Norwood - 30 Old Church Lane

At this inspection we found the service remained Outstanding.

Norwood – 30 OCL had a manager registered with the Care Quality Commission (CQC), however the registered manager had been promoted to Head of Care Services and an acting manager had been appointed to undertake day to day management of Norwood – 30 OCL. The registered manager was still present for about two days per week at Norwood – 30 OCL and the acting manager will register with the CQC in April 2018. 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 were safe. Staff demonstrated thorough understanding and knowledge of how to protect people who used the service from harm. The service ensured that sufficient levels of staff were deployed to make sure people's needs were met at any time. People who used the service were listened to and consulted as to what made them anxious and supported them to take a full part in their home and in the community. Norwood – 30 OCL introduced creative ways of retaining and developing staff, which ensured consistency and meant people who used the service were supported by staff which knew them well. Risk assessments formed part of the care planning process and encouraged people to stay as independent as possible without compromising their safety. Risk assessments were reviewed regularly by involving people who used the service, their relatives and staff who supported them. Medicines were continued to be managed safely with the emphasis of reducing rather than increasing the medicines people who used the service were prescribed. This was in particular paramount in relation to medicines prescribed to manage behaviours that challenge the service.

People who used the service, relatives and befrienders spoke highly about the care provided and received at Norwood – 30 OCL. The service consistently supported people who used the service to maintain and build

relationships internally and externally. Norwood – 30 OCL looked at creative ways to help people who used the service to gain new skills, become more independent and become a valued member within the community, by following their aspiration of gaining payed employment. Staff and people maintained excellent professional relationships and staff demonstrated an exceptional understanding of people's needs, abilities and likes and dislikes. People who used the service continued to take part in national and international fundraising events with the help of staff.

Each person had a clear and detailed care plan tailored to their individual needs. The care plans highlighted specific support needs, particularly involving anxiety and how to support the person to manage these. All people had a specific autism care plan which gave detailed information about the person's condition and information where the person required additional support to maintain their independence. All people made a wish list annually, which looked at aspirations and goals individuals and the service wanted to achieve. People had developed an individual timetable of activities, which was communicated with people through pictures to help them to understand better of what they were doing each day. Some people were doing voluntary work, while others had a leaflet distribution job which they were paid for. People developed their social skills by interacting with peers regularly and were also supported to plan trips to visit relative's that did not live locally.

The registered manager, acting manager and staff were continuously praised for their support and people, staff and relative's felt they were extremely open and approachable. Staff felt as part of an open and empowering culture where they were respected as individuals and as part of a team. Relative's had the utmost confidence in management and always felt welcomed and kept up to date with how people were.

The staff team at Norwood – 30 OCL had a sound understanding of the Mental Capacity Act (MCA) 2005.The service promoted choice and decision making in particular regarding decisions about people's care and safety. Nevertheless the manager and staff understood their responsibilities under the Deprivation of Liberty Safeguards (DoLS).These provide legal safeguards for people who may be deprived of their liberty for their own safety. Staff had sought support from health professionals to enable people to make decisions about their own health and wellbeing.

Staff told us that they felt supported and listened to, they praised the regular supervisions and appraisals which helped them to develop their understanding of people and also was a contributing factor to staff working at Norwood – 30 OCL for a number of years. This in return benefitted people who used the service who were supported by a staff team who knew them well and understood their routines. Staff received a wide range of specialised training to ensure they could support people safely and carry out their roles effectively.

People were supported to maintain their health. Over the past year Norwood – 30 OCL had supported people who used the service with serious health concerns, via visits and being treated by specialist consultants. Relatives spoke highly of the healthcare support people who used the service received. Annual health action plans and hospital passports were designed together with people to ensure healthcare was consistent when moving between different healthcare disciplines. There were clear guidelines in how to support people when accessing different health professionals such as the GP, Dentist or Chiropodist.

The registered manager and registered provider had developed robust systems to ensure that quality audits were completed monthly and included checks on the building, people and staff's welfare. People and staff had regular meetings where they were given updates on the service and the opportunity to voice any concerns. The registered manager and registered provider looked for ways to continually improve the quality of the service. For example they had continuously developed systems to monitor behaviours;

challenged poor practice and involved people used the service and relatives to contribute to the running of the service and organisation.

Further information is in the detailed findings below.

The five questions we ask about services and what we found