Hannahwood Transitions

About the service

Hannahwood Transitions is a residential care service that provides personal care and support for up to 23 adults with learning difficulties and or autism. At the time of our inspection 15 people were living at the service.

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

Right Support: 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 in the service supported this practice. The model of care at Hannahwood Transitions maximised people's choice, control and independence. Staff were committed to supporting people in line with their preferences and supported people to receive their medicines safely and as prescribed. People were enabled to access health and social care support in the community.

Right Care: Risks associated with people's care were assessed and included in their support plans. Care records guided staff on the action they were to take to mitigate risks to people and themselves.

Right Culture: The registered manager and staff were clear about their aim of providing person-centred care. They had a good knowledge of the service and understood the needs of people they supported. Staff supported people to lead confident, inclusive and empowered lives.

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 service was good (04 August 2017).

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hannahwood Transitions on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The service is registered to provide support with accommodation and nursing care for a maximum of 23 people within five purpose built bungalows. Hannahwood Transitions is located on the same site as Dame Hannah Rogers’ school and is run by the Dame Hannah Rogers Trust which is a charity organisation supporting children and adults with physical and learning disabilities.

The home had 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We carried out a previous inspection of this service on 13 October 2014 where we rated the service as ‘good’.

This inspection took place on 22 and 28 February 2017 and was unannounced for the first day of the inspection. At the time of our inspection there were 13 people living in Hannahwood Transitions. The service met people’s different needs by offering full time residential care, including some nursing care, temporary respite care and day services. People using the services had a range of needs. All the young adults who were living at Hannahwood Transitions at the time of our inspection had learning disabilities and complex physical disabilities. Some people required more significant support than others and almost all people were wheelchair users. People living at the service were widely referred to by relatives, staff and the registered manager as ‘young adults’ and we have therefore used this on a number of occasions through the report.

Strong values underpinned the work carried out at Hannahwood Transition. The Trust’s mission statement was “Our mission is to empower, advocate and enrich the lives of children and adults with disabilities”. Their core values included “Providing education, training, advocacy, work opportunities, care and other support services for children, young people and adults in needs, their families, carers and associated professionals”.

Some comments made by relatives included “It couldn’t be any better” and “Dame Hannah Rogers is an amazing place for young adult with complex needs, (Name of loved one)'s life has just taken off since (they) went to live there, (they) absolutely love all the opportunities, the great staff & the bungalow & other young people” and “As a parent this is a wonderful comfort to know that your child is cared & looked after as you would do yourself is a peace of mind one can only imagine”.

The service achieved these values through the constant striving for excellence and improvement, through continually seeking people’s views and enabling people to have happy lives filled with activities and the promoting of skills development. The service had cultivated a warm, welcoming and inclusive culture where people and staff felt encouraged to express themselves and share their views. All levels of staff focussed on delivering a clear vision of working alongside people to enrich their lives.

The Trust worked hard to create strong links with the local community in order to increase awareness and integration. The Trust held strong values relating to providing people with disabilities with as many opportunities as possible in order to improve their lives. For example, they had identified a lack of opportunities in relation to the education of young adults with physical and learning disabilities so had worked with the head teacher of the school on site to design a teaching package bespoke to these people’s needs. This package was available for people who had either finished the available college courses or who were not accessing them. This enabled people to continue in education, challenge themselves intellectually, learn new skills and improve on existing skills. The package was named ‘Hannah’s Living Learning and Moving on Education Provision’ and had been accredited by Asdan Personal Project Programme which was a Curriculum Development Organisation and Awarding Body. This package explored key issues for people living with learning and physical disabilities and enabled people to broaden and inform their adult view on life. For example, people undertook lessons in their rights and responsibilities in the world, democracy, family, the environment and the world of work. People highly enjoyed undertaking this package and had made strong community links through it. For example, they had worked with a local food bank in order to support families and children with little extras at Christmas and Easter. This had been hugely successful and had resulted in press coverage for the learning group and their work.

Dame Hannah Rogers Trust used innovative methods to ensure people’s needs were met when at the service, but also within the wider community. One of the mission statements of the Trust was to improve public knowledge and understanding about disability. People and staff were encouraged to join and influence a number of community programmes in order to ensure people’s needs were understood and met wherever they were. For example, one of the occupational therapists for the service, alongside a person who lived at the service, had joined the sustainable transportation group. The person had been supported to speak at a meeting about the limitations of travelling around the local area of Ivybridge with a wheelchair. As a result the council widened a number of pavements and put in more crossing points for wheelchairs. This hugely benefited people who used the service as well as any other people who may have disabilities who lived in or visited the area.

Every person, relative and healthcare professional we spoke with expressed how impressed they were with the exceptionally caring nature of the staff and their attitudes. They all spoke of the staff with high admiration and praised them for the caring ways in which they supported people. Comments from people included “It’s almost like going out with your friends. They’re lovely, really really lovely”. Comments from relatives included “The staff are so caring” and “We are so impressed with the kind, caring, young and vibrant staff”. Staff told us that being caring and kind was a fundamental requirement of their job and was their focus. During our inspection we saw positive and caring interactions between people and staff. Staff knew people’s needs, preferences, likes and dislikes and spoke about people with respect and admiration.

The Trust and Hannahwood Transitions worked hard to ensure people felt empowered and involved in all aspects of their care. The service was continually working towards improving the service and making it more person centred. They had recently introduced a number of projects, procedures, forms and meetings focussed on gaining people’s views about the service. People were also involved in the recruitment of staff and creating a monthly newsletter which celebrated people’s interests and achievements. A strong focus was on improving people’s skills, enabling their independence and empowering them to have a voice. People were supported to understand and make decisions through the use of different communication methods and devises.

Staff knew how to recognise possible signs of abuse which also helped protect people. Staff knew what signs to look out for and the procedures to follow should they need to report concerns. Safeguarding information and contact numbers for the relevant bodies were accessible. Staff told us they felt comfortable raising concerns.

People were protected from risks relating to their health, mobility, medicines, nutrition and behaviours. Staff had assessed individual risks to people and had taken action to seek guidance and minimise identified risks. Where accidents and incidents had taken place, these had been reviewed and action had been taken to reduce the risks of reoccurrence. Staff supported people to take their medicines safely and as prescribed by their doctor.

Recruitment procedures were in place to help ensure only people of good character were employed by the home. Staff underwent Disclosure and Barring Service (police record) checks before they started work in order to ensure they were suitable to work with people who were potentially vulnerable.

Staffing numbers at the service were sufficient to meet people’s needs and provide them with the care and support they required. Staff had the competencies and information they required in order to meet people’s needs. Staff received thorough and ongoing training as well as regular supervision and appraisal. The service had a strong focus on investing in staff and encouraging them to develop in their careers. Staff were provided with and encouraged to undertake further training in areas which interested them. This helped ensure each staff member was able to reach and sustain excellent standards of care for people and also ensured people who lived in the service were supported by staff who were continually enabled to learn, progress and specialise in order to help them in their daily lives.

Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and put it into practice. Where people had been unable to make a particular decision at a particular time, their capacity had been assessed and best interests’ decisions had taken place and had been recorded. Where people were being deprived of their liberty for their own safety the registered manager had made Deprivation of Liberty Safeguard (DoLS) applications to the local authority.

People were supported to have enough to eat and drink in ways that met their needs and preferences. People were supported to make choices about what

We also undertook this inspection to look at safeguarding concerns raised by OFSTED in relation to the children's service, which is also part of the Dame Hannah Rogers Trust and situated on the same site as the adult service ( Newberry and Gilly's). OFSTED regulate and inspect residential and educational services for children.

We also undertook this inspection to answer five key questions; is the service safe, caring, effective, responsive and well led?

Two adult social care inspectors carried out this inspection. A pharmacist Inspector attended for one day of the inspection and looked at medication procedures in the service. The Pharmacist also looked at concerns from the previous inspection and how these had been addressed.

The people living at Newberry and Gilley's required a high level of support from the staff team. Most people being supported had limited verbal communication therefore it was difficult for people to tell us about their experiences of the service. The service consisted of five separate bungalows. Two of the bungalows were used specifically for people receiving short term respite care. The other three bungalows supported people on a full time basis. During the inspection we spent time in the bungalows, speaking to staff and observing the care being provided. We also met and spoke with the Registered Manager, deputy manager and Director of care for the service.

Is the service safe?

People we met looked happy in their surroundings and had clearly built up trusting and positive relationships with the people supporting them.

Systems were in place within the service to ensure that medication was managed and administered in a way that was appropriate and safe.

Staffing levels had been reviewed due to recent safeguarding concerns within the service. Records and staff we spoke with confirmed that staffing levels were appropriate to meet people's needs and to keep them safe.

Behaviour management plans had not been completed to ensure that episodes of behaviour were managed in a way that was appropriate and safe.

Records we looked at did not include information about the risk to people in the event of a fire or the plans to evacuate and protect people should a fire break out within the service.

We spoke with staff and looked at the training records during our inspection. We found that staff did not have sufficient training and skills to enable them to deliver care and treatment to people safely and to a sufficient standard.

The provider had not responded appropriately to safeguarding concerns raised within the service. Some of the quality monitoring systems in the service, particularly in relation to checks on equipment and staff training had not been reviewed in light of these recent safeguarding concerns.

Is the service effective?

It was clear from what we saw and by speaking with staff that they understood people's needs and knew them well.

Support plans were in the process of being developed to include specific information about how people chose and preferred to be supported.

We saw that regular discussions took place about people who used the service and annual reviews were held with all relevant agencies.

We were told that senior staff regularly checked people's support plans and any changes were recorded within daily communication books. However, it was not evident that the service had a formal review process to regularly review and up-date peoples support arrangements.

Is the service caring?

During the inspection we spoke with staff and observed some of the care being provided. We observed that people looked happy and relaxed in their environment. We saw that people laughed and smiled when staff spoke and interacted with them. We saw that some people used electronic equipment to assist with their communication. Staff providing support were familiar with this equipment and people's different communication methods. One staff member supported an individual to communicate with the inspector. The person used their communication aid to tell us that they were 'ok, thank -you'.

We observed staff asking people if they were comfortable and checking if people were happy with the care being provided.

Is the service responsive?

We saw that changes were being made to support plans, which would take into account people's preferences and choices about how care would be delivered.

We saw that staff were aware of people's communication methods and were able to use this knowledge to respond promptly to people's needs and requests.

We saw that people's health needs were clearly documented and met by the service. People who used the service had access to specialist assessment and support provided by the organisation. This included access to physiotherapy, occupational therapy and speech and language services. Information about visits to and from healthcare professionals had been recorded as part of people's healthcare records. A registered nurse was available within the service at all times and a local GP undertook a surgery at the service each week.

Is the service well led?

We spoke with the Registered Manager about recent safeguarding concerns within the service. We were told that staffing levels and staff support had been reviewed and that these arrangements had been considered sufficient and appropriate to keep people safe and meet their needs. The Registered Manager and Deputy Manager told us that they met with staff regularly and undertook spot checks within each bungalow to ensure that people's support needs were being appropriately met.

We saw that, since the last inspection, a deputy manager had been appointed to the service. The Registered Manager said that this appointment had had a positive effect on the service and had provided additional support for the staff team. One staff member we spoke to said 'The deputy manager is good, and moving changes forward quickly'.

People were not protected from the risks of inappropriate or unsafe care because quality monitoring procedures within the service were not sufficient. Gaps in monitoring of equipment and staff training had not been picked up as part of the home's quality monitoring procedures.

Staff we spoke to understood that people needed to be involved in decisions about their care. Records confirmed that when people lacked the capacity to make decisions the service made appropriate arrangements to ensure that people's rights and best interests were taken into account and protected.

We saw that people appeared happy and relaxed within their environment. People were supported by a skilled and motivated staff team to develop their skills and to access a range of social and educational opportunities.

Staff we spoke to felt well supported by their colleagues, senior staff and management. Opportunities were available for staff to discuss the needs of people they supported as well as their particular job role and training requirements.

Some of the arrangements for handling, administering and recording medications did not protect people who used the service.

Some of the records we looked at were poorly organised and did not in all cases provide staff with clear, up to date and detailed information about people's needs.