Totteridge House

Some records were not accurate and complete. Auditing and monitoring of the service was taking place however, the audits had not identified the shortfalls we found in record management or that sufficient staff were not provided at night-time to provide people with the level of support outlined in their PEEP's.

Some risks to people were identified and mitigated. Staff were aware of people's risks and how best to support them. Sufficient staff were provided during the day which enabled people to have the support they required and access to community activities. The night-time staffing levels did not take account of the support outlined in people's Personal Emergency Evacuation Plans (PEEP's) which had the potential to put people at risk. The PEEP's were reviewed in response to our feedback and we have made a referral to the local fire service.

Safe medicine practices were promoted, and systems were in place to safeguard people from abuse. Staff were clear of their responsibilities in recognising and reporting potential safeguarding incidents. Accident and incidents were recorded and showed a debrief of incidents and a review of positive behaviour management plans to prevent reoccurrence.

People were supported to have maximum choice and control of 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.

Staff felt suitably inducted, trained and supported in their roles. Staff were suitably recruited, although some records relating to recruitment were not on electronic staff files to demonstrate the checks they had carried out. These were added to the file after the inspection.

The service had an experienced manager who was committed to providing a person-centred service for people. They acted as a positive role model to staff and had built positive relationships with health professionals and families. Relatives were complimentary of the registered manager and the stability they had brought to the service. Health professionals told us they worked collaboratively with them. A health professional told us the service supports people with very high complex needs. They commented "The registered manager is always available, leads from the front, is hands on, person centred and see what is important for a person. She puts the people they support at the centre of everything they do."

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. 'Right support, right care, right culture' is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

The service was able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture.

Right Support: People were provided with the right support, communication aids and equipment to enable them to be involved in making choices, promote their independence and develop life skills.

Right Care: Person centred care was provided which promoted positive outcomes for people. There was a reduction in distress for people and people were treated with compassion. This promoted their well-being and enabled them to achieve their goals and aspirations which included access to community activities such as swimming, driving experience, holidays and college.

Right Culture: The registered manager promoted a positive, open culture within the service, where staff felt supported, trained and able to raise concerns to enable them to support people to lead inclusive and empowered lives.