Independence Homes Limited - 7 Hall Road 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 - 7 Hall Road accommodates seven people with a learning disability in one adapted building. The service specialises in supporting people with epilepsy. 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 six people using the service.

This inspection took place on 24 April 2018. At our last inspection of the service in January 2016 we rated the service ‘good’. At this inspection we found the evidence not only continued to support the rating of good, we also found for the key question ‘is the service effective?’ the service had improved to ‘outstanding’. There was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns.

Relatives told us the care and support their family members received from the service with their healthcare needs and conditions had led to demonstrable improvements in the quality of their life. People’s care and support was planned and delivered by staff to help them experience the best possible outcomes in relation to their healthcare needs. To support them to do this staff took a holistic approach when planning how people's needs should be met and accessed a wide range of resources to ensure the planning and delivery of care and support adhered to current best practice and evidence based guidance, legislation and standards.

People were supported to access the services they needed to manage their healthcare conditions effectively to help them live healthier lives. Staff used their good links with the health care services involved in people’s lives to ensure people got appropriate support when they needed this. Staff followed the advice and support provided by professionals so that people experienced positive improvements in their health. People were encouraged to eat and drink enough to meet their needs and had meal plans that catered for their specific needs. Staff monitored what people ate and drank and responded quickly to any concerns about this so that people had access to the appropriate support when required. Creative methods were used to support people who were experiencing difficulty in eating which had achieved positive outcomes for people.

Technology and equipment was used to support the delivery of highly effective care and had led to people experiencing positive health related benefits and improvements in their overall wellbeing and quality of life. The provider’s bespoke epilepsy alarm system ensured people received timely support from staff when required.

People were safe living at Independence Homes Limited – 7 Hall Road and staff knew how to safeguard them from the risk of abuse. Staff had access to up to date guidance on how to minimise identified risks to people to keep them safe from injury or harm. Risks posed to people by the premises were in the main appropriately managed. However, the assessment process used to identify environmental risks posed to people was not fully effective as one of the measures identified by the provider to reduce the risk of burns and scalds to people in the premises was not appropriate to this service. The registered manager was already aware this risk assessment needed to be updated and amended and was taking action after this inspection to do this. Notwithstanding this issue the provider had 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 premis

We undertook an unannounced inspection on 25 January 2016. At our previous inspection on 21 March 2014 the service was meeting the regulations we inspected.

7 Hall Road provides accommodation, care and support to up to seven adults with epilepsy and learning disabilities, some of whom also have physical disabilities. At the time of our inspection seven people were using the service. Each person had additional communication needs, including supporting non-verbal communication.

The service had a registered manager who was 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.

People received a highly individualised and personalised service. Staff were knowledgeable about people’s support needs and their preferences as to how they wished to be supported. Support was tailored to meet people’s needs and staff had in-depth knowledge of the people they were supporting. People’s relatives were extremely positive about the service their family member received and felt they received high quality care that met their needs.

People’s health needs were reviewed to ensure they received the support they required. This included regular review of their epilepsy and supporting them with seizure management. People were also supported to access specialist support from a range of therapists, including physiotherapy, occupational therapy, and speech and language therapy. This supported people to maintain their health needs, and ensure they had the equipment and support they required to promote good health. Safe medicines management was in place and people received their medicines as prescribed. The provider’s medical team reviewed people’s medicines and monitored them to identify any side effects.

A nutritionist worked with staff to ensure people had their dietary requirements met. Staff were aware of people’s individual nutritional needs and provided them with the support they required. Staff supported them to develop their eating and drinking skills, and supported people as necessary to ensure their nutritional and hydration needs were met in line with their preferences.

Staff had developed trusting relationships with people. They were aware of people’s preferences, wishes and interests. They were aware of people’s communication methods and how they expressed themselves. Staff supported people to develop their communication skills and used their knowledge of people’s interests to aid communication.

People were supported to make decisions about their care and choices about how they spent their time. Staff used various methods to support people to make decisions, including supporting them to develop pictorial memory aids and activity plans.

Staff supported people to develop their skills and to progress towards the goals they wanted to achieve. This included supporting them to develop their independence in the community, supporting them to participate in new hobbies and to attend college courses.

Relatives told us staff were highly skilled and trained. Staff felt the training at the service was to a high quality and provided them with the skills they needed to support people. This was particularly in regards to epilepsy and managing people’s health needs. Staff’s competency and performance was regularly reviewed during supervision and appraisals. Staff were supported and encouraged to develop their skills and implement these within service delivery. A staff recognition scheme was in place to acknowledge staff that had ‘gone above and beyond’ and a member of staff had recently won the provider’s employee of the month award due to the consistently high quality support they provided.

People’s relatives and staff felt com

We received anonymous information from a member of the public stating that staffing levels were inadequate because there were only three members of staff to care for six people with complex needs. We spoke with the manager and examined staff records. We found no evidence to indicate that staffing levels were inadequate and did not meet the needs of people using the service.

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, observed the care provided and we spoke with the relatives of two of the people using the service.

One relative said “There has always been good communication with the home and they always let us know what’s going on. We work in partnership with them to meet my daughter’s needs”. The other relative said “The standard of care provided at the home is very good. Staff are good, they receive a lot of training and I am really, really pleased with the home”.

Both relatives told us they were aware of the homes complaints procedure. Both said they would contact the registered manager if they needed to make a complaint.

People were cared for in a clean, hygienic environment. People were protected from the risks of inadequate nutrition and dehydration.

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.

We spoke with four members of staff, the deputy manager, Senior Operations Director and spent time in the lounge observing staff giving support to four people who use the service. Staff spent time with people individually, talking with them, supporting them in daily living tasks and with activities. This gave people a sense of purpose. Staff clearly knew people well, what they liked doing, the help and support they needed and how to keep them safe when they had seizures.

We saw bedrooms had been personalised to each person's taste with pictures, photographs and belongings. People who use the service were supported to maintain important family links.

Staff said they "enjoy working here", "I like working here", "we get the training and support we need to carry out our role" and "we have time to be with people, doing what they want and like to do".

Quality assurance systems in place across the organisation included regular checks being made on care plans and other personal records, medication administration, storage and records and staff training and support. Staff at the home completed similar checks each week and were familiar with the systems in place to monitor the services provided.

Due to their needs, people living at 7 Hall Road were unable to share direct views about their experiences at the home. 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 relaxed and at ease in their surroundings. We saw good interactions between staff and people who use the service. Staff were alert to changes in people’s mood, behaviour and general wellbeing and knew how they should respond to individual needs.

We saw that people living in the home are provided with a range of stimulating and varied activities to meet both their specific physical needs and social interests. This extends to both within the home and the local community.

People living in the home have both learning and physical disabilities, some of whom have complex needs and limited communication abilities. There is an experienced manager and skilled staff team who know and understand each person's specific needs and individuality.

There is a stable staff team who meet the health and personal care needs of each individual in a person centred way.

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