39 Hawthorne Grove

39 Hawthorne Grove is a care home for people living with a learning disability and/or autism. It provides personal care to three people.

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 learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

People were protected from potential risks of abuse and harm by staff who had been trained and knew how to report any concerns.

People had a variety of risk assessments which identified areas of risk and gave guidance to staff on how to minimise those risks.

Medicines were administered, stored and managed safely.

Staff were recruited safely and told us they had good support from the registered manager. They had regular one to one supervision and an annual appraisal. The registered manager operated an open door policy and staff felt very able to approach them with any issue.

People’s needs were assessed by a multi-disciplinary team of health and social care professionals. Care plans were developed using person centred language and detailed individual needs, preferences and methods of communication.

We observed and we were told staff were kind caring and compassionate and delivered dignified and respectful care to people. 39 Hawthorne Grove was homely calm and relaxed. People appeared to be happy and content.

The service had a new registered manager who had made significant improvements to communication, record keeping and the quality of people’s lives. We received very good feedback about their management style and competency.

The service had robust quality assurance and audits in place to monitor the quality of the service, senior management also had good oversight.

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 interest; the policies and systems in the service supported this practice.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

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 service was good (published 19 September 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection on 3 February 2017, we found breaches of Regulation 9 and Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to take action to make improvements on ensuring the principles of the Mental Capacity Act 2005 were followed to gain consent. We also asked for improvement in the approach used to meet people’s needs. The provider sent us an action plan on how these improvements were to be made. We found this action was completed.

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.

The people at the service were not able to tell us about their experiences of living at the home. f Staff were aware of how people communicated and how to interpret their body language and facial expressions.

We saw people moved freely around the home, spending time in their bedrooms, kitchen and conservatory. Some people congregated in the kitchen when staff were preparing meals. This meant people enjoyed the company of staff and were comfortable with the staff.

Staff had attended training in safeguarding of adults. The staff we spoke with were knowledgeable about safeguarding of vulnerable adults procedures. These staff knew the types of abuse, how to identify abuse and how to raise their concerns. We saw the “See Something Say Something” and Whistleblowing procedures on notice boards, which gave staff guidance on how to raise concerns directly to the organisation.

We saw staff encouraged people to participate in in-house activities and people joined in with the activities. People sought assistance from staff to undertake activities. We saw one person smiled when the staff helped them with sensory objects. Staff ensured people had access to the community and on the day of the inspection people went out together for lunch and in the afternoon one person went out with a member of staff.

Care plans in place included people’s preferences and their abilities to manage their care. Care plans were reviewed regularly. We saw care plans directed staff on the non-verbal language used by people and how to respond to wishes and requests. Staff said they read the care plans and where there were changes to the care plan they signed them to indicate they had read, understood and agreed with the actions. Care plans were combined with the risk assessment. Where risks were identified measures were introduced to minimise the risk. Accidents were reported by the staff and where people sustained an injury a body map was completed to illustrate the location of injuries.

The environment was suitable for the people living at the service. The accommodation was arranged on one level which meant that people with mobility impairments had access to all parts of the property. Bedrooms were large and decorated to reflect their personalities.

There were two staff on duty at all times. At night two staff slept in the premises. Staff said the staffing levels were adequate to meet people’s needs. We saw staff were not rushed and time was taken with people.

We found safe systems of medicine management. Medicine care plans were in place for each person. Staff signed medicines administration records (MAR) charts to show medicines administered. Protocols were in place for medicines to be administered as required. Body maps were used to illustrate where on the body staff were to apply topical cream.

We saw staff offer people choices. Members of staff were aware of the day to day decisions people made. People’s capacity to make complex decisions was assessed and included medical treatment, temporary relocation and finances. People were subject to continuous assessments and DoLS (Deprivation of Liberty safeguards) applications were in place.

Health action plans were in place on how people were to be supported with their ongoing healthcare needs. Professionals that supported them were listed in the plans, for example, dentists, speech and language therapists and district nurses. Reports of their visits were maintained along the outcome of their visits.

New staff received an induction when they started work at the service. Staff were supported with the roles and responsibility of their job. This included training, one to one supervision with the registered manager and annual appraisals.

The dietary requirements of people were catered for. Menus were prepared in accordance with people’s likes and dislikes. The week’s menu was on display with photographs of foods and meals which gave people a reference of the meals to be served that week. We saw one person preferred to have finger foods and this was catered for.

Quality assurance systems were in place. The views of people and their relatives were gathered. However people were not able to express their experiences about the care they received. Staff supporting people with the surveys documented how people responded when they took steps to gather their feedback. One relative responded and the staff received positive feedback about the care they delivered to their family member.

Audits were undertaken to assess the delivery of care people received. Where there were shortfalls an action plan was developed on how the standards were to be met.

Staff said the team worked well together and felt valued by the registered manager. Staff said they shared the values of the organisation and were aware of the challenges, for example improving the rating of the home.

We recommended the registered manager considers using visual information to help people understand the decisions to be made. Consideration should be given to social stories.

A registered manager was 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.

Members of staff knew the actions to take for some risk but not all risks were assessed. For example, support plans developed alongside risk assessments were not in place for weight management. Risk assessments were not in place to ensure people’s safety or to enable them to take risks safely. For example, people with mobility needs.

Members of staff were not always working within the principles of the Mental Capacity Act 2005 (MCA). People’s capacity to make specific decisions was not assessed, for example, flu vaccines, and for some medical treatment. Relatives without Power of Attorney were able to make best interest decisions for their family members. Legally only relatives with power of attorney are able to make best interest decisions.

Support plans had not been updated since 2013 and some lacked detail on how staff were to assist people with meeting their needs. They were not developed in line with best practice and changes in legislation such as Mental Capacity Act 2005 (MCA).

Where, people at times became frustrated and anxious, support plans were developed on how staff were to respond to the triggers and prevent the situation from escalating. Support plans were not developed for people who refused personal care. This meant staff were not given guidance on how to gain people’s consent when they refused care and treatment.

We saw people sitting comfortably in communal areas with staff. Staff were aware of the safeguarding of vulnerable adults from abuse procedures. They knew the types of abuse and the actions they needed to take should they suspect abuse had taken place.

We saw staff enabled people to make decisions about their meals. Staff showed people the options available and confirmed the decision with the person. Although there was good interaction between people and staff we did not see people given an option on where to have their refreshments. Staff directed people to the dining room when refreshments were made.

Two staff were on duty throughout the day and at night two staff were sleeping in the property.

People were supported with their ongoing health and had an annual health check with their GP. However, health action plans were not updated to reflect people’s current healthcare needs. People had regular checks from the dentists and opticians and had regular visits from chiropody.

Medicines were administered by the staff. Staff said their competency with medicine management was checked annually. Medication Administration Record (MAR) charts were signed by the staff to indicate the medicines administered.

People were supported to participate in community activities such as bowling and in-house activities which included meal preparation and reflexology.

Annual service reviews were undertaken to assess all areas of the service. Shortfalls were identified at the most recent quarterly audit which included reviewing documents such as support guidelines and health action plans and reassessing staff’s competency with medicine administration. The action plan from the shortfalls identified was to be completed between January and March 2016.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We found that staff consulted with people in order to gain their consent. When consent was required that related to complex decisions, we found that advocates had been involved so that people's best interests were taken into account. We found that people's health and welfare needs were being met and that support given was individualised and person centred.

We found that the home was clean, safe, well maintained and suitable to the needs of the people living there. Staff were available in sufficient numbers and were experienced and knowledgeable; ensuring that they were able to meet the needs of people living in the home.

We found that there were systems in place to enable people and their advocates to raise concerns or complaints, and that when received these were acted upon.

In this report a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.