Tigh Sogan

When we last visited the home on 20 October 2015 the service was meeting the regulations we looked at and was rated Good overall. At this inspection we found the service had improved significantly and was Outstanding overall.

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. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a registered manager in post at the time of our 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.

The provider had excellent systems in place to support people in relation to behaviours which challenged the service. The registered manager and staff closely assessed people's needs in relation to behaviours and implemented consistent ways of working tailored to each person. People experienced a reduction in behaviours which challenged and this helped improve their quality of life. Staff received training in relation to positive behaviour support and understood people's needs well.

Care plans were carefully designed so people's emotional needs, individual preferences and interests were well catered for. Each person was supported to live a meaningful life despite difficulties they experienced in their day to day lives and previous difficulties in engaging in activities. People had individualised activity programmes in place which met their particular interests and needs very well. Staff supported people to increase choice and control in their lives through their excellent understanding of people's needs and preferences. People were at reduced risk of social isolation as the provider actively encouraged socialising and building relationships.

Systems were in place to reduce the risk of abuse. Staff received regular training in safeguarding and staff understood their role and responsibilities in relation to this. The provider identified, assessed and managed risks relating to people's care as well as to the premises. The premises were well maintained and clean with

sufficient space for people. People were free to choose where they spent their time in the service. Good infection control processes were in place.

The provider carried out recruitment checks to determine whether staff were suitable to work with people. People and staff were involved in the recruitment process. There were sufficient numbers of staff deployed to support people with each person receiving individual support throughout the day. Processes were in place to manage people's medicines safely.

People were supported by staff who were well supported with induction, training, supervision and annual appraisal to help them understand their role and responsibilities.

People received coordinated care when moving between services such as hospital admissions and when newly admitted to the care home. People were supported in relation to their day to day health and to access healthcare services they required. People received their choice of food and the provider encouraged healthy eating. People were encouraged to exercise and maintain a healthy weight.

The provider had followed the Mental Capacity Act 2005 in assessing people's capacity to consent to their care. The provider applied for authorisations to deprive people of their liberty (DoLS) as part of keeping them safe, which involved keeping the front door locked to keep people using the service safe.

Staff were caring and treated people with dignity and respect and dignity was actively promoted in the team. Staff understood people's communication needs well and adapted their communication for the different individuals. People were encouraged to develop their independent living skills.

People's care plans reflected their physical, mental, emotional and social needs, their personal history, individual preferences, interests and aspirations. Staff used the information in people's care plans in promoting choice and providing opportunities in people's lives. Processes were in place to support people to develop end of life care plans as the provider was liaising with the local hospice.

The registered manager created a positive, encouraging environment for people, staff and relatives who visited the service and had a good understanding of their role and responsibilities. Leadership was visible and capable at all levels and staff also understood their role well. Staff worked together as a team.

The provider had good governance systems in place to audit and improve the service with frequent checks of the service in line with CQC standards. Systems were in place for the provider to communicate and gather feedback from people, relatives and staff. The complaints process remained suitable.

The five questions we ask about services and what we found