The Hermitage

The Hermitage is a residential care home providing personal care for up to 7 people living with a learning disability and/or autism. At the time of this inspection there were 7 people living in the home.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

People were happy and content living in the home. They received person-centred care where they were at the heart and focus of the support provided to achieve positive outcomes.

Right Support

The provider supported and encouraged people to be as independent as possible. Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life. People were supported by staff to pursue their interests. People had a choice about their living environment and were supported to personalise their rooms.

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.

Right Care

People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs. People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs. People could take part in activities and pursue interests that were tailored to them.

Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

Right Culture

People and those important to them, including advocates, were involved in planning their care. People were supported by staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have. This meant people received compassionate and empowering care that was tailored to their needs.

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 29 August 2018).

Why we inspected

The inspection was prompted in part due to concerns received about person-centred care, staffing levels, people's lack of choice and control over their lives and closed culture. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe, effective, caring, responsive and well-led sections of this full report.

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.

Follow up

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

The Hermitage 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 Hermitage is registered to provide residential care and support for up to seven adults with a learning disability or autistic spectrum disorder. At the time of our inspection there were seven people living in the home.

A registered manager was in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 registered manager was moving to manage another of the provider’s services and a new manager had recently moved to the Hermitage.

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.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People were protected from abuse and harm. Staff had completed safeguarding training and were confident in identifying the signs of abuse and what action to take to keep people safe. Safeguarding concerns and accidents and incidents were recorded, collated and analysed to identify any patterns or trends.

The provider continued to operate a robust recruitment process. Sufficient, appropriately trained staff were deployed to meet people’s needs. Staff were supported by the provider and the registered manager. Training, supervisions and appraisals were up to date.

The provider had systems in place for the receipt, administration and disposal of medicines. Identified risks were assessed and managed to minimise the risk to people who used the service and others.

People were provided with a choice of healthy food and drinks to help ensure that their nutritional needs were met. The service ensured people received care and support from healthcare professionals including occupational therapists, and GPs.

Feedback was encouraged from people who used the service, relatives, staff and external healthcare professionals. We observed positive interactions between staff and people who used the service. People were supported to be as independent as they wished.

Information was available in people’s preferred format, the home used a range of accessible information tools enabling people to express themselves.

People are 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 supported this practice.

Comprehensive care plans were available to staff. These were personalised and described how people preferred to be supported. Relatives were complimentary about the service especially the caring nature of staff.

Systems were in place to monitor, identify and manage the quality of care provided.

Further information is in the detailed findings below.

We previously inspected the service on 25 January 2014 and found the service was meeting the requirements of the regulations we inspected against.

The Hermitage is registered to provide residential care and support for up to seven adults with a learning disability or autistic spectrum disorder. At the time of our inspection there were six people living in the home.

At the time of our inspection there was 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.

During our inspection we noted that some statutory notifications had not been submitted. The registered manager acted immediately and submitted the notifications to CQC. We are dealing with this outside of the inspection.

Staff had a good understanding of safeguarding and were confident in their role in safeguarding people.

Risk assessments were in place for people when required and there were clear links to care and support plans. There were also general risk assessments regarding the premises and environment.

The home had an up to date fire risk assessment in place but we noted there were no personal emergency evacuation plans (PEEPs) that detailed people’s individual needs in case of a fire. The registered manager informed us people would remain in their bedrooms and would not leave and the home had fire doors and a sprinkler system to give people maximum time in the event of a fire for the fire brigade to take action. The registered manager told us they would put appropriate plans in place. We noted staff had knowledge about how to support people during evacuations.

Medicines were managed safely, effectively and in a way which reflected people’s individual needs. All records were up to date and fully completed, with medicine audits being carried out regularly.

Staff were recruited in a safe and consistent manner with all appropriate checks carried out. Staffing levels were consistent with people’s needs and reduced accordingly on weekends and during holiday periods when people were spending some time away from the home.

Staff had up to date training in autism, safeguarding, Mental Capacity Act 2005 (MCA) for people who lacked capacity to make a decision and deprivation of liberty safeguards (DoLS) to make sure people were not restricted unnecessarily.

People’s capacity to consent to care was clearly outlined in their care records. People were supported to maintain a balanced and healthy diet, and to attend any health services when required.

The registered manager and staff we spoke to had a good understanding of the MCA and DoLS. Best interest decisions were evident within care files.

DoLS authorisations were in place for some people who used the service. Where delays were experienced due to applications being with local authorities there was evidence of the registered manager requesting updates and chasing authorisations with the local authorities in question.

Staff received regular supervision and annual appraisals. Staff told us they felt supported in their roles and they could approach the registered manager if they had any issues or concerns.

We observed a mealtime at the home. People were enjoying their meals, some independently and others with verbal support from staff. There were choices available for people and menus were tailored people’s preferences.

The service provided personalised care. Staff had good knowledge of each person and knew how to support them in a way that met their specific needs. Relatives told us they felt people were looked after and well cared for in the home. Each person had a range of social activities they took part in on a weekly basis.

Staff were aware of how people might communicate if they were unhappy with a situation.

Relatives felt involved in care planning and knew how to make a complaint or comment. There had been no complaints about the service.

Relatives and staff felt the service was well run and the home was well managed. There was an open, calm, approachable culture within the home. Staff felt supported in their roles and were kept informed and updated in relation to any changes in the service.

The provider had a quality assurance system to check the quality and safety of the service provided, and were effective in identifying issues and required improvements.

We viewed five private rooms and the communal areas in the home and found a safe, inviting and friendly atmosphere throughout. There were two large, bright and airy communal lounges and dining rooms and a large, well-kept garden that was available for people to use for activities. We reviewed communications between relatives of the people who lived there and the home and found that there were no current complaints