Chitty Barn

Updated 17 March 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on19 December 2017 and was unannounced. The inspection was carried out by one inspector.

Before the inspection we looked at information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We looked at previous inspection reports and notifications we had received. Notifications are information we receive from the service when significant events happen, like a serious injury.

During the inspection we spent time with people who live at the service. The registered manager was not available at the service. We spoke with the service manager, the shift leaders and staff. After the inspection we received feedback from two health and social care professionals. We looked at two people’s care plans and the associated risk assessments and guidance. We looked at a range of other records including three staff recruitment files, the staff induction records, training and supervision schedules, staff rotas, medicines records and quality assurance surveys and audits.

Updated 17 March 2018

Chitty Barn 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. The service is registered for three people with complex learning disabilities and who, at times, may present behaviours which can challenge. The service is a bungalow in the centre of Dover. The front door of the home leads directly into the living room. There are three bedrooms, a kitchen, bathroom and separate laundry room. Outdoor space is limited as there is no back garden and a paved forecourt at the front of the service. At the time of the inspection two people were living at the service.

At the last inspection, the service was rated Good. At this inspection we found in some areas the service remained Good whilst in others the service was Outstanding.

Chitty Barn 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 and citizen.

People living at Chitty Barn had complex needs, which included restrictive routines which impacted on their daily lives which could at times last for many hours. With the help of health care professionals, individual behaviour training sessions and consistent staffing this behaviour had been reduced and people were now able to access the community, and visit their local GP.

At times people could become anxious which led to their behaviour becoming challenging. Without the correct support this could have a negative effect on themselves and others. The service was working with health care professionals to support people in the least restrictive ways as possible.

Staff were passionate about how to uphold people’s rights and supporting them to have control over their lives. They demonstrated awareness about people having the same opportunities as themselves to lead fulfilling lives of their choice.

The provider had a positive approach to support people to reach their full potential, whilst reducing risks and keeping them safe. Staff had a good understanding of how to protect people from harm whilst upholding their rights to make choices and take risks to enhance their lives and seek new adventures.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice

People said they felt safe living at Chitty Barn. Staff had completed training on how to keep people safe and understood their responsibility to report any incidents to the management. Robust systems were in place to make sure people’s finances were protected.

Checks on the premises were in place, including cleaning schedules, to reduce the risk of infection and keep the premises clean. Repairs to the premises were recorded and acted on promptly to make sure the premises were safe. The design of the premises was based around a family home and. adaptations had been made to some of the furniture to reduce the risk of people harming themselves and others if they displayed behaviour that could be challenging.

Accidents and incidents were recorded and sent electronically to the management team for further assessment. This enabled them to look for patterns and trends, take any further appropriate action and learn from incidents when things went wrong.

People received their medicines from trained competent staff. Medicine records were clear, checked and in good order to ensure people received their medicines safely. People’s medicine was reviewed regularly to make sure they were receiving the right medicines they needed to keep well.

When people came to live at the service a thorough care needs assessments process was in place to ensure their needs would be met and they would be happy living with the other people at the service. However, no one had come to live at the service since the previous inspection.

People received their care and support from trained, skilled staff who had received ongoing training and development. There was enough staff on duty at the time of the inspection. Staffing levels ensured that people received their one to one support which was based on people’s needs and activities. Staff had been recruited safely and introduced to people before they came to work at the service.

People were encouraged to eat their meals when they wanted to around their daily routines. They were involved in the menu planning and received guidance of how to maintain a healthy weight whilst still enjoying treats and different foods. People were treated with dignity and respect and their independence promoted at all times.

Staff worked with health care professionals to support people with their health care needs. When people were unwell they were encouraged to visit their GP or attend specialist services so they could get the support they needed.

People told us the staff were kind and caring. Staff were passionate about upholding people's equality and diversity and ensured they were treated with respect. They knew people’s rights and how to make sure people were not discriminated against. They did not see people’s complex needs as a barrier but looked for ways of supporting them to live their lives positively and in line with their choices and preferences.

Staff recognised when people needed additional support to make important decisions and one person was accessing advocacy services to help them make an important decision about their care.

People’s care plans were personalised with clear guidelines of how to support them with their emotional and physical needs in line with their choices and preferences. The plans were reviewed and updated so that all staff and health care professionals were able to track people’s progress and make necessary changes to continuously improve their care.

People were encouraged to take part in activities of their choice and staff continually looked for ways for people to flourish such as work experience in places where they had an interest. Staff actively supported people to look for opportunities and reduce the risks of discrimination, such as being involved in the local football club, accessing work experience and enjoying a social life.

Staff had received support through one to one meetings and their training and development needs were discussed at an annual appraisal. Senior managers had also held additional supervisions sessions after the equality and diversity training to ensure staff embedded this practice.

People were being supported to form relationships and understand personal boundaries. Staff looked for ways of encouraging people to develop and reach their full potential and recognised when people needed to gain further independence and consider moving into supported living services. .

Staff worked together to ensure the continuous improvement of the service. They told us that the people were at the heart of the service and they strived to improve their daily lives. Staff responded to people promptly and positively, ensuring they felt valued and empowered to make decisions of what they wanted to do.

The service was extremely well led with the ethos of being open and transparent. Staff openly discussed how they could do better and how they were supported and mentored by the service manager to improve their practice. They told us about how managers talked with and involved health care professionals for feedback about staff practice and how they could support and understand people better. The staff worked as a team and morale was high with an emphasis on team work and mutual respect.

Checks and audits of the quality of the service were made by staff and senior management team and the environment was checked daily and weekly to ensure the premises were safe.

The organisation had a senior team of experienced and qualified professionals who worked with other organisations to keep up with current practice and new ways of working. They were innovative and always looking to promote new ideas and services for people to access and worked with the local authority to promote people’s individuality and lifestyles.

Staff told us that everyone in the service was valued, people the staff and relatives. The staff were proud to work for the organisation which had the right values to enrich people’s lives. They said it was a good place to work as the ethos of the service was family orientated and that included the staff, they told us that everyone was treated the same. They were proud to say that even the head of the organisation knows every person they provide a service to.

The provider kept up to date with current practice and were always looking for ideas from everyone involved in the service. Staff told us they were listened to and management acted on what they said. Staff were committed to the visions and values of the service and had a good understanding of the best practice guidelines and promoted people’s equality, diversity and human rights.

Services that provide health and social care to people are required to inform the CQC, of important events that happen in the service like a serious injury or deprivation of liberty safeguards authorisation. This is so we can check that appropriate action had been taken. We had been notified of significant events at the service.

Services are required to prominently display their CQC performance rating. The provider had displayed the rating at the service and on their website.