Garden House

There were areas of improvement in relation to how people were protected from risks associated with infection control. We have made a recommendation about this in the report.

Staff received an induction when they first started working at the service. Training was updated regularly and staff told us the training was good and equipped them to carry out their roles with confidence. There were sufficient staff to support people according to their needs. Staff told us they were well supported and had regular supervisions with the deputy manager.

People were supported to have choice and control in their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. However, the layout and size of the premises were not in line with best practice guidance. This impacted on people's autonomy and opportunities to take part in independent living skills. People were living in a large group setting which is different to how most citizens choose to live their lives. Menus were developed by staff with no input from people who lived at the service. We have made a recommendation about developing the service in line with best practice guidelines.

The registered manager told us they had discussed ideas with the providers for developing the service in line with Registering the Right Support guidelines. However, there were no firm plans or timescales for making these improvements.

When we arrived at Garden House the atmosphere was busy and friendly. Staff were supporting people to get ready to go out on various trips. They spent time encouraging people and making sure they were happy with the days arrangements.

People and relatives told us staff were enthusiastic and were kind and helpful. Relatives confirmed they were kept informed of any changes in their family members health needs and were able to speak with a member of the management team at any time.

People spent time taking part in pastimes that reflected their interests. As well as daily events such as shopping and café trips, various celebrations were hosted at Bowden Derra Park. Relatives and residents from the local community were invited to attend these events.

The registered manager and senior management team were highly visible in the service and staff told us they were approachable and would listen to any concerns they had.

Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in- depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement. As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people. The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.