About the service: Ranworth House is a residential care home. The home is registered for up to nine people living with a learning disability, complex needs and autism. There were nine people living at the home at the time of inspection, both young men and women. People had access to two communal lounges, a dining area, kitchen and sensory room. People had their own personalised rooms with en-suites.

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

People’s experience of using this service: The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways; promotion of choice and control, independence and inclusion. People’s support focussed on them having as many opportunities as possible for them to gain new skills and become more independent.

People living at the home benefited from outstanding care and support in a safe environment. There was a truly person-centred approach to the support people received. Staff had excellent knowledge and skills in supporting young people with a learning disability and saw people as individuals. Staff ensured people received a safe service where they were supported to take positive risks to develop their skills and broaden their horizons.

Relatives and healthcare professionals consistently told us people were treated with exceptional kindness, compassion and respect. We received overwhelmingly positive feedback on how staff were supportive and went the extra mile to get care and support just right for people. A relative told us, “staff are extremely kind, when I pick him up he and the others are always happy, staff really know his needs well.”

People were given choice and control over their lives which promoted their independence. A relative told us, “They do so many things to support people, like I have never seen before. There are no barriers for my daughter, she does all the things she likes.” Each person was respected as an individual, with their own social and cultural diversity, values and beliefs. Staff were particularly good at noticing very subtle changes to people’s health and mood and acted quickly to ensure their health needs were met.

People had access to a variety of stimulating activities tailored to their personal interests. Staff recognised the importance of people leading their activities to get the most from opportunities. Staff took positive risks, and thought creatively, to ensure people could do what they wanted to and put strategies in place to overcome any barriers to accessing activities and new opportunities.

Staff were motivated by, and proud of, the service. One staff member said, " I am very proud of how the service users have developed and how we have bought out the best in them by really listening and understanding their needs.” Staff were, without exception, positive about all aspects of the service. There was a particularly strong emphasis on continuous improvement with staff gaining additional qualifications and knowledge to better support good outcomes for people. The leadership of the home was exceptional and the registered manager was focused on delivering high quality person centred care and continuously driving improvements at the home to broaden people’s life experiences.

Further information is in the full report.

Rating at last inspection: Outstanding (The last report was published on 2 July 2016).

Why we inspected: This was a planned inspection based on the rating at the last inspection. The rating for the home remains Outstanding and the key question, Well-Led has improved to Outstanding.

Follow up: We will continue to monitor the intelligence we receive about this home and plan to inspect in line with our re-inspection schedule for those services rated Outstanding.

This inspection took place on 4, 5 and 10 May 2016 and was unannounced. Ranworth House provides care and support for up to nine people with a learning disability and/or other complex needs. The home is a large detached house with two lounges, a sensory room, dining room, kitchen and surrounding garden. Each person had their own en-suite bedroom. There were nine people with an age range of 22 to 30 years living in the home at the time of our inspection.

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 experienced excellent care and support. They were supported to live safe, fulfilled and meaningful lives in the way they wanted to. Staff knew how to safeguard people from abuse and what they should do if they thought someone was at risk. Risks to individuals were extremely well managed and people were able to stay safe without having their freedoms restricted. Managers and staff promoted peoples independence and encouraged positive risk taking. If an incident or accident did occur, they were well reported and investigated. Staff understood the importance of learning from incidents, so they could make sure they did not re-occur.

There was always enough staff on duty. Staffing levels were regularly assessed and care workers were flexible about the hours they worked. Staff turnover was very low and relatives said how important this was to their family member. Staff knew people well and understood how to meet people’s complex needs. Recruitment practices were robust.

People’s medicines were exceptionally well managed. Staff were very well trained and people received their medicines safely and on time. The registered manager had liaised with the pharmacist to ensure some medicines were dispensed in different ways, to make sure people got their full dose of medicines safely. Staff understood when they needed to give people medicines on an ‘as and when basis’, and how some people communicated non-verbally this was what they needed.

The registered manager and staff had a good understanding of the Mental Capacity Act (2015) (MCA) and gained consent from people in line with legislation. Deprivation of Liberty Safeguards (DoLs) referrals had been made to the appropriate authorities. Where best interest decisions had been made on behalf of a person, all of the relevant people were involved.

People were well supported to eat and drink enough. Food was homemade and nutritious and people were involved in making decisions about menus. People were supported with healthy eating and to maintain a healthy weight, with specialist diets when required.

The registered manager and staff ensured everyone was supported to maintain good health. They took a proactive approach to ensuring people’s complex health needs were always met, and consistently ensured that when people needed specialist input from health care professionals they got it.

Staff were extremely caring and always ensured they treated people with dignity and respect. They had an excellent understanding of the care and support needs of every person living in the home. People had developed very positive relationships with staff and there was a friendly and relaxed atmosphere in the home. People were well supported to do the things that were important to them, such as going to college, playing football or voting. Staff were well supported with training, supervision and appraisal which helped them to ensure they provided effective care for people.

People and those important to them, such as their relatives or GP, were asked for feedback about the quality of the service. Any feedback received was acted on, and any concerns were dealt with quickly before

We used a number of different methods to help us understand the experiences of people using the service. Not all of the people who lived at Ranworth House were able to communicate with us. We found by observation and looking at care plans that people were involved in making decisions about their care and treatment.

We examined three care plans and observed how staff supported people living in the home. We found that people’s care was planned and delivered in a way that protected them from unlawful discrimination.

We examined the home’s policy, practice and records in relation to medication. We found that staff were properly trained, medication was stored appropriately and administered correctly. We saw that record keeping in relation to medication was accurate and up to date.

We examined three staff files and found that the provider used effective recruitment and selection processes to ensure the care and safety of people living at the home. All staff were subject to appropriate checks before they began working at the home.

We examined the provider’s quality assurance files and spoke to staff and saw that there were effective systems in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others.

On the day of the inspection eight people were being supported to live at Ranwoth House. People had a range of verbal skills and understanding. We spoke with family members and observed how care was being provided to help us understand the experiences of people using the service.

People were encouraged to be as independent as they were able and wished to be. People’s privacy was promoted. Staff were observed to speak to people in a calm, friendly and unhurried manner allowing time for responses.

People’s care needs were identified in person centred plans and updated as people’s needs had changed. The support plans provided staff with structured guidelines that respected people’s wishes.

The service had systems in place to ensure people were protected from abuse, or the risk of abuse and their rights were respected and upheld. Staff had an understanding of safeguarding issues and how to report abuse or allegations of abuse.

We observed people were supported by sufficient levels of staff that had appropriate training and qualifications and who received relevant training that ensured they kept their knowledge and skills up to date to meet people's needs.

We saw that there was a quality assurance system in place that allowed for the service to conduct their own regular reviews to ensure that they service was safe and suitable and that met people’s needs. People's and their relative’s views were taken in account in the way the service was delivered.

The inspection visit lasted for nearly four hours, and during that time we met four people living in the home and five support workers. The manager was on leave, and an acting manager was carrying out her role. For ease of reading this report she is referred to as the manager. She was present throughout the time of the visit. The company’s Operations Manager was also present for some of the time.

We observed support workers in the lounges, dining-room and corridors, and tried to talk with them. In response to questions we received some smiles, some nods, some answers of “yes” and sometimes no reaction. We asked two people if they liked living in the home, and if the staff looked after them well. Both people answered “yes” to both questions. We observed that people living in the home were generally relaxed and were enabled to carry out their own preferences. We saw that staff interacted well with them.

We viewed responses to questionnaires from relatives, and some included comments such as the following:

“We are very happy with the quality and standard of care and the support provided.”

“The staff are always friendly when we visit.”

“We would prefer weekly contact with the home.” (We found that this had been arranged).

“Some of the staff are exceptional.”

“The home is very clean and always smells nice.”