We visited Independence Homes Limited – Foxley Lane on 18 and 21 November 2016. The inspection was unannounced.

The service provides specialist residential care for up to eight people living with epilepsy and other neurological or physical needs. At the time of our inspection there were seven people with complex needs 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 understood their personal responsibilities. Handovers between shifts ensured staff were aware of what had been happening and how people were. Staff were always in close proximity to people in communal areas. The service had provided a safe environment for people using the service. Equipment used by the service was modern, well maintained and relevant to people’s needs. Risk assessments reflected people’s needs, preferences and goals and supported staff to provide safe and appropriate care. There were sufficient numbers of suitably trained and qualified staff to meet people’s complex needs.

Staff were supported with extensive training and regular supervision meetings. The service was working within the principles of the mental Capacity Act. We found relatives where appropriate were involved in the planning of people’s care and support. People’s nutritional requirements were met through a varied diet and the availability of drinks and snacks at all times. The service ensured people’s healthcare needs were met and staff were given further support by access to a specialist epilepsy nurse and an epilepsy specialist who were available to provide advice at any time.

Relatives and healthcare professionals spoke positively about the service and staff. We observed and listened to people and staff. Staff communicated well and people responded positively. Relatives of people were involved in the ongoing planning of care and support. People’s preferences were taken into account when providing care and support and their choices respected. Staff treated people with dignity and respected their privacy.

Detailed preparations and assessments took place before people moved into the service to ensure everything was in place to meet their complex needs. The care provided was person centred and responsive to people’s needs. Care records, including person centred plans and delivery plans were written using person centred language. The service provided specialist care for people living with epilepsy and enabled staff to do so through extensive training and the availability of clinical advice and support. The service ensured they were up to date with recognised good practice and liaised closely with healthcare professionals. The service had access to two vans enabling them to support people to attend appointments and providing opportunities for activities. Activities played an important part in people’s lives and staff had the confidence and experience to take people out on planned and unplanned activities. The provider had processes in place to obtain feedback and ideas from the relatives of people using the service and using that information where deemed appropriate to improve service provision.

Staff and relatives spoke positively about the management team at the service. They felt confident they could raise any concerns or issues. Staff meetings were held once a month. The service had a system of reviews, checks, visits and audits to assess, monitor and improve service provision.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:-

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, looking at records and speaking with the relatives of people using the service, and members of staff. People using the service were unable to express their experiences verbally as a result of their complex needs.

Please read the full report for evidence that supports our summary.

Is the service safe?

People were cared for in an environment that was safe, clean and hygienic. One person told us, “Never had concerns about cleanliness.”

We found that staff were supported with regular training and supervision to provide safe and appropriate care. One relative of a person using the service told us, “They make it feel like a home.” A visitor commented, “I think they have been absolutely wonderful here.” Members of staff treated people with respect and dignity.

We saw that there were effective recruitment and selection policies in place. Appropriate checks on staff took place before they started their employment.

We looked at a random selection of care files and delivery plans for people using the service. We found that they were person centred and reflected the individual needs of each person. We saw they covered a comprehensive range of care and healthcare needs including individual risk assessments. We found that they were regularly reviewed and up to date which supported staff to deliver safe and appropriate care.

We found that there were procedures in place to deal with foreseeable emergencies. For example, people were at risk from seizures. Procedures were in place to monitor and respond to seizures and staff were trained to administer emergency drugs. Members of staff were first aid trained and received fire safety training once a year.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

The Care Quality Commission monitors operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We saw that they had policies and procedures in place in relation to DoLS. People using the service had their mental capacity assessed and recorded. We were assured by the manager that they would reassess people using the service in light of recent judgements and subsequent guidance in relation to DoLS.

Is the service effective?

People’s needs were assessed and care and treatment was planned and delivered to reflect their needs. We were told that an assessment of people’s needs was carried out before people came to the home.

People using the service were encouraged to take part in a wide range of activities. We saw a timetable of activities displayed.

Is the service caring?

We observed staff interactions with people at various times in our inspection. They were friendly and inclusive. Relatives commented positively about staff and the care they provided. One person commented, “High quality care.”

Is the service responsive?

Relatives were involved in making decisions about people’s care and treatment. We saw that care planning was person centred and recorded how people preferred their care and treatment to be delivered.

The provider employed a specialist epilepsy nurse and a learning disability nurse to support staff with advice and training. They also ensured that the service provided reflected advances in epilepsy treatment and published research.

Is the service well led?

People’s representatives and staff were asked for their views about their care and treatment and they were acted on. There were a number of audits in place to monitor and assess service provision.

Relatives, visitors and members of staff told us that the manager and deputy operated an ‘open door’ policy and were approachable.

We spoke with relatives about the care and treatment provided to people. One relative told us, “It’s just like an extended family, they are not just carers, they really care.” Another relative told us, “Foxley Lane delivers an exceptionally high standard of care.”

We found that care plans were personalised and reflected people's needs. Medication was appropriately stored and administered. The home had been purpose built for people with epilepsy and had up to date equipment and facilities to meet their needs.

We found that there were sufficient numbers of staff who were appropriately trained and experienced. The home had an effective sytem to deal with complaints and comments.

On the day of our inspection we met most of the people living at Independence Homes Foxley Lane and most of the staff working on that day. We spoke to 4 support staff, the driver, the cook and the Deputy Manager and met the Senior Operations Manager. We spent time in the house and met six people who lived there. We spoke to a person visiting a person and we talked to parents of people who lived there on the phone.

We saw that people living at Independence Homes Foxley Lane were well cared for by a well trained staff team who liked working there, were very enthusiastic about their work and committed to providing a high quality service for the people they supported. A lot of attention was paid to the individual needs and preferences of people living there and there were enough staff to ensure these could be met.

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. Parents and friends of people living there were confident that people living there were well cared for and safe. They said that “it’s really lovely here; the staff are really friendly”; “it’s a real home for people” and that staff and the manager were “excellent” and “first class”.

Due to their needs, the people living at 37 Foxley Lane do not have the capacity to 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. The reader should note that ‘PCP’ stands for person centred plan. This is a plan of care that is developed with a person using the service or their representative.

During our visit people were relaxed and showed signs of well being when interacting with both the staff and other people using the service. We observed that staff were attentive and that people were given time to try and express their needs. Staff demonstrated a good understanding of each person’s communication style or body language and knew how to respond to individual needs.

People's needs are regularly reviewed to make sure they get the right care and support. When a person's needs change, the service is good at making sure that appropriate action is taken. This includes consultation with other relevant healthcare professionals and making any necessary adjustments to people's care and support plans. Staff in the home and other health professionals closely monitor each person’s epilepsy needs to ensure that they stay as well as possible.

We saw that people were provided with a range of personalised and meaningful activities and supported by staff on a one to one basis. People benefit from a stable staff team who have worked at 37 Foxley Lane for a number of years.

Staff told us that they were happy working at the home and described the training as ‘excellent’. Staff felt well supported by the registered manager and deputy. They felt there was good teamwork and a positive atmosphere. Comments included, “everyone’s very professional”, “good rapport with the parents” and “there is good information share.” Staff described the manager as “very much hands on, absolutely brilliant”, “efficient “and “fair”.

A visiting professional told us,” the service is very personalised and they recognise people’s individual needs. The communication is good and staff use their initiative well.”

Please refer to each outcome below and within the main report for more detailed comments about specific aspects of the service.

We would like to thank all those who took part in this review for their time, assistance and hospitality.