Insight SBS ltd 201 London Road

Insight SBS ltd 201 London Road is a care home providing support for up to three people with learning disabilities in one adapted building. There were three people living at the service at the time of the inspection. Insight SBS Ltd 201 London Road and Aspley House work together as one service but are registered separately. This means that both services are inspected and reported on separately. The services are across the road from each other. The registered manager and staff work at both services and the main office of the two services is at Aspley House.

Insight SBS ltd 201 London Road is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At the last inspection on 24 November 2015, the service was rated Good. At this inspection we found the service was Outstanding.

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, relatives and health and social care professionals were consistently extremely positive about the service. Relatives told us that people had less incidents of behaviour that challenged and had seen improvements in people's health. People told us that they were more independent and happier. One person said, "I am really happy now that I have moved in here, I feel more in control of my life". The registered manager told us that since the last inspection they had embeded new ways of working and people had more choice and control over their lives.

Some people at the service could display behaviours that had a detrimental effect on them and the people around them. Staff responded exceptionally well to people who are at risk of displaying behaviours that may harm themselves or others. There was a positive behaviour support team which ensured that people had the help they needed to identify and manage the causes of these behaviours and reduce their occurrence. People and staff were supported to maintain a positive relationship after an incident of behaviour that challenged.

The provider had adopted a nationally recognised comprehensive training system to support people with behaviours. This system enabled staff to gain the skills needed to support people with behaviour that challenged in an effective way. There was a focus on learning and development and supporting staff to meet their potential. Staffing was tailored to people's individual care and behavioural needs through assessment,

planning and best practice. This also ensured that there were sufficient numbers of staff to meet people's needs and support people to live meaningful lives. Staff training had been consistently updated and staff had the skills and knowledge they needed to support people with learning disabilities. Staff had regular supervision meetings and annual appraisals and told us that they felt happy in their roles and well supported.

People were involved in the recruitment process in a meaningful way and they had an influence on the outcome of staff appointments. People had been supported to teach other people about the recruitment process and then they too became involved in staff recruitment. This contributed to new staff being suitable for people's needs as well as them being recruited safely as pre-employment checks were carried out.

People were supported to enjoy a meaningful lifestyle and restrictions on their freedom were minimised. There was a person centred planning coordinator dedicated to ensuring that there was a personalised approach to assessing and addressing people's needs. People's needs were continually holistically assessed and support plans were frequently updated and monitored to ensure that they remained up to date and accurate. People were continually involved in decisions about their support and support was built around the person and adapted to suit them. People are supported to have maximum choice and control of their lives. Staff planned how they could support people in the least restrictive way possible. There were policies and systems in the service support this practice. Staff assessed and minimised risks to people and risks were managed in the least restrictive way. People were involved in planning how risks were managed through meetings with the provider, the person centred coordinator and positive behaviour support staff. Staff were aware of people's decisions and respected their choices and had the guidance they needed to support people effectively.

Since moving in to the service people had become more independent and have achieved goals that they previously thought were unobtainable. Staff supported people to become more independent with aspects of daily living. People were learning how to shop and cook for themselves, use public transport and go out in to the community. People were supported to increase their engagement in activities of daily living. People had control over their diet and chose what they ate and when. People were encouraged to eat healthily and were provided with the information they needed to help them make their own healthy life choices.

People took part in a variety of activities and were supported to try new things. Staff continually assessed where they could reduce the support people needed to engage in activities to enable them to be more independent.

People were supported by staff to access the health care they needed to maintain and improve their health and well-being. Peoples' health and long-term conditions were well managed and people had seen their health improve. When people accessed other services such the GP they were supported by the service staff and there was continuity of care.

People's privacy was respected and they were supported to lead dignified lives. Staff were kind and treated people with respect. Staff recognised when people were upset or distressed and responded to this. People were provided with emotional support in a way that suited them. Staff knew people well and had developed effective ways to support people to communicate about issues they felt anxious discussing. People were supported to maintain positive relationships with those who were important to them, meet new people and build new relationships. People were well known in the community.

There was a complaints system in place if people or their relatives wished to complain. People were encouraged to express their views through a variety of ways. There were systems in place to gather feedback

from staff, professionals and relatives. Feedback was used to improve the service. Relatives told us that they felt well informed and that communication was positive and proactive. People were supported to discuss their wishes and preferences for the end of their lives.

The environment met people's individual needs and was personalised to reflect the people that lived there. The service was clean and well maintained. Staff were aware of infection control and the appropriate actions had been taken to protect people.

People, staff, relatives and health and social care professionals told us the service was well-led. The provider had a clear vision and values for the service which staff understood, shared and acted in accordance with. The provider visited the service weekly and attended meetings with people every two weeks. Staff and the registered manager understood their roles and responsibilities. The service had good working relationships with health and social care professionals and worked jointly with them to plan peoples support.

The registered manager and positive behaviour support team regularly audited the service to identify where improvements were needed. Audits thoroughly covered all aspects of the service provided. Findings from audits were analysed in depth and was used to monitor the effectiveness of the support people received. The service regularly reviewed and challenged their own practice and sought new ways to support people to improve their lives. When things went wrong lessons were learnt, learning was shared and improvements were made. Staff understood their responsibilities to raise concerns and incidents were recorded, thoroughly investigated and acted upon. Lessons learnt were shared and trends were analysed.

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.

There continued to be systems in place to keep people safe and to protect people from potential abuse. Staff had undertaken training in safeguarding and understood how to identify and report concerns. Medicines were managed safely and people received their medicines on time and when they needed them. People were supported and encouraged to manage their own medication where appropriate and in a safe way.

People had been supported to consider and record their personal wishes for the end of their life.

The five questions we ask about services and what we found