

Feedback from people’s relatives was overwhelmingly positive. They complimented the caring nature of staff and felt that the service was well-led. They praised the approach of staff and stated that they felt their relatives were safe living at Abbeymead Lodge. The strong leadership team ensured that the values and vision of the service were embedded in the care practices of staff. The management team had strong emphasis on driving improvement and improving the quality of people’s lives. All health care professionals who contacted CQC about the service acknowledged the consistent dedication and approach of staff.

People’s needs had been assessed and their support requirements and preferences were recorded in detail to provide staff with the guidance they needed to support people. Staff had a continuous approach and a healthy balance of supporting people to understand the potential risks linked with their activities such as being in the community independently without being risk averse or impacting people’s confidence and anxiety about being independent. People were continually reassured and praised for their achievements. The staff approach focused on people’s individual needs and how to maximise their potential and personal growth. Staff used innovative ways to obtain people’s consent to care. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People were supported to maintain relationships with people who were important to them. Staff ensured people’s human rights and diverse needs were supported.

Effective systems were in place to manage people’s medicines so that they received them safely and on time. People were supported to access health care services and to maintain a healthy lifestyle. Health care professionals complimented the responsiveness and caring nature of staff.

Sufficient numbers of staff were available to ensure people’s well-being and for them to safely be involved in activities. New staff were suitably vetted and trained before they supported people. Staff had a good understanding of people’s needs and had been trained to carry out their role. Staff consistently praised the support they received from the management team. They told us they felt supported and trained and had access to the information they needed to support people. They understood their responsibility to report concerns and poor practices.

The service had an open and progressive culture to improve the quality of lives for people. The focus of the home was to ensure that people’s individual and diverse needs and their human rights were valued and respected and at the centre of the care being delivered. Systems

We spoke with five people living in the home and six members of staff. We observed people interacting animatedly and happily with staff. People told us they had no concerns and were happy living in the home.

People were fully involved in the planning of their care. They told us "I talk to my key worker (allocated member of staff)" and "my key worker helps me". They said they enjoyed going to college, to work and for short trips away. People had access to information about their care and support in easy read formats using personal photographs and pictures. People were supported to be independent around their home and in the local community.

People had access to safe and accessible accommodation which was well maintained and decorated to a high standard. People told us they had chosen the colour schemes for their rooms. Arrangements were in place to ensure effective systems to minimise risks to people.

Staff were properly trained and supervised. They were able to gain the skills and qualifications relevant to their work. For instance they had completed courses in autism awareness, diabetes and epilepsy. Staff told us they completed assessments and were observed in their work to ensure they were competent to carry out their role. People told us "staff are nice" and "staff are ok".

There were opportunities for people to provide feedback about their care and support. They had access to the complaints procedure in an appropriate format and to residents' meetings.

We spoke with four people who were living in the home and observed the care and support being provided to people during our visit. We talked with five staff about the care they provided. Feedback given to the home by parents, relatives and external organisations was also noted.

People were encouraged to develop the confidence to become independent in their daily living skills. We saw people going out to the dentist or using public transport. People helped around their home doing their laundry, preparing meals and washing up.

People told us they discussed their care with their key workers. We found their records were produced in easy read formats. There was evidence within people's care records of their feedback and comments about each aspect of their care. Records were kept up to date to reflect any changes in their needs.

Suitable arrangements were in place to make sure people were safeguarded from the risk of abuse. Safeguarding information was provided in an easy read format for people. People told us staff helped them with their finances and to update inventories of their personal belongings.

Systems were in place to make sure that the appropriate records were obtained for new staff before they started work. New staff completed an induction programme.

An effective quality assurance programme was in place involving people and external organisations. Comments included, "looked after well", "treated well as individuals" and "professional care".

This inspection took place on 22 and 23 October and was unannounced. Abbeymead Lodge can provide accommodation and personal care for up to eight adults with a learning disability, autism spectrum condition and/or physical disability. Eight people were living at the home when we visited and they had a range of support needs including help with communication, personal care, moving about and support if they became confused or anxious. Staff support was provided at the home at all times and some people required the support of staff when away from the home.

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 and associated Regulations about how the service is run.

The provider had established a clear set of values that ensured people were at the centre of every aspect of the service. The values ensured staff understood the expectations on them; to provide individualised and empowering support within a culture of continual improvement. As a result, the home had a positive culture and staff had a “can do” attitude.

Whilst staff understood the importance of keeping people safe, they also understood the importance of helping people to take risks and reach their potential. As a result, people had been supported to identify areas of their lives they wished to develop and were then encouraged and assisted to achieve this. People had been supported to seek voluntary employment, use public transport independently and to take part in other activities in the community. These were significant steps for people and they were clearly proud of their growing achievements.

People were supported by an exceptional staff team who were caring and supportive, who knew them well and treated them as individuals. Staff were patient and respectful of people’s unique preferences and made every effort to help people make decisions about their care and support to ensure they remained in control of their own lives. Staff had an excellent understanding of the Mental Capacity Act 2005 and focussed on helping people make decisions rather than making decisions for them. Staff were highly motivated and flexible which ensured people’s plans were realised so that they had meaningful and enjoyable lives.

People’s physical and health needs were met by staff with a comprehensive knowledge who worked well with health and social care professionals. People had been supported to manage their own medicines as far as possible and staff had helped people develop the confidence to attend health appointments when needed. People were supported to make healthy choices about food and staff supported this by providing freshly cooked food as often as possible. A structured meal plan had been replaced with a more flexible approach and was working well.

Staff felt well supported and had the training they needed to provide personalised support to each person. Staff spoke particularly positively about the person specific training they had received. Staff were keen to learn and took the time to read relevant articles outside training. Staff met with their line manager to discuss their development needs and action was taken when concerns were raised. This process was supported by regular observations of their practice. Staff understood what they needed to do if they had concerns about the way a person was being treated and were prepared to challenge and address poor care to keep people safe and happy.

People’s feedback and views influenced the way the service developed and improved. Staff ensured everyone knew how to make a complaint by providing information that was accessible to them. People were involved in staff recruitment, encouraged to make complaints and to give feedback. Action was taken to address any issues raised.

The registered manager and provider regularly assessed and monitored the quality of care to ensure national and local standards were met and maintained. Continual improvements to care provision were made which showed the registered manager and provider were committed to delivering high quality care. As part of the open culture, staff were encouraged to report mistakes and learning took place following any incidents to prevent them happening again.