This inspection took place on 7 and 8 January 2019 and was announced. This was to ensure someone would be available to speak with and show us records.

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

An Caladh House accommodates up to ten people with learning disabilities in one adapted building. On the days of the inspection there were ten people using the service.

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.

The service had a registered manager in place. A registered manager is a person who has registered with CQC to manage the service. Like 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 our last inspection we rated the service good. At this inspection we found the service had improved to outstanding. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns.

The service was exceptionally person-centred and delivered support in a way that met people’s individual needs. Person-centred means the person was at the centre of any care or support plans and their individual wishes, needs and choices were considered.

Without exception staff and management worked in a way that put the needs of people first. Support plans were written in an extremely sensitive and thoughtful way that reflected people’s life history, and likes and dislikes in great detail.

The service went the extra mile to protect people from social isolation and was extremely responsive to people’s individual needs.

The service went over and above complying with the Accessible Information Standard (AIS). Pictorial information was used to support people to communicate and to provide steps for them to follow to increase confidence and promote independence.

There was a strong emphasis on continuous improvement and research was carried out into best practice. Governance was extremely well embedded in the running of the service.

The service had a positive culture that was person-centred and inclusive. Family members spoke very highly about the management team. Staff were highly motivated and proud to work for the service.

The service worked well in partnership with other health and social care professionals to improve outcomes for people.

Accidents and incidents were appropriately recorded and investigated. Risk assessments were in place for people and described potential risks and the safeguards in place to mitigate these risks. The registered manager understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding adults.

Medicines were stored safely and securely, and procedures were in place to ensure people received medicines as prescribed. The manager and staff were working with healthcare professionals to reduce people’s needs for psychotropic medicines. Psychotropic means medicines prescribed to alter behaviour, perception or mood.

The home was clean, spacious and suitable for the people who used the service. Appropriate health and safety checks had been carried out.

There were enough staff on duty to meet people’s needs. The provider had an effective recruitment and selection procedure in place and carried out relevant vetting checks when they employed staff. Staff were supported in their role via appropriate training and regular supervisions.

People were

We carried out this announced inspection on 19 May 2016.

An Caladh House is based in the village of Washingborough, which is a short distance from the city of Lincoln. It provides accommodation and support for up to ten adults with a learning disability. There were ten people living in the home at the time of our inspection.

There was an established registered manager in charge of the home. 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.

Staff knew how to respond to any issues related to people’s safety and people were kept safe from harm. People’s medicines were managed safely and staff worked with people in ways which helped to avoid the risk of accidents. Background checks had been completed before any new staff were appointed and there were enough staff available during the day and night to provide the care people needed.

People were treated with kindness and compassion. Staff recognised people’s right to privacy, respected confidential information and promoted people’s dignity. People had been consulted about the care they wanted to receive and all of the care they needed. Staff were creative in overcoming any potential obstacles regarding communication and in doing so supported people to pursue a wide range of interests and to maintain their individual hobbies in the way each person had chosen.

People had benefited from staff having access to a structured induction and up to date training and guidance to support them in carrying out their roles. Staff had developed and maintained the skills needed to care for people in the right way and people had also been supported to receive all of the healthcare assistance they needed.

People were supported to eat and drink enough to keep them healthy. Where people had special dietary requirements we saw that these were provided for.

Staff had ensured that people’s rights were respected by helping them to make decisions for themselves. The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards under the Mental Capacity Act 2005 and to report on what we find. These safeguards protect people when they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe. In relation to this, the registered manager had worked with the relevant local authorities to ensure that people only received lawful care that respected their rights.

Regular monitoring and quality checks undertaken ensured that any issues related to the running of the home which might be identified would be quickly resolved. There was a clear system in place for resolving more formal complaints.

Staff were supported to speak out if they had any concerns because the home was run by the registered manager and provider in an open and inclusive way.

People living at the home, their families and visiting health and social care professionals were invited to comment on the quality of the services provided. The provider and registered manager had developed a culture based on listening and learning about how care should be provided in order to identify and take action to keep improving the services provided at the home.

A single inspector carried out this inspection. 10 people were using the service at the time of the inspection, however due to their complex needs and limited verbal communication it was only possible to speak with two people. We observed the care being provided and people’s reactions to the staff and the support they received. We looked at three people’s care records. We talked with three staff and the manager and examined training records and documentation of quality audits.

This helped us to answer the questions below.

Is the service safe?

The environment was clean and hygienic and appropriate steps were in place to reduce the risk of infection. There were procedures in place for the management of waste and risks from legionella contamination of the water supply.

The Home had policies and procedures in place in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards to protect the rights of people using the service. It was clear from talking with staff that they had an in-depth understanding of mental capacity issues. Staff had been trained in the use of restraint. Steps were taken to maximise people’s participation in decision making and a multi-disciplinary approach was taken to ensure best interest decisions were made.

Individual risk assessments had been carried out and care was planned in response to these. This meant care and support was planned in a way that was intended to ensure people’s safety and welfare.

Safe systems were in place for the management of people’s medicines and staff had completed training and competency assessments in medicines administration to ensure their knowledge and skills were up to date.

Is the service effective?

Full assessments of each person’s care and support needs were undertaken and care plans provided detailed information on the way care was to be provided. They were reviewed regularly and updated as necessary to ensure the support provided was appropriate to each person’s individual needs.

The service worked in collaboration with other agencies and professionals, ensuring care was effective and specialist input obtained where necessary.

Staff were given access to appropriate training and support to enable them to provide effective care.

Is the service caring?

The staff knew the people who used the service well and had positive relationships with them. They provided encouragement and support to enable people to give their views and make their wishes known. Staff were able to interpret non-verbal communication and cues to indicate people’s wishes.

People’s preferences, interests, and diverse needs were recorded and care and support was provided in accordance with their wishes.

People were encouraged to participate in activities they enjoyed thus promoting their well-being. People were able to choose whether or not to participate in activities and if a person indicated they would prefer to do something else this was listened to and acted on.

Is the service responsive?

We saw the service responded to the needs of individual people and tailored the service to take account of their changing needs and wishes.

People completed a range of activities inside and outside the service. The home had its own transport which enabled them to be flexible and meet people’s individual wishes in a timely manner.

Is the service well led?

Quality review systems were in place to assess the quality of the service and identify the need for improvement. Information gained from audits was used to improve the service.

There was a planned approach to education and training and staff had received the training they required to deliver safe and effective care. Systems were in place for supervision and appraisal.

Staff told us they felt well supported by the manager and were encouraged to undertake further development.

On the day of our inspection we found that ten people lived at An Caladh House. We met and spoke with three people. Due to their health conditions or complex needs, not all people were able to share their views about the care they received. We observed their experiences to support our inspection.

We spoke with the registered manager, a senior member of care staff and two support staff. We looked at two care records, four staff files and reviewed the provider's policies.

We found that the provider had systems in place to gain the consent to care and treatment of people who used the service. We found staff had an understanding of the needs of people who used the service. We found care and treatment was planned and delivered in a safe way, which met people's individual care needs. People we spoke with were positive about the care they received. One person told us, "I like it here and I like the staff."

We found the provider worked well with other services to ensure the health and wellbeing of the people who used the service.

We found the provider had appropriate arrangements in place to manage medicines.

We found there was an effective recruitment process in place to ensure that staff had the skills to meet people's needs.

People who used the service appeared happy and relaxed. One member of staff told us, "It's their home, their choice."

As part of our inspection we spoke with a number of staff. They told us they liked working at the home. One staff member said, "It's brilliant, I love it here. Our standards are very high and the guys (residents) are great."

Although the people who used the service were not able to communicate with us, they appeared happy and were treated as individuals. All staff interacted with people at every opportunity. People were allowed use of the kitchen and living rooms at any time and were always supervised. People chose their own food and did their own shopping at either the local shop or supermarket.