This was an unannounced inspection which took place on 15 May 2018.

The Tager Centre is a care home without nursing which is registered to provide care and accommodation for up to 16 people with learning disabilities. It specialises in supporting people who are on the autistic spectrum. At the time of our inspection there were 16 people living at the home. The home is split into four wings with four people living on each wing. All bedrooms are en-suite, with each wing having communal lounge, dining and kitchen areas.

At the last inspection, on 23 February 2016, the service was rated as good in all domains. This meant that the service was rated as overall good. At this inspection we found the service had improved to outstanding in two domains and therefore had improved to an overall rating of outstanding.

Why the service is rated outstanding.

The service was exceptionally responsive and strove to meet people’s aspirations and lifestyle choices. It was flexible and readily adapted to meet people’s changing, diverse and complex needs. It was extraordinarily person centred and people were seen and responded to as individuals. Activity programmes were creative and designed to meet people’s individual preferences and choices. Care planning was highly individualised and regularly reviewed which ensured people’s current needs were met and their uniqueness and individuality was respected.

There is a registered manager running the service. 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.

The registered manager was extremely experienced, respected and highly thought of by staff, families and other professionals. She and the management team ensured the service was exceptionally well-led. The management approach was inclusive of all parties and there was a strong emphasis on developing all staff members, regardless of role, for the benefit of people living in the service. There was an open and transparent culture where all visitors to the service were welcomed and listened to. There was a strong drive to enable people to benefit from regular community presence and to have fulfilling and satisfying life experiences. The approach of the home was embedded so that new staff were incorporated into the ethos and values of the service in a seamless manner.The registered manager and the staff team were committed to ensuring they offered people the very best care possible and that people were as involved as possible in running the service. There were examples of excellent and consistent practice which had enhanced and improved the lives of people living in the service. These are detailed in the main body of the report.

The quality of care the service provided was constantly assessed, reviewed and improved by the provider, people and the staff team. The service was run in line with the values that underpin “Registering the right support’’ and other best practice guidance. These values include choice, promotion of independence and inclusion. The service followed the principles that people with learning disabilities and autism can lead as ordinary a life as any citizen.

People’s safety was contributed to by staff who had been trained in safeguarding vulnerable adults and health and safety policies and procedures. Staff understood how to protect people and who to alert if they had any concerns. General operational risks and risks to individuals were identified and appropriate action was taken to eradicate or reduce them. All aspects of safety were considered and actions were taken to assist people to remain as safe as possible.

People continued to be supported by appropriate staffing ratios, which were reviewed on a daily basis. Staff were able to meet pe

The Tager centre is set in the grounds of Ravenswood village. Ravenswood was set up in 1953 to provide education and accommodation for people with learning disabilities. People living at Ravenswood come from many different backgrounds, with the Jewish culture being at the centre of Ravenswood’s ethos. The Tager centre offers care and accommodation for up to 16 people with learning disabilities. It specialises in supporting people who are on the autistic spectrum. Autism is a lifelong condition that affects how a person communicates with and relates to other people, and how they experience the world around them. At the time of our inspection there were 16 people living at the home. The home is split into four wings with four people living on each wing. All bedrooms are ensuite, with each wing having communal lounge, dining and kitchen areas.

The inspection took place on 6 February 2016. This was an announced inspection which meant the provider knew we would be visiting. As we were visiting the service on a Saturday we rang the day before the inspection to ensure there would be someone at home on the day of our visit. We also wanted to make sure the manager would be available to support our inspection, or someone who could act on their behalf.

A registered manager was employed by the service. 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 had developed caring relationships with staff and were treated with dignity and respect. People were supported by staff who knew them well and understood their care and support needs. Staff showed concern for people’s well-being and quickly responded to their requests for support to meet their needs. Relatives spoke positively about the care and support their loved one received.

People were supported to maintain relationships with people that mattered to them. Relatives said they were kept informed of their loved ones health and well-being and any changes in their needs.

People were kept safe by staff who recognised the signs of potential harm or abuse and knew what to do when safeguarding concerns were raised. Staff felt confident concerns raised would be listened to and acted upon by the management team. People were supported to take risks to retain their independence whilst plans were in place to minimise these risks.

Staff were aware of people’s dietary needs and preferences. People had access to sufficient food and drink and were supported and encouraged to maintain a healthy diet. As the Jewish culture is at the centre of Ravenswood’s ethos, staff were required to follow specific guidance when preparing food in line with Jewish dietary laws.

People had access to health and social care professionals. Care plans were in place to meet people’s health needs and were regularly reviewed. There were safe medication administration systems in place and people received their medicines when required.

Safe recruitment procedures ensured people were supported by staff with the appropriate experience and character. Training records confirmed staff received training on a range of core subjects as required by the provider.

Staff were knowledgeable about the rights of people to make their own choices and decisions. This was reflected in the way their care plans were written and the way in which staff supported and encouraged people to make decisions when delivering care and support. Staff and the manager had an understanding of the Mental Capacity Act (2005).

The service had a positive open culture that was person centred, and inclusive. People, relatives and staff were empowered to share their views on how to improve the service for people.

Quality assurance systems were in place to moni

At an inspection on 22 March 2013 we found the provider had not always completed all the required recruitment checks in accordance with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 Schedule 3.

At our inspection on 8 April 2014 we found the provider had taken action to address this breach of the regulations. We found they had completed all required recruitment checks for staff employed by the service in the four files we looked at.

A full employment history was recorded for care workers in each of the recruitment files we looked at. We saw evidence that gaps in employment history were identified and investigated, with an appropriate written explanation recorded. Evidence of previous good conduct in positions of employment in a health and social care environment was sought and verified.

We did not speak with people who use the service during this inspection. We spoke with the registered manager, care workers and administrative staff on the day of our inspection, and the provider’s Human Resources (HR) manager to gather additional information.

We were told that the service specialises in supporting people on the autistic spectrum respecting their individual requirements in structure and routine. We saw the relationship and interactions between staff and people who use the service were positive and respectful. We spoke with one person using the service who told us that they were happy with the service provided and that the care was of an excellent standard provided by friendly professional staff. We saw people had a variety of choices in the way they were supported. For example, we saw people could choose what they wanted to eat for each meal and they had the freedom to change their decision

We spoke with three care staff who told us that they supported people to be as independent as possible and supported them to work towards and achieve personal goals. We looked at a range of files that demonstrated the personalised approach in place to support the staff’s comments. We observed that the manager operated a model of good practice by offering staff regular supervision and access to a framework of training.

We observed staff treating people with respect and were able to see that there was a good relationship between staff and people who use the service. We observed staff assessing people’s needs and ensured that care was provided in line with individual care plans. We saw that people were comfortable and that adequate numbers of staff were available to provide the individualised support needed.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex need which meant they were not able to tell us about their experiences.

We saw people had a variety of choices in the way they were supported. For example, we saw people could choose what they wanted to eat for each meal and they had the freedom to change their decision.

We looked at two people's planning and delivery of care. We saw there was comprehensive but individualised risk assessments and care plans for the people who use the service.

We saw the facilities were clean, well maintained and appropriate for carrying on the regulated activity.

The provider had a robust interview and selection technique which actively involved people who use the service. However, the provider did not always undertake the appropriate background or document checks prior to new care staff taking up employment, to ensure that people who use the service were not placed at risk.

People who use the service, their families and visitors knew of the care home's complaints system.