Restormel House

People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

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.

People living at Restormel House had a range of complex care needs and required a high level of support with daily living inside and outside the home. Some people had previously lived in settings where they had been restricted from making everyday choices and others were experiencing change as they moved from being a child into adult services. Although people had capacity, some of their communication skills were limited. We met all five people during our visit and were able to observe interactions and talk to people about their daily routines and plans.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered person's'. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated regulations about how the service is run.

At the last inspection on the 20 January 2016, the service was rated as good in the domains of safe, effective, caring, responsive and well led. This meant the service was rated as good overall. At this inspection we found the service remained good in safe and effective, but had improved to outstanding in caring, responsive and well led. This means that at this inspection the service is rated as Outstanding overall.

Why the service is rated outstanding.

There was a very positive culture within the service. The management team provided strong leadership and led by example. Relatives, staff and other agencies were very positive about the leadership of the service. They described the registered manager as, "Excellent", "Supportive, always available" and "Proactive, always thinking ahead". We observed positive and compassionate interactions between staff and the people they supported. Staff said they loved their work and were passionate about providing high standards of

care. The provider really inspired staff to provide an excellent quality service. Staff had been nominated and received awards to celebrate their contribution to care and a number of aspiring leadership opportunities were available to encourage progress and development.

There was a 'can do' approach to working with people. The registered manager and staff recognised that people they supported were young and despite their needs wanted to experience the same opportunities as other young people their age. Risks in relation to people's care were assessed, understood and managed well. Staff worked very hard to manage risks, whilst not restricting people's opportunities. For example, one person wanted to attend an event to see favourite film and TV characters. Staff supported the person to consider the risks involved in this activity and to plan the event safely. The person's involvement, staff skills and determination resulted in the person having a wonderful experience, which we were able to see had been documented for them in photographs.

People were encouraged to lead active lives and were supported to participate in community life as much as possible. Small steps had been taken to help people achieve their goal. For example, one person who had previously spent most of their time at home had been supported to go out into the community. Staff initially supported them to look online at items in a shop, then went with the person in the car several times to familiarise themselves with the route before finally going into the shop to buy what they had seen. Staff said these were often long processes, "But we aim to get there in the end". Another person had been supported to access work opportunities and had successfully secured paid employment.

There was a strong emphasis on people being able to develop their independence and to move on from Restormel House if they chose to do so. We heard about people who had moved on from the service since the last inspection and these achievements had been documented in the homes 'Journeys file'. Staff had supported people to plan their move, access advocacy services and organise their finances. People's progress and achievements were recognised and celebrated.

People's safety was paramount in the service. People were supported to understand how to keep safe. The local police diversity officer visited the service to talk to people about safety topics such as, keeping safe in the community, bullying and hate crime. A staff member had attended a training course at a local drug and alcohol service so that they could provide people with information and advice when the needed it. This included information about sexual health and relationships. They told us "We support young people who need good, clear information and support to keep them safe and healthy".

Staff undertook regular safeguarding training and understood how and when to report any concerns about abusive or poor practice. People using the service also had access to relevant contact numbers if they wanted to report any safeguarding concerns. Safeguarding was discussed regularly within staff and resident's meetings. Robust recruitment practices ensured staff employed in the home were suitable to work with vulnerable people.

The service had a culture which recognised equality and diversity amongst the people who lived in the service and the staff team. People were not discriminated against in respect of their sexual orientation. Staff recognised that some people were exploring their sexuality and supported them sensitively and appropriately when required. Staff had supported one person in relation to their particular lifestyle choice. Staff had spent time with the person to gain a better understanding and had developed a plan with the person to help ensure appropriate support was provided. Innovative and sensitive methods had been used to protect people's privacy at all times.

Staff were sensitive and respectful in relation to people's religious and cultural needs. The Regard

Partnership mission stated that they wanted staff to experience a 'positive, inclusive, working environment where diversity is celebrated'. Recruitment processes and the planning of staff demonstrated that the provider and registered manager recognised the benefits of having a diverse community of staff who valued one another and the different contributions they could make.

The registered manager and staff had been creative and innovative in ensuring they responded appropriately and effectively to people's communication needs. Care plans, risk assessments, behaviour support plans and health information had, where appropriate, been translated into pictures and symbols for the person to understand. People's daily routines, menu's and activity plans were also provided in a way the person could understand and use to organise their time. Easy read information had been developed covering a range of topics, which people might require access to, including, equality, diversity and human rights, confidentiality, resident's money and sexual health issues. This helped to ensure people had access to the information they needed in a way they could understand it. The registered manager continued to explore the use of technology to assist with responding to people's individual care needs. People either had their own computer or access to the homes computer system. We saw one person writing their weekly menu and shopping list on the home's computer. The registered manager said this was a very important task for the individual but also allowed staff to spend valuable and positive time with them. Each person had a memory stick to allow them to access information about their support arrangements and identify any issues or changes.

Restormel House mainly supported younger adults. The atmosphere in the home reflected this younger age group with lots of laughter, jokes, music and activity. When we arrived, some people were busy getting ready for their day and others were either having a lie in or relaxing having breakfast and chatting with staff. We observed people were making choices and leading a busy and full life. People clearly saw Restormel House as their home and were empowered to treat it as such. We observed people answering the door to visitors, using the kitchen freely to prepare drinks and snacks and offering their views and feedback as we inspected the service. Staff were enthusiastic and energetic. We saw how staff were patient and respectful towards people at all times even when faced with challenging and unpredictable situations.

Personalised care was central to the homes philosophy and staff demonstrated they understood this when talking about how they met people's individual care and support needs. People's care records and support arrangements were highly personalised, which ensured care was tailored to meet their individual and diverse needs. The values of the service included 'compassionate care',' excellence' and 'hard work' with a vision to provide excellent care and support, to continuously improve the quality of the service and to make people's lives better every day. These values were understood and shared by the whole staff team who reflected the same ethos in the way they cared for people. We saw people were enabled to live a happy fulfilled life, to feel safe, enabled to try new opportunities, achieve goals and reach their potential.

Exceptionally good governance of the service by both the provider and the registered manager benefitted people who lived there because it ensured the quality of care was maintained and enhanced. The registered manager felt strongly supported by the provider and effective governance of the service was visible with the registered manager, regional manager and regional director regularly involved and present in the service. Regular audits were carried out including health and safety, environment, care documentation, staffing levels, training, staff supervision and medication. These audits were well organised and easily accessible. There was a live computer system which was kept up to date so the provider could see how the service was performing at any time.

Information gathered about people and the service was used to aid learning and drive continuous improvement across the service. The provider and registered manager promoted the ethos of honesty,

learning from mistakes and admitted when things had gone wrong. They understood and reflected the requirements of the Duty of Candour. The Duty of Candour is a legal obligation to act in an open and transparent way in relation to care and treatment.

People had their health needs met. People were supported to access a range of social and healthcare services, and arrangements were made for these visits to take place in the home if the person required. The provider and registered manager also sought advice from external agencies to further enhance people's lives and to enable them to grow. They understood the importance of working within a multi-disciplinary team that focused on person centred care. The registered manager and staff had built extremely good working relationships with other agencies such as the specialist mental health teams, learning disability services, local police, and drug and alcohol services. This multi-agency approach, along with a skilled staff team had resulted in positive improvements in relation to people's behaviour, well-being and general health.

People's medicines were stored and managed safely. People could make choices about their diet and were fully involved in the planning of meals and mealtimes. Staff provided people with information about healthy eating options and people with particular health needs were supported to explore and understand information about an appropriate and safe diet.

Staff were well trained and said training was relevant to their role and kept updated. The registered manager was passionate about developing the skills of the team and kept themselves updated with current issues and best practice. Individual staff members were nominated champions in particular areas of care, such as behaviour and diabetic care. They attended training and used their skills and knowledge to support staff and help ensure the whole team had the skills and knowledge needed to provide high quality care.

Management and staff understood their role with regards to the Mental Capacity Act (2005). People's consent was sought before care and support was provided. People were supported to make choices about their care and lifestyle. When larger more significant decisions were needed other people, including advocates, were involved to support the person with the decision-making process.

The provider had a complaints policy in place, which had been produced in a user-friendly format for people to access and understand. The service had received very few complaints since the last inspection, but any received had been clearly documented and dealt with in line with the provider policy. We saw people were confident to raise any day to day concerns by speaking to staff who answered their questions and resolved issues promptly and sensitively where possible. Residents meetings also provided a forum for people to raise any concerns and recent meetings had documented a variety of topics discussed with action plans when needed. A 'grumbles' book was available, which ensured people's voice was heard and small issues dealt with before they developed into bigger problems.

The five questions we ask about services and what we found