Archived: Harwich House

Harwich House is a residential care home that provides support for up to nine people who are living with a learning disability or autism. The service is based in Littlehampton, West Sussex and is provided by a national provider, Aitch Care Homes (London) Limited.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with a learning disability and/or autism to live meaningful lives that include control, choice and independence. People using the service received planned and co-ordinated person-centred support that was appropriate and inclusive for them.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to nine people. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercoms, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were discouraged from wearing anything that suggested they were care staff when coming and going with people. At the time of inspection seven people were using the service.

People’s experience of using this service and what we found

Risks to people’s safety had been assessed yet there were insufficient measures used to ensure the guidance provided to staff had been followed. Two people had not been supported in accordance with their assessed needs in relation to modified diets and fluids as well as a known health risk. Medicines management was not always safe.

There was a lack of oversight to assure the registered manager and provider that people were receiving safe and effective care that met their assessed needs. Issues found as a result of the inspection had not been identified by the quality assurance processes used.

Staff had received training specific to people’s needs yet issues found at the inspection raised concerns about the quality and effectiveness of training and the understanding of some staff. Staff were provided with clear guidance based on people’s assessed needs yet had not always implemented this in practice.

People’s goals and aspirations had not been fully considered. We have made recommendations that the registered manager and provider seeks advice and guidance from a reputable source in relation to ensuring people's needs and aspirations are appropriately considered and planned for.

People were provided with choice about what they had to eat, and drink and were observed enjoying the food that was provided. Changes to the menus had been made to ensure people received a balanced diet to support their health and well-being. People’s needs had been considered in the adaptation and design of the building. Changes had been made to communal spaces to ensure there were areas for people to use should they prefer time away from others.

Without exception, relatives told us staff were kind and caring. People were comfortable in the presence of staff and were observed holding staff’s hands and showing affection. Staff responded appropriately, reminding people of boundaries whilst showing people they cared. People’s independence was encouraged. People were asked their opinions and were supported to retain and develop skills such as gathering laundry. One person sometimes supported staff when preparing food or drinks. People were treated with respect and their privacy and dignity was maintained.

Staff were mindful of the importance of supporting people to enjoy new experiences. People were supported to play an active part in the local community and enjoyed trips to local areas, cafes, shops and places of interest. People and their relatives were able to share their concerns and make complaints if they were unhappy with any aspect of care. Relatives told us when they had raised concerns these had been listened to, acted on and changes made as a result.

The registered manager supported staff to implement the provider’s values in practice. People, relatives and healthcare professionals worked together to ensure people were supported in their best interests and valued as individuals. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems supported this practice.

There were enough staff to meet people’s assessed needs. Lessons had been learned from incidents and accidents and practice was changed to ensure people’s safety and well-being. People were protected from the spread of infection.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People’s support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection

The last rating for this home was Good (Published 14 September 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified two breaches in relation to oversight of risks and safety and the leadership and management of the service. Please see the action we have told the provider to take at the end of this report.

Follow-up

We will continue to monitor the intelligence we receive about this service. We will request an action plan from the registered manager to understand what they will do to improve the standards of safety and governance. We plan to inspect in line with our re-inspection programme. If we receive any concerning information we may inspect sooner.

Harwich House is a large house and offers residential care without nursing. There were shared bathrooms, a communal kitchen and a communal lounge and dining area.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

Why the service is rated good:

Throughout the inspection we were assisted by the registered manager. The service had a registered manager in post. 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.

Staff and relatives all described the management and leadership in exceptional terms. Staff talked positively about their jobs and their shared commitment to people achieving their best. Care was based on best practice and the staff team highly motivated to achieve excellent care and good outcomes for people. The provider and registered manager were proactive and determined, they ensured effective and close monitoring of all aspects of the service to ensure ongoing improvement across all areas.

On the day of the inspection staff within the service were relaxed, there was a calm and friendly atmosphere. Everybody had a clear role within the service. Information we requested was supplied promptly, records were organised, clear, easy to follow and comprehensive.

People had limited verbal communication but we observed they felt comfortable with staff. Care records were personalised and gave people as much control over aspects of their lives as possible. Staff responded quickly to people’s change in needs and were sensitive to their moods. People or where appropriate those who mattered to them, were involved in regularly reviewing their needs and how they would like to be supported. People’s preferences were identified, known by staff and respected.

Staff put people at the heart of their work; they exhibited a kind and compassionate attitude towards people. Strong relationships had been developed and practice was person focused and not task led. Staff had appreciation of how to respect people’s individual needs around their privacy and dignity and were conscious of behaviours people might display which could compromise their dignity.

People’s risks were managed well and monitored. People were promoted to live full and active lives. Staff were highly motivated and creative in finding ways to overcome obstacles that restricted people’s independence.

People had their medicines managed safely. People received their medicines as prescribed, received them on time and understood what they were for. People were supported to maintain good health through regular access to health and social care professionals, such as GPs, speech and language therapists and the local learning disability team.

People we observed were as safe as possible. The environment was uncluttered and clear for people to move freely around the home, equipment was well maintained and outings to external venues risk assessed. Staff discreetly monitored people’s behaviour and interactions to ensure the safety of all the people and staff at the service. All staff had undertaken training on safeguarding vulnerable adults from abuse, they displayed good knowledge on how to report any concerns and described what action they would take to protect people against harm. Staff told us they felt confident any incidents or allegations would be fully investigated.

People were supported by staff that confidently made use of their knowledge of the Mental Capacity Act (2005), to make sure people were involved in decisions about their care and their human and legal rights were respected. Families were involved in decision making and advocacy services were used when required. The service followed the laws and processes in place which protect people’s human rights and liberty. Deprivation of Liberty Safeguards (DoLS) were understood by the registered manager and staff. Those who had restrictions in place to had the required legal authorisations.

People were supported by staff teams that had received a comprehensive induction programme, tailored training and ongoing support that reflected individual’s needs. Training included epilepsy, first aid, diet and nutrition and equality and diversity.

People were protected by the service’s safe recruitment practices. Staff underwent the necessary checks which determined they were suitable to work with vulnerable adults, before they started their employment. The provider was committed to employing people with the right skills, values and attitude to work with vulnerable people.

We reviewed complaints the service had received and these had been dealt with promptly by the registered manager in line with the provider’s policy and procedure. Easy read, pictorial formats were available for people who were unable to verbally communicate their concerns.

There were robust quality assurance systems in place. Feedback from relatives and professionals was noted, listened to and action taken. Detailed recording of incidents were undertaken and monitoring of people’s behaviour to reduce the likelihood of a reoccurrence. These were analysed from trends. Learning from incidents and concerns raised was used to help drive improvements to people and the service and ensure positive progress was made in the delivery of care and support provided by the service.

We were not able to speak with some of the people who use the service due to their disabilities. Instead we spent time observing the interactions between staff and people. We found this interaction to be positive and friendly. Staff spent time with people

engaging in play and providing reassurance and support when people requested help.

We spoke with one person who told us that they were very happy living in the service and had no concerns. They spoke positively about their activities and the staff who support them.

We spoke with three staff members during this inspection they demonstrated a good knowledge of the needs of the people they supported. The staff we spoke with told us that they had a good level of training including an induction and they were encouraged to develop their skills. They also told us that they felt supported in their work and had regular supervision.

We found that the provider had addressed the concerns raised at the last inspection of this service. Training and developing staff was effective. The systems for recruiting staff had been improved to demonstrate people were protected. The service reported notifiable incidents to the commission as required.

We spoke with two people who told us that they were very happy living in the service and had no concerns. They spoke positively about their activities and the staff who support them. We also spoke with family members who were visiting at the time of our inspection. They told us that they were happy with the service and the way their family member was cared for.

Staff feedback was mixed. The staff we spoke with told us that they had a good level of training and they were encouraged to develop their skills. They also told us that they did not always feel supported in their work. We found that whilst the provider had a system for training and developing staff it was not always effective. We also found the systems for recruiting staff were not robust enough to demonstrate people were protected.