About the service

Claxton House is a care home that offers care and support for up to 15 people with learning disabilities or autistic spectrum disorder. There were 15 people using the service at the time of our visit.

The care service was not 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. However, people were given choices and participation within the local community was encouraged.

People’s experience of using this service

• People were supported to be safe. Staff understood their responsibilities to protect people from abuse and avoidable harm. Risk was assessed and managed. People’s human rights and freedoms were respected within the service's risk management plan.

• Routine checks and maintenance were carried out on the premises and equipment. Staff knew what to do in the event of an emergency, accident or incident.

• There were enough staff to meet people’s needs and to spend time with them. Staff were recruited in a safe way.

• People’s medicines were managed in a safe way and were reviewed by the prescribing doctor to make sure they remained effective. People had access to the healthcare services they required. Staff referred people promptly and followed the advice and guidance provided by other professionals.

• People had enough to eat and drink and were encouraged to follow a healthy diet and maintain a healthy weight.

• The service was spacious and met the needs of people who lived there. People’s rooms were personalised. The service was clean and tidy throughout. Staff knew how to reduce risk of cross infection. They had access to the protective equipment and cleaning products they required to achieve this.

• Staff had the training and support required to meet people’s needs. Care and support followed best practice, up to date guidelines, and legislation. Staff had opportunities to learn and develop their skills and qualifications.

• Consent to care and support was always sought in line with legislation and guidance. People were encouraged to make choices and decisions about their care and support and the things they did each day.

• Staff were kind and compassionate. People and staff had developed positive relationships. Staff were passionate and motivated about improving outcomes for people and increasing people’s skills and independence. Privacy and dignity was promoted by all staff.

• Staff knew people extremely well. They knew about the things that were important to people and the things that may cause distress. Staff knew the best way to communicate with people and how to offer support and reassurance when this was required. People led active lives and took part in culturally relevant activities in and outside of the home.

• There was a complaints procedure and people were confident speaking with staff about any concerns. People, relatives and staff were asked for their feedback and their views and opinions were listened to and acted on accordingly.

• Staff understood their roles and responsibilities. There was strong leadership and support structures in place. Managers were open, inclusive and accessible. Staff and managers shared a vision based on providing person-centred care and support and improving outcomes for people. There were effective systems in place to monitor the quality of the service and to drive improvement.

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

Rating at last inspection

At the last inspection we rated this service Good (report published on 17 June 2016).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. I

The inspection took place on 26 April 2016 and was unannounced.

Claxton House provides accommodation and personal care for up to 15 people with a learning disability or autistic spectrum disorder.

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 2008 and associated Regulations about how the service is run.

People were safe in the home. Risks to people were identified and well managed, this included risks associated with the environment and premises. Medicines were managed safely and administered when people required them. The service understood its role and responsibilities in order to protect people from abuse and took action when required. Staff demonstrated an awareness of adult safeguarding and knew how to report concerns. The registered manager understood the importance of people’s human rights and took action to protect these.

There were sufficient staff to meet people’s needs, and staff had been recruited following safe recruitment practices. New staff received a comprehensive induction that supported them to carry out their role. All staff were provided with support and responsive training that met people’s individual needs.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and report on what we find. Staff and the management team were knowledgeable about the MCA and Dols and the service was following the legal requirements.

People were supported to maintain their health, this included supporting people to eat healthily and maintain a balanced diet. The service took action to ensure people received the health care they required.

People were supported by staff who cared for them and knew them as individuals. Staff took a lot of effort and put in time outside of their working hours to make sure that people living in the home felt loved and got the care and support they needed. Staff understood the importance of promoting people’s independence, dignity, and respect. People’s views about their care was sought and respected by staff. There were communication systems and aids in place that were individual to people’s needs that supported people to express their views. This meant people had opportunities express their views and decisions.

The care provided was individual and responsive to people’s needs. People and their relatives were involved in the planning and reviewing of their care. As a result of this people received the support in a way that they wanted.

Activities were varied and people were supported to participate in activities of their choice. The home was in a small rural village and was part of the village community.

There was a homely family atmosphere which helped the service to promote a person centred, inclusive and empowering culture. People and staff were involved in the service, their ideas and comments were listened to and actioned. Staff were positive about the management team and the support they provided. There were systems in place to monitor the quality of the service. The management team engaged with opportunities that helped develop the service and share good practice.

We know from previous inspections of Claxton House that people living there prefer to be called residents. Most of the residents present were preparing to eat their main meal early so they could go to the theatre for a pantomime. Staff were also putting up decorations for someone's birthday. There was an atmosphere of excitement with people looking forward to the outing and celebrations. Some residents were busy preparing for this and not everyone was able to communicate verbally with us. Two people agreed they were looking forward to the show.

Residents had their needs assessed and there were plans of care for how to meet them safely. This included guidance about how to minimise agitated behaviour and how to support people to eat and drink safely. A resident agreed they were proud of their achievements to lose weight. We also found that people had access to other professionals who could offer support and advice to help keep them well. This included speech and language therapy, psychiatric and dental services. One person had been to the dentist on the day of our inspection and told us that their teeth were "...alright." We noted that staff on duty interacted well with residents, offering reassurance, encouragement and support when this was needed.

Medicines were stored safely. There were systems for ensuring that any omissions were identified promptly. Medicines were not always promptly disposed of although action was taken during our inspection to ensure this happened where appropriate.

People living in the home said they liked to be known as 'residents'. People spoken with told us that the staff treated them well and that if they had any issues about the care provided to them they knew who to speak to. One person said, "The manager would sort it out." People told us about the things they wanted to do and their goals were recorded in their individual plans of care. One person told us about the progress they had been making towards their goals.

The management team encouraged a small group of people to work together in solving problems and talking about their feelings, with people supporting one another. We saw that some people had made their own 'cards' with colours and shapes of their choosing to enable them to express emotions that they found difficult to put into words.

We found that care and support was focused on the needs and abilities of each person. Staff were able to give us examples of the different levels of support or monitoring they needed to offer. We concluded that people related well to the staff on duty. We observed that there was lots of chatter, smiles and laughing together.