Cunningham House

Cunningham House is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The service provides a range of specialist assessment and rehabilitation programmes for people with acquired brain injuries, other neurological conditions or early onset dementia. They may also have other associated complex cognitive impairments or physical disabilities. Cunningham House is registered to provide accommodation, nursing and personal care for up to 18 people in one single story, adapted building; the accommodation consists of 14 bedrooms and 4 flats. At the time of the inspection there were 16 people living at the service.

At the last inspection, on 2 and 3 March 2016, the service was rated 'Good'. At this inspection we found that the service was now rated 'Outstanding'.

There was a registered manager in post. A registered manager is a person who has registered with the CQC 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 service demonstrated an excellent commitment to providing outstanding support, which put people at the heart of everything. The provider and registered manager led the staff to deliver person centred care, which had achieved consistently outstanding outcomes for people.

Staff continuously went beyond expectations to ensure that people received truly individualised care that was flexible and responsive to their needs. Staff respected people's individuality and empowered people to express their wishes and make their own choices.

Staff demonstrated the provider's values of offering person centred care that respected people as individuals in all of their interactions with people. Staff at all levels had a strong belief that they were providing the best possible support for people, and were confident and empowered in their roles because of the strong leadership and management across the service.

Staff were innovative in their approach to support, and were enthusiastic about supporting people to overcome life's challenges. People and their relatives consistently told us that the service provided exceptional care and support to people.

There was a very effective system of quality assurance that ensured people consistently received exceptional

care and support. The people receiving support from the service had an enhanced quality of life because the service worked innovatively to respond to people's feedback and enable people to have meaningful experiences.

Staff had an understanding of abuse and the safeguarding procedures that should be followed to report abuse. Detailed risk assessments and behaviour management plans were in place to manage all risks within a person's life. Staff were confident in supporting people with complex needs and behaviours and enabled and empowered people to live as independent a life as possible safely. There were arrangements in place for the service to make sure that action was taken and lessons learned when things went wrong, to improve safety across the service.

Staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service. People could be assured that they would be supported by sufficient numbers of staff with whom they had developed positive relationships.

Staff were provided with an extensive induction and on-going training was available to ensure they had the skills, knowledge and support they needed to perform their roles. Staff were very well supported by the registered manager and senior management team, and had regular one to one supervisions.

People received their medicines as prescribed and their health and well-being was monitored by a multidisciplinary team of staff. People were supported to access health professionals in a timely manner when they needed to. People were supported to have sufficient amounts to eat and drink to maintain a balanced diet.

Staff knew their responsibilities as defined by the Mental Capacity Act 2005 (MCA 2005). The registered manager was aware of the process to make referrals to the local authority if people lacked capacity to consent to aspects of their care and were being deprived of their liberty. Staff consistently gained people's consent before providing support

People were involved in planning how their support would be provided and staff took time to understand people's needs and preferences. Care documentation provided staff with appropriate guidance regarding the care and support people needed to maintain and develop their independence.

Further information is in the detailed findings below.

The five questions we ask about services and what we found