Stakesby Road

Stakesby Road is situated in Whitby and accommodates up to three people who have profound and multiple learning disabilities. 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.

Inspection site visits took place on 26 March and 11 April 2018 and were announced. At the time of this inspection, the service was providing support to two people.

At the last comprehensive inspection in October 2015 we found the service was meeting requirements and awarded a rating of good. At this inspection we found the registered manager and staff team had developed the service further to achieve an outstanding rating.

There was a manager in post who had registered with the Care Quality Commission. They assisted throughout the inspection process. 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.

Discussions with staff demonstrated they were extremely passionate about the people they supported, building effective communication and improving the quality of life people had. Staff spoke with empathy and enthusiasm as they explained future activities planned and improvements people had made with their health and well-being. Staff approached and responded to people as individuals, tailoring how to do this based on their in-depth knowledge of the person. This meant we observed meaningful relationships based on trust and mutual respect.

Staff described the importance of people being able to have meaningful, private communication with relatives. Photographs of activities and daily events were taken by staff and placed in a memory book. This gave relatives the opportunity to stimulate meaningful conversations with the person about their week without staff being present.

Potential barriers to communication were addressed through staff's in depth understanding of people's unique communication styles which were detailed in people's care records. People had access to a range of technology as well as communication boards, picture cards and photographs. It was clear staff understood the importance of maximising the opportunities for people to experience

sensory stimuli such as touch.

People were encouraged to form goals towards their independence such as becoming more active and were supported to work towards these through keeping them under review. Case studies were produced by staff to record progress and what the outcomes for people were.

Respect and regard for privacy and dignity were at the core of the service's culture and values. Staff had received training in how to treat people with respect and kindness. The ethos of the home was to make people feel special and that their lives and feelings mattered.

Relatives, staff and people were equal partners in designing the care people wanted in the way they wanted it. Staff gathered each person's life history and used this to develop positive relationships and design care which included the person's preferences. Support plans were written in an exceptionally person-centred way with detailed instructions on how to provide care which was appropriate to the person.

The service had a creative approach in supporting people to make their own decisions. The use of technology was embraced to enable people to make decisions around daily lives. Where people lacked the capacity to make particular decisions a person-centred approach to each decision made in the person's best interest had been considered.

Staff at the service had a proactive approach to promoting and improving people's health and nutrition. Excellent relationships with the other professionals had been developed. They visited the service on a regular basis to offer guidance, advice and also delivered person-centred training. Records showed that people's weight was closely monitored and any concerns were reported immediately to relevant professionals.

Relatives and professionals confirmed that the registered manager listened to and acted upon any views without hesitation. There was a strong sense that the communication between the registered manager and people, relatives and staff was open, enabling and supportive.

The registered manager was continuously trying to improve the service and the quality of care provided. They kept a reflective log on research, taught sessions and training they had attended so they could take control of their own learning and understand areas for improvement.

Comprehensive and exceptionally effective quality assurance systems were in place which were completed by the registered manager and senior managers from Wilf Ward Family Trust to monitor and improve the service. Actions required were clear, concise and completed in a timely manner.

The day-to-day values and culture of the service were highlighted at handovers, supervision and in monthly staff meetings. Staff meetings were an opportunity for staff to contribute their views. We saw a real person- centred culture where staff displayed empathy and worked with people and their relatives to understand how to best support them.

A complaints policy was in place and displayed at the service which was also available in easy read format. Relatives we spoke with told us they would be confident in raising any concerns and were certain the registered manager would take appropriate action.

Safe recruitment processes had been followed. The registered manager had developed the recruitment process to ensure people who used the service and relatives were included in staff selection. Interview

questions were developed by relatives, which focused on areas they considered most important when recruiting new staff. Potential new recruits were asked to spend time with people whilst under supervision to allow the registered manager to observed interactions to assess if potential staff followed the services values.

A safeguarding and whistle blowing policy was in place. Staff had received safeguarding training and had a clear understanding of their responsibilities to report any concerns. People were supported by a regular team of staff who were able to effectively communicate with people and were aware of people's body language and gestures that would indicate there was a concern.

Staff and management at the service embraced positive risk taking to ensure people had fulfilled lives. Thorough risk assessments were in place and regularly reviewed and updated when needed.

Systems were in place to ensure that medicines had been ordered, received, stored and administered appropriately. Staff had received appropriate training and had their competencies in this area assessed by management.

Staff had access to personal protective equipment (PPE). People's personal toiletries were kept in allocated cupboards and the environment was exceptionally clean and tidy throughout. Staff had received training in infection control and were aware of best practice guidance and how this applied to their role.

Staff had received extensive training in areas the provider considered mandatory. Training was provided through a range of provision to accommodate to encourage engagement.

Staff were receiving regular and constructive supervision and appraisal, which were recorded and focused on areas of improvement, how this could be achieved as well as acknowledging good practice and progress made. Staff were encouraged to progress within their role.

The five questions we ask about services and what we found