The Outstanding assessments were for "Caring" and "Well Lead". Director of Manor Community Deian Glynn, was particularly pleased with the positive reference to membership of C&SW of which he is also a director.
Here are the CQC details for the areas in which they were judged to be outstanding:
The views of people were sought in a way that was informal, relaxed and tailored to their individual needs.
This demonstrated a person centred ethos and creativity and, ensured any barriers to effective communication were overcome.
They used a sensitive approach that respected people's cultural backgrounds and mental health needs. We found during our visit that spending time with people andtalking about things important to them, was an approach they were more familiar and comfortable with and enabled us to assess their experience of the service more effectively than asking more direct questions. Staff supported this and introduced us to everyone individually and explained why we were visiting.
The registered manager listened to people and staff to ensure there were enough staff to meet people's needs. They demonstrated their responsibilities in recognising changing circumstances within the service and used a risk based approach to help ensure that staffing levels and the staff skill mix was effective.
Staff had the knowledge and skills they needed to carry out their roles effectively. They enjoyed training and sharing what they had learnt with colleagues. Staff were supported by the provider and the registered manager at all times. The service complied with the Mental Capacity Act 2005 (MCA) and Deprivation ofLiberty Safeguards (DoLS).
People received a varied nutritious diet, suited to individual preferences and requirements. Mealtimes were flexible and taken in a setting where people chose. Staff took prompt action when people required access to community services for expert treatment or advice. Staff had a good awareness of individuals' needs and treated people in a warm and respectful manner. It was evident that they were committed to the people they supported. The registered manager and staff were knowledgeable about people's lives before they started using the service. Every effort was made to enhance this knowledge so that their life experiences remained meaningful.
People received appropriate care and support because there were effective systems in place to assess, plan, implement, monitor and evaluate people's needs. People were involved throughout these processes. This ensured their needs were clearly identified and the support they received was meaningful and personalised.
Regular monitoring and reviews meant that referrals had been made to appropriate health and social care professionals and where necessary care and support had been changed to accurately reflect people's needs. People experienced a lifestyle that met their individual expectations, capacity and preferences. Everyone involved in this inspection demonstrated a genuine passion for the roles they performed and individual responsibilities. They wanted to ensure that those living at the service felt safe and valued. Staff embraced new initiatives with the support of the registered manager and colleagues. They continued to look at the needs of people who used the service and ways to improve these so that people felt empowered to make positive changes.
The service works in partnership with other organisations to make sure they are following current practice. The organisation is a member of Care and Support West. The provider is also a director of the body and attends various board meetings and meetings regarding the current topics within the care sector. The registered manager is the lead manager of the Bristol Registered Managers Network, facilitated by Care and Support West. The registered manager is also a member of the National Skills Academy. Senior staff attend various workshops and seminars in relation to the care sector that are organised and attended by experts.
Last year the provider attended the Health and Care exhibition which is one of the biggest health and social care exhibitions run in the UK, they have registered to attend again this year. The PIR stated, "There are many speakers at the event and exhibitors. It has been a great way to ensure we keep abreast of the key discussion points, whilst at the same time experiencing and discussing new ways of working".
There were various systems in place to ensure services were reviewed and audited to monitor the quality of the services provided. Regular audits were carried out in the service including health and safety, environment, care documentation, staffing levels, training, staff supervision and medication. Action plans were developed with any improvements/changes that were required.
The registered manager and senior staff knew when notification forms had to be submitted to CQC. These notifications inform CQC of events happening in the service. CQC had received notifications from the provider in the 12 months prior to this inspection. These had all given sufficient detail and were all submitted promptly and appropriately. We used this information to monitor the service and ensure they responded appropriately to keep people safe and meet their responsibilities as a service provider.
Staff had supported some people for many years. People were confident in their surroundings and with each other. We had several opportunities to see how relationships between the registered manager, staff and people was promoted and supported. Conversations were personal and reflected positive, respectful
interaction. You could see there were genuine friendships between staff and people that promoted an inclusive atmosphere. There was a sense of living together as an 'extended family'. Conversations were lively and people were informing staff what they planned to do that day. We heard normal everyday conversations for example, one person said they were having a lie in, someone said they wouldn't be home for lunch and another person said they would be making an appointment with their GP. Some people did not have significant family members. One support worker told us, "I do feel like a surrogate mum to one person and that suits me fine if it means they feel happy and loved".
Advocacy services were also available and had been used in the past. One relative we spoke with told us they were, 'very pleased with everything'. They said, "Staff are very kind and my relative is very happy here, everyone is very approachable and easy to talk with". We looked at the most recent completed questionnaires received from three relatives. There was a section that asked for their views about the care and support people received. It was evident they were 'very satisfied and grateful' and they named staff and thanked them personally for their support. Comments included, "We are very pleased with the service provided", "Great success in dealing with needs admirably, and I am very grateful" and, "We are always welcomed by staff on duty". Scores for all individual questions were rated as 'good' and/or 'excellent'. One relative recently wrote to the home thanking the staff for visiting their daughter during a short stay in hospital. They commented, "You all do a fantastic job here with the residents, it's always a pleasure to visit".
Staff morale was positive and they were enthusiastic about the service they provided. We asked them what they were particularly proud of and what went well. Comments included, "I'm always proud of individual's progress and the sense of achievement for them and for us", "I see very caring staff who support people to follow their dreams", "There is a strong sense of an extended family unit where we do all we can to make people feel special" and, "We respect people's diversity and individuality". Staff saw their role as 'supportive and advisory', whilst respecting that people must 'make their own decisions even if they make mistakes and learn from them'.
Throughout the inspection we saw various examples where acts of kindness and care had a positive impact on people's lives and wellbeing. The registered manager and staff demonstrated a determined, positive commitment to people and would always go that extra mile in order to ensure they felt valued. Staff supported people as equals; their approach was respectful and patient. It was evident that over time staff had built up positive relationships with people that were based on trust and personalisation. They wanted people to feel important and live a life that was meaningful and fulfilling. The registered manager and staff provided us with an extensive background of people's lives prior to living at the home and it was evident they knew people well. This had helped enhance a person centred approach to care and support where people could aspire to achievable goals and aspirations.
The registered manager and staff promoted a delegated support worker role. The registered manager explained how it was essential to match the right member of staff with the right person to ensure the support worker role was meaningful for people. All staff completed a 'staff profile sheet' which helped best match the client to a staff member. They considered personal preferences and interests, age, personalities and experience and the partnering was reviewed to ensure they remained effective. Examples included shared interests in sport, religion and hometowns. One staff member explained that sometimes people 'just clicked' with certain members of staff and were more 'responsive and engaged' with others. One relative we spoke with said their son's support worker was, 'very good with them' and the relative was 'very grateful'. They told us their son's progress was 'very much down to the relationship between the support worker and their son'.
The care and support provided was developed around 'Compassionate Care (Seager 2006)', the concept of which is to focus on creating a secure and psychologically healthy, caring relationship between staff and individuals.
Whilst staff remain professional they show empathy, understanding and compassion in the spirit of a homely environment which gives individuals confidence to take positive risks, become independent and recover, knowing that a safe and caring environment awaits them. There was a real sense of an empowering culture for people who lived at the home. Independence and autonomy was promoted at all times and was at the centre of all care and support people received. It was never assumed that people who moved to the home would stay on a permanent basis. Support pathways were developed with individuals and relevant professionals to support phased progression for the potential to live in an alternative independent community setting. The registered manager and staff recognised individual capabilities and worked on strengthening these.
Two people had recently successfully moved from the home into supported living. This was a testament to the drive, patience and commitment of everyone in the home who had supported them and made this happen. One person wrote to the home and said, "Thank you for letting me live here and for all your warm welcomes. All the staff were very nice, bless you all".
Other examples were shared where people and staff had felt proud of individual successes around independence and being in control. One person had previously found it challenging when managing their own money. They often spent it very quickly and then ran out before their next allowance was due. Staff educated the person about the value of money and the advantages of budgeting and saving. Over time the person had adopted these principles and they had started to save money so they could treat themselves to something nice. This approach had also helped people to appreciate the value of personal effects and how much they had cost.
The ethos of the service was that people should be afforded every opportunity to live a normal life and enjoy those things that everyone has a right to. Ideas and initiatives to support this were constantly thought about and discussed with people and amongst staff. This year people had said they would like the option to consider short breaks or holidays abroad. This was evidenced in the monthly 'house meetings' minutes. To do this they would require passports and no one currently living in the home had one. The registered manager spent a considerable amount of time and dedication supporting individuals to apply and obtain passports. During this process it was identified that some people didn't have the required documents and they had to apply for these in addition. This included birth, marriage or adoption certificates. Although the implications of applying for passports had not been anticipated the registered manager continued their efforts with the applications as promised. They were delighted to share with us that a small group of people had enjoyed a mini cruise this year and plans were being discussed for future trips out of the country. The whole process had been an extensive piece of work. The registered manager and staff should be congratulated on their continued efforts to overcome obstacles and achieve the desired goals for people they supported.
There was a strong, visible person centred culture and people were supported, encouraged and provided with information that helped them to express their views and opinions and make decisions. One example of this was the EU referendum, were people had been helped to understand the choices available and some of the implications. Following which they were supported to cast their vote.
Another person had recently attended a hospital appointment and met with their consultant to discuss the treatment and aftercare they would be receiving for an operation. The registered manager spoke with us about how they helped the person understand the implications and potential risks when having a general anaesthetic and balancing these against the positive results the operation would provide. This approach had increased the person's awareness so they could decide whether to proceed with the treatment or not. During the consultation the registered manager had noticed that the consultant was talking to his patient through the registered manager rather than directly at them. The registered manager pointed this out to the consultant and asked them to speak directly to the person. This was a good example where the ethos of empowerment and promoting equality and people's rights was paramount and supported at all times.
The PIR stated, "Person centred care is not only based on current support needs and wishes but also looks toward the future". This would include choices and preferences around people's wishes should they become ill, require end of life care in addition to what arrangements they would like when they die. The registered manager spoke with us about how they helped to raise awareness about these decisions and how people had been supported; this was also confirmed in people's care records. There were examples where people had been assisted respectfully and sensitively. This included one person who had been recently supported when making decisions about whether to receive treatments following a terminal diagnosis or whether to consider alternative palliative options of care provision. Two people had also recently expressed a wish to make plans for their funeral and they had chosen what they wanted to wear, the hymns they wanted and, who they would like to perform a reading. Another person was being supported to write their last will and testament.
Families and friends were kept informed and involved with the service by producing quarterly newsletters. These were available in the home and sent to family members especially to those who were unable to visit regularly. The newsletter provided information about significant events with photographs and future plans for the coming months. The introduction of the quarterly news letters in 2015 had received positive comments from people who used the service. These were being further developed to help improve existing satisfactory methods of communication with 'residents, family, friends and staff'. The PIR stated, 'The newsletters will improve communication around key policies and highlight how everyone can be further involved in the running of the home and support community events'. Personal invites were sent to families and friends so they could join in any celebrations or events.