Independence Homes Limited - 33 Russell Hill is a ‘care home’. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Independence Homes Limited - 33 Russell Hill accommodates nine people with a learning disability in one adapted building. 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. At the time of this inspection there were 8 people using the service.

This inspection took place on 7 February 2018. At the last inspection in June 2015 the service was rated ‘good’ overall and ‘outstanding’ in our key question “is the service responsive?” At this inspection we found the service remained ‘good’ overall and remained ‘outstanding’ in our key question “is the service responsive?”

Since our last inspection, people continued to receive highly personalised care and support, tailored to meet their individual needs, which was leading to demonstrable positive outcomes and enhancements to their quality of life. People remained actively involved in planning and making decisions about their care and support needs. Staff displayed excellent understanding and awareness of people’s needs and how these should be met in line with people’s specific preferences and choices. Staff understood the importance of respecting people's rights and how to promote equality and inclusion within the service so that people did not experience discriminatory behaviours and practices when being supported with their needs. Relatives said the care and support provided to their family members was helping them achieve a good quality of life.

People were safe living at Independence Homes Limited - 33 Russell Hill. Staff protected people from the risk of abuse and used the provider’s safeguarding policy and procedure for reporting any concerns they had about people to the appropriate person and authority. Risks to people's health, safety and wellbeing were assessed and reviewed and staff followed current guidance on how these should be minimised to keep people safe from injury or harm.

The provider ensured risks posed to people by the premises were appropriately managed. The provider maintained a servicing programme of the premises and the equipment used by staff to ensure those areas of the service covered by these checks did not pose unnecessary risks to people. The premises was kept clean and clear of slip and trip hazards so people could move freely and safely around. Staff followed good practice to ensure risks to people were minimised from poor hygiene and cleanliness when providing personal care, cleaning the premises and when preparing and storing food. Medicines were stored safely and securely and people received them as prescribed.

There were enough staff to keep people safe. The provider maintained recruitment checks to assure themselves of staff's suitability and fitness to support people. Staff had regular and relevant training to keep their knowledge and skills up to date with best practice. Staff were happy in their work, motivated and supported by the provider to meet the values and vision of the service which were focussed on people experiencing good quality care and support.

Staff used information and guidance, based on best practice and current standards to plan and deliver care that would support people to experience good outcomes in relation to their healthcare needs. People’s care and support needs were discussed and reviewed with them regularly to ensure the support provided continued to meet these. People were encouraged to keep healthy and well, to eat and drink enough to meet their needs and helped to access healthcare services when needed. The provider’s bespoke epilepsy alarm system ensured peopl

People using the service had complex needs which meant they were not able to tell us their experiences. We used other methods to help us understand the experiences of people using the service. We reviewed people's records and spoke with the relatives of three of the people using the service.

One relative said “Russell Hill is an amazing place. They really know what they are doing”. Another relative said “I am really pleased and really happy with the service my son receives. The care of his epilepsy is second to none”. Another relative said “I think the support workers are excellent. My daughter is as well cared for as she can be and she’s happy living at Russell Hill”.

We found that people’s needs were assessed and care was planned and delivered in line with their individual care plan.

There were effective recruitment and selection processes in place.

The provider had effective systems in place to assess and monitor the quality of service that people received.

Relatives told us they were aware of the homes complaints procedure. All said they would contact the registered manager if they needed to discuss any concerns they had or to make a complaint.

People living at Independence Homes Russell Hill have little capacity to understand or express the care and treatment choices available to them.

We saw and were told that people at Independence Homes Russell Hill received a good quality care. Most people who live there are unable to communicate verbally but one who could told us that he “liked living there” and showed us pictures of holidays he had been taken on with other people in the home. A parent said that “it has a homely feel and the support workers are very good. My child is very happy there. The medical care is exemplary”.

The systems in place to ensure that care was appropriate and safe were thorough and up to date and the building was appropriate for the needs of people, very pleasant and well maintained. The staff we met were committed, highly skilled and experienced and they liked working at Independence Homes.

Two of the parents we spoke to were confident that people living there were happy and were safe although they did mention issues which they had taken up with the home over the last year.

Prior to our visit, we asked the provider to complete a self assessment for eight of the outcomes. This information is used to help us reach a decision about whether the service is meeting the essential standards. The returned Provider Compliance Assessment (PCA) was informative and included detailed information about how the home complies with the standards as well as plans for development and improvement. Some of the information is included in the report and we saw lots of evidence that the home's practices reflected what they said in their self assessment.

People living at 33 Russell Hill do not have the capacity to fully share their views regarding their care. In order to make judgements about the care that individuals receive, we observed care practices; interactions with staff and tracked three people's records of care. Case tracking means we looked in detail at the care people receive.

During our visit people were offered choices, spoken to respectfully, made to feel involved and showed signs of well being when interacting with both the staff and other people using the service. Staff were alert to changes in people’s mood, behaviour and general wellbeing and knew how they should respond to individual needs.

The manager and staff team have developed good relationships with those who live at the home and understand their needs, wishes and aspirations to enable them to live a fulfilling life. Comments from staff we met included, “the care is really good, service users are put first,” and “good teamwork, people are well looked after and can do what they like.”

We also met with two social care professionals from a purchasing local authority who gave positive feedback about the home.

Please refer to the outcomes within the main report for more detailed comments about specific aspects of the service.

We visited Independence Homes Limited – Russell Hill on 17 and 18 June 2015. The inspection was unannounced.

The service provides specialist residential care for up to nine adults with epilepsy and other neurological or physical needs. At the time of our inspection there were eight people using the service.

The service had a registered manager. 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.

Relatives of people using the service and staff told us people were safe. Staff had completed safeguarding training and knew how to recognise abuse and report safeguarding incidents. They were aware of how they could escalate concerns and whistle blowing procedures. The service was a safe place for people, visitors and staff as the building and equipment used was well maintained. People were regularly checked by staff throughout the day and night and there was a range of personal and room alarms that indicated when a person might need assistance. People’s needs were assessed and reflected in detailed risk assessments. There were sufficient numbers of staff to meet people’s needs and safe recruitment procedures were followed. People received their medicines as prescribed and at the appropriate time.

Staff had the skills, knowledge and experience to deliver effective care and treatment. Mental capacity assessments were completed to establish each person’s capacity to make decisions and consent to care and treatment. We saw evidence of family involvement, consent to care and treatment and where appropriate best interests meetings. Where it was necessary to deprive people of their liberty the service was obtaining appropriate authorisations under the Deprivation of Liberty Safeguards. People had a healthy diet and were supported with their complex healthcare needs.

Relatives and visiting professionals commented positively about relationships between people using the service and staff. We observed and listened to numerous incidences of positive interactions between people and staff. People and their relatives were actively involved in all aspects of care and treatment. People’s preferences were taken into account and staff treated people with dignity and respected their privacy.

People received first rate personalised care that was responsive to their needs. Care plans were person centred and focused on people’s complex social and healthcare needs. The service was very proactive and responsive in addressing and meeting the needs of individuals. The provider invested in staff and equipment to ensure the care and support provided was of a high standard. People using the service benefited from the wide range of activities that enhanced their lives and reduced the risks social isolation. Although people using the service had complex needs the staff had a ‘can do’ attitude and found innovative ways to enable people to take part in activities. Relatives were confident that they could raise concerns with staff and those concerns would be addressed.

Staff spoke positively about the management team and were confident they could raise any concerns or issues. Staff meetings were held on a regular basis. The service had a system of audits and performance monitoring to assess the quality of service they provided.