About the service:

• London Care Partnership Limited – 89 Ewell Road is a residential care home that was providing accommodation, care and support for nine young men with a learning disability and/or autism at the time of the inspection.

We rated London Care Partnership Limited – 89 Ewell Road as Outstanding because:

• The care service has been developed 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.

• People received support from an exceptionally caring service, receiving national accreditation for their levels of autism knowledge and support. Staff prioritised people’s needs, in an inclusive environment that ensured choice and inclusion was routinely promoted.

• The service was especially responsive to needs of people at the home, with a wide range of person centred activities. People led on the day to day management of their lives, and the home ensured that care was always personalised to meet the needs of each individual living there.

• The management of the service was held in high accolade, with positive feedback about the registered manager in how they interacted with people and supported the staff team. The quality of living for people was placed at the forefront of developments within service to ensure that care provision was innovative and continually improving.

• The service ensured that care delivery was safe, with risks to people continually assessed to ensure both their home environment, and outings in the community were safe. Premises were well maintained, and staff were safely recruited.

• People received effective care, that promoted a good quality of life ensuring a variety of healthcare needs were met. People’s consent was sought with relation to their care and treatment options.

Rating at last inspection:

• At our last inspection of the service was rated ‘Good’. At this inspection we found the service to be ‘Outstanding’.

Why we inspected:

• This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

• We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates in line with our re-inspection schedule for those services rated Outstanding.

We undertook an unannounced inspection on 30 June 2016. At our previous inspection on 8 October 2014 the service was meeting the regulations inspected.

London Care Partnerships Limited – 89 Ewell Road provides accommodation, care and support to up to nine people with a learning disability and/or autism. At the time of our inspection eight people were using the service. A ninth person was moving into the service the following day.

A registered manager was in post and available on the day of the inspection. 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.

An individualised service was provided that met people’s needs. Staff were aware of what support people required and how they wanted this support to be delivered. Staff worked with the provider’s behaviour analyst to develop strategies to help people to reduce incidents and minimise behaviour that challenged staff. We saw this included supporting people to manage their behaviour through the implementation of reward charts. The behaviour analyst also worked with staff to give them techniques to support people during key life events and transitions.

Staff were aware of people’s preferred communication methods and how they processed information. Staff took account of how people received sensory information, and were working with specialists to help people who had hypersensitivity of particular senses.

Staff made people feel comfortable and supported them to develop their confidence. Staff also supported people to manage and express their emotions. People were supported to develop friendships and relationships with family members.

People were involved in decisions about their care and how they spent their time. Staff encouraged them to try new things and experiences. Staff were supporting people to maintain a healthy lifestyle and to increase the amount of exercise they undertook. They educated people on healthy eating and supported them with their nutritional needs.

People were able to express when they needed to see a healthcare professional, and staff liaised with specialists as necessary to meet people’s health needs. People received their medicines as prescribed, and received regular health reviews from their GP.

There were sufficient staff to keep people safe, and the numbers of staff on duty was flexible to meet people’s needs and what activities they were undertaking. Safe recruitment practices were in place to ensure staff employed were suitable to work with people. Staff received regular training and support to ensure they had the knowledge and skills to undertake their roles.

Staff were aware of their responsibilities under the Mental Capacity Act 2005 and to safeguard adults. Staff discussed any concerns about a person’s safety with the service’s management team.

Staff, people and their relatives felt able to speak openly and have honest conversations with the registered manager. Processes were in place to review any complaints received and the management team used feedback to review service delivery. Systems to review the quality of service provision were in place and improvements were made where required.

The service had successfully achieved autism accreditation from the National Autistic Society and the provider had achieved the Investors in People (IIP) accreditation. IIP sets a standard for managing and supporting staff.

The registered manager was aware of the requirements of their registration with the Care Quality Commission and adhered to these.

At our last inspection of the service on 28 May 2014 we observed that some staff did not always knock on people’s bedroom doors before entering and a relative told us staff did not engage positively with people who used the service.

Following that inspection we asked the provider to take action to achieve compliance with the appropriate regulation. The provider sent us an action plan in July 2014 setting out the steps they had taken to do this. During this visit we checked these actions had been completed.

At the time of our inspection there were nine people living in the home.

During our visit we spoke with three people using the service, the registered manager and four support workers. We spent time observing care and support being delivered in the main communal areas. We also looked at three people’s care plans, five staff files and other records relating to the management of the service.

This unannounced inspection was carried out by a single inspector. We considered all the evidence gathered under the outcomes inspected and used the information to answer the question; Is the service caring?

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service caring?

The service was caring. People told us they were happy living in their home. They also told us staff were kind and caring, and our observations supported this. One person told us “I love it here” and “the staff are nice and I like my key-worker”.

People also told us staff respected their privacy and dignity. One person said, “Staff always knock on my bedroom door before they come in.” We saw staffs' interactions with people and their approach was friendly, caring and respectful. Staff told us they had been reminded about the importance of knocking on doors and seeking people’s permission to enter before doing so. Care and support was centred on people’s individual needs and wishes. Staff were familiar with people’s individual needs and knew how to meet them.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led? The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

All those who lived at the home were young males aged between 18 and 25 years who had complex needs including autism and/or a learning disability. Some people were not able to verbally communicate, others choose not to speak and others could verbally express themselves clearly, but were not always able to answer our questions about the care they received. After the inspection we telephoned seven family members or the professional people who offered support to people. Two other family members also called the Care Quality Commission to speak to us about the care their family member received. We looked at the care records of five people, spoke with four people, seven family members and six members of staff.

Below is a summary of what we found.

Is the service safe?

Care plans had details of people's needs and how these were to be met. These plans were regularly reviewed with the person using the service. Risk assessments relating to the care and support being provided were regularly reviewed to ensure people's individual needs were being met safely. People were supported to take their medicines in a safe way.

Staff told us that their policy was not to physically restrain people using the service. Instead they used techniques to diffuse situations, and had learnt ways to do this in challenging behaviour training.

Staff had undertaken training on the Mental Capacity Act 2005 but not on the recent changes to the Deprivation of Liberty Safeguards. But staff understood how this could impact on the people they cared for.

Is the service effective?

The home is one of several within the same group and since the home opened in July 2013 there had been two managers and families that we spoke with told us about the high turnover of staff and that there could be poor communication between staff. They told us about several incidents where messages had not been passed on to their family member and where incidents relating to the person using the service had not been passed on to them. They felt this lack of communication was because of the frequent changes to the staff team.

We saw that eight staff were new to the organisation and were still within their probationary period and had not completed all of the training available.

Is the service caring?

We observed that staff did not knock on people’s door before entering and on two occasions we saw that people were still in bed. We observed and families that we spoke with also mentioned times when they had observed staff telling people what to do and not engaging with them positively.

Care plans we viewed detailed people's individual preferences, so that staff knew people's individual wishes. Risk assessments were included for all aspects of a person’s daily life, including the activities they do, being out in the community and travelling. These included triggers to watch for that may upset a person, things to avoid and what to do if an incident occurs.

Is the service responsive?

People's needs were reassessed on a regular basis and we saw the service responded to any changing needs. People had access to other services and to professionals who worked with the provider and staff for the benefit of people who used the service.

We saw that each person had an activity plan and the staff explained that these were developed based upon the interests and support needs of the individual. During our visit we observed staff supporting people to access different activities including going out to have breakfast in the local café, a shopping trip to the supermarket, a visit to the cinema and accompanying another person to play pool.

Is the service well-led?

The home employed a manager who knew their staff and people well.

The manager told us about the audits that they conducted and showed us the recorded evidence to support them. Health and safety checks included fire drills, ensuring window restrictors were in place and working and first aid boxes were correctly stocked and contents within date. Other areas that were audited were staffing levels, staff rotas and training and supervision. Care and activity plans were also monitored. We saw that the manager’s monthly audits for medication were up to date.

The manager told us that as the home had been open for less than a year they had not sent out satisfaction surveys to families or to professionals who work with people who use the service but this process would be starting soon.

In this report the name of a registered manager Gregory Ernest John Anstead appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.