Cascade (Wilson House)

Updated 5 March 2019

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 on 30 January 2019. The inspection was announced on the 29 January 2019 because it is a small service and we needed to be sure that somebody would be in.

One inspector and an expert by experience carried out this inspection. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. Their area of expertise was learning disability.

Before the inspection we reviewed information, we held about the service. We reviewed information the provider sent us in the Provider Information Return (PIR). 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 requested feedback from the local authority quality monitoring team, a mental health social worker, a specialist nurse, two clinical psychologists and Healthwatch. Healthwatch are a consumer champion for users of this type of service.

During the inspection we spoke with the registered manager, the group compliance manager, the group education manager and four care staff. We spoke briefly with six people about the service they received. We reviewed documents and records that related to the management of the service. This included, four people’s care records, a range of policies, procedures and guidance used by staff in their role, records of safeguarding, accidents, incidents and complaints, audits and quality assurance reports, three staff member files, checks and risk assessments for the environment and records associated with the management and administration of people’s medicines.

Updated 5 March 2019

This inspection took place on 30 January 2019. The inspection was announced on the 29 January 2019 because it is a small service and we needed to be sure that somebody would be in. At the last inspection the service was rated as Good overall with Outstanding in caring (report published June 2016).

This service provides care and support to people living in two ‘supported living’ settings, so that they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

Cascade Supported Living provides personal care for people with a learning disability and autistic spectrum disorder. 13 people were receiving a service at the time of 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. Registering the Right Support CQC policy.

Not everyone using Cascade Supported Living receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

We were supported during this inspection by a registered 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.

Positive outcomes for people routinely exceeded expectations. Staff worked hard to provide a consistently better quality of life for people by supporting them to develop in areas such as communication, social interaction, education and independence. People spoke highly of the support provided and told us how they had achieved improvements in their own abilities, independence and confidence.

The provider placed a clear emphasis on good governance, and promoted a transparent culture of leadership. The service was routinely challenged by feedback from people, staff and other stakeholders. Quality assurance was robust with an emphasis on learning from mistakes and being open and honest when things go wrong. The provider demonstrated an innovative high level of experience and capability to deliver excellent care; they were extremely knowledgeable and inspired confidence and passion in the staff team. They promoted a culture that was extremely person-centred and inclusive and which provided high-quality care with good outcomes for people.

People were encouraged and supported to take positive risks without unnecessary restrictions, to live meaningful lives. Staff showed an excellent understanding of their roles and responsibilities for keeping people safe from harm. They routinely questioned any areas where risks or ‘near misses’ were evident and implemented innovative solutions to keep people safe. For example, the implementation of ‘Social stories’ were used to embed routine and safety into people’s lives.

People were assured of receiving care and support to develop their daily living skills, independence, goals and aspirations. A holistic approach which included people, their relatives, staff and other health professionals had been adopted in the assessing, planning and delivery of people’s care and support. Care plans were extremely detailed and identified intended agreed outcomes with people. People were supported to monitor and evaluate their progress using a ‘spectrum star’ which consisted of between five and ten distinct areas that are important to the person’s overall quality of life and to the aims of the service.

The provider was creative in seeking people's feedback and people were actively involved in making

decisions about the care that they received. Their opinions were respected and listened to. The service was run very much around the needs of those living there.

Everybody enthused about how consistently kind and caring staff were. The provider worked in close partnership with other health professionals who consistently recorded positive feedback of how the service exceeded ‘normal’ expectations for a supported living service of this kind. The provider had developed strong familiar relationships with people and family members and were described as ‘going above and beyond’ in order for them to live an excellent quality of life.

People were protected from, and had an awareness of what constituted abuse and how to maintain their safety. Staff had received inclusive and comprehensive up to date safeguarding training and systems and processes were in place to support them to routinely raise any concerns for further investigation.

People were supported to take their medicines safely as prescribed. People were supported to take control of their medicines and to understand and reduce the reliance on medicines used to manage behaviour resulting in positive health benefits. Health professionals confirmed people’s reliance on medicines to manage behaviour had reduced because alternative interventions had been agreed and implemented to support people at difficult times.

Staff supported people to meet their needs safely and in a person-centred way. Staff worked with people to plan their care and support them to attain achievable goals and outcomes. People confirmed they received care and support from regular care workers who they knew. We found people were involved in safe recruitment and selection procedures to ensure new staff were suitable and had the appropriate skills, knowledge and compatibility to meet their individual needs.

Consent to care and support was sought in line with legislation and guidance. Staff were confident when working with regards to the Mental Health Act 2005. Restrictive practices were kept to a minimum and reviewed in best interest meetings for their effectiveness. People were supported to make choices, according to any beliefs or personal preferences. Information was communicated in a range of formats that was accessible to everyone regardless of their ability.