Aspley House

At the last inspection, the service was rated Good. At this inspection we found the service was Outstanding. There was a registered manager at the service who was supported by a deputy manager. 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.

People could become anxious and display behaviours which could have a detrimental effect on themselves and people around them. Without the right support these behaviours would occur frequently. Some people had previously had experiences which had made them feel unsafe and their lifestyles had been restrictive. Staff supported people in a way that minimised risks and protected them from harm. People were supported to have maximum choice and control of their lives and staff supported people in the least restrictive way possible; the policies and systems in the service supported this.

The providers had fully embraced the principles of Positive Behavioural Support (PBS). PBS is recognised in the UK as the best way of supporting people who display, or are at risk of displaying, behaviour which challenges.. The providers had resourced and modelled people's care in accordance with current PBS best practice principles. The provider's philosophy focussed on using PBS alongside person centred planning (PCP) to enhance people's lives and expand their opportunities.

People were supported by staff who had been recruited safely and staffing levels were based on people's needs and activities. People were involved in the recruitment process in a variety of ways. The provider had a comprehensive training and support system which enabled staff to gain the specialist skills needed to fulfil their role. Staff were involved in advocating for people and spoke with pride about what people had achieved. Staff supported people with kindness and compassion using their knowledge of people to provide frequent gentle interactions that prevented people from becoming anxious or distressed. People had limited verbal communication skills and staff used a range of communication tools including Makaton and picture cards to support people to express themselves.

The service had fostered positive working relationships with health and social care professionals which led to joint working to expand people's communication skills and identify new ways for people to access health care. People were involved in planning and preparing their own meals and trying a wider range of meals.

People were involved in planning their own care and care plans reflected their needs and wishes. Staff had the guidance required to meet people's needs and support them through incidents of challenging behaviour

whilst continuing to develop their independence. People had been supported to consider and record their wishes for the end of their life. There was a 'no blame' culture throughout the service, which focussed on opportunities for learning and improvement. Audits of the service were specifically designed to recognise the specialist nature of the support provided and to establish new ways to monitor the quality of the support people received.

People were supported to achieve things that had previously been thought of as 'impossible.' For example, planning a holiday abroad or selecting their own snacks at a local shop. People took part in a variety of activities and were continually encouraged to try new things. People told us about visiting the local cinema and theatre with their friends. The PCP team held regular forums where people from all of the provider's services could meet to give their views and shape the service moving forward. Training courses were provided for people, alongside practical independent living skills, they could also access courses about relationships, sexuality and sexual health, keeping safe and bereavement.

The service supported people to build relationships with neighbours and local businesses to promote understanding and minimise discrimination. Staff understood their responsibilities in relation to keeping people safe from harm. Risks to the environment were identified and mitigated. People were supported to have their medicines in the way they preferred by trained and competent staff.

The providers and registered managers provided consistent and positive support to the service. There was a sense of equality between people and staff in all roles, and a sense of pride in the quality of care people were receiving and the positive outcomes they had achieved as a result.

The five questions we ask about services and what we found