Archived: High Hurlands Community Homes

High Hurlands Community Homes is a collection of five individual cottages providing accommodation and support for 15 people with a learning disability, some of whom also have physical disabilities, in a small village set in the countryside on the outskirts of Liphook in Hampshire. High Hurlands Community Homes are set in the grounds of High Hurlands Nursing Home which is a separate service operated by the same provider. The people living at the Community Homes had access to the facilities available at the nursing home, which included a sensory room, a hydro pool and specialist activity rooms.

At this inspection we found that evidence continued to support the overall 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.

Policies, procedures and staff training were in place to protect people from avoidable harm and abuse. Staff had identified risks to people and these were managed safely. Recruitment processes were followed to ensure suitable staffing levels and the provider had thorough pre-employment checks in place to ensure staff were suitable to support people with a learning disability. Arrangements were in place to receive, record, store and administer medicines safely and securely.

People were cared for by staff who had received comprehensive training, support and supervision in their role. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People were supported to eat and drink sufficiently for their needs. Staff supported people to see a range of healthcare professionals in order to maintain good health and wellbeing.

Staff treated people with kindness and compassion. Staff supported people to make choices about their lives. Staff treated people with respect and upheld their dignity and human rights when delivering their care.

People had a comprehensive assessment of their support needs and guidelines were produced for staff about how to meet their individual needs and preferences. Support plans were reviewed with people and their families and relevant changes made where needed. Staff encouraged people to be as independent as possible. Activities that were appropriate to each person were offered and encouraged. Processes were in place to enable people to make complaints and these were responded to appropriately.

The provider had effective governance processes in place. People, their families, staff and professionals were encouraged to be actively involved in the development and continuous improvement of the home. The provider had robust quality assurance systems which operated across all levels of the service. Staff had worked effectively in partnership with other agencies such as social workers, occupational therapists, physiotherapists, GP's, and pharmacies to promote positive outcomes for people.

The service was last inspected in May 2016 where one breach of regulations was found.

High Hurlands Community Homes had a registered manager 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The service is required by a condition of its registration to have a registered manager. The registered manager was unavailable on the days of our inspection; however the provider was available, along with other member of the management team.

There were sufficient staff to meet people’s care needs. Where shortfalls were identified the provider managed these internally by deploying staff flexibly across the community homes and nursing home, in order to ensure staffing levels were maintained.

However, the provider had not in every case ensured that all the relevant recruitment checks were carried out for newly employed staff. This meant that people might not always be protected from the risk of employment of people who were not suitable for their role.

Staff had undertaken training in safeguarding adults and understood their role in relation to keeping people safe from the risk of abuse. Where safeguarding incidents had occurred these had been dealt with appropriately, including being correctly reported to the relevant authorities and action taken to minimise the risk of re-occurrence.

Risks to people had been assessed and measures were in place to manage them. Staff understood the risks to each person and ensured these were managed appropriately. The outcomes of incidents were reviewed in detail at monthly meetings in order to identify any potential risks to people and in order to take any required actions to keep people safe.

There were effective systems and processes in place to ensure people’s medicines were ordered and stored safely and that their administration was documented. Staff had undertaken training to enable them to administer people’s daily medicines safely.

Staff received an appropriate induction and continued to receive regular supervision and relevant training in their role. People were cared for by well trained and well supported staff.

People’s relatives told us they had been consulted about decisions that their loved ones lacked the capacity to make for themselves. Deprivation of Liberty Safeguards (DoLS) applications had been made for all people as required. Mental Capacity Assessments and Best Interest decisions had been carried out for people on some areas such as implementation of their care plan. We have made a recommendation that the provider ensures that appropriate mental capacity assessments and best interest decisions are clearly documented for some specific decisions taken on a person’ behalf, for example around restraint, in order to demonstrate that the least restrictive outcomes for people were always in place.

People were supported to eat and drink enough to maintain a healthy balanced diet. People had access to freshly cooked food which looked and smelt appetising and which people could help prepare. People enjoyed their meals which were a social occasion in each of the cottages.

People’s records demonstrated they were supported by staff to see a range of health care professionals. Staff were proactive in ensuring that people were able to access healthcare services when they needed to.

We saw that staff were kind, warm and thoughtful in delivering care to people and went out of their way to ensure that people had a positive and personalised experience of care. They ensured they communicated with people in a way which helped people feel included and that they mattered. They were knowledgeable about people and spoke of them as if they were their own relatives or friends. Staff had the skills, understanding and motivation to deliver good quality care.

People were supported by staff to be involved in decisions about what they ate, what they wore and what they wanted to do each day. Staff had access to guidance about how to communicate with people, which they followed. The provider had implemented the use of “storyboards” as a means for people to communicate decisions about their care, and that staff used to communicate back to people. Staff and relatives were able to describe to us how people’s privacy was maintained when their care was provided. We saw that staff treated people with respect when they were delivering care and support to them.

People’s relatives were involved in the planning and reviewing of their care on their behalf. Staff had a good knowledge of each person’s care needs, interests and characteristics. People were encouraged to be independent where possible. Staff supported people to attend a well organised and extensive programme of activities which enabled them to lead stimulated and fulfilled lives.

Relatives told us they had little cause to complain, but felt they would be relaxed and confident in approaching the registered manager or provider if they had any concerns, as they knew that they would be dealt with promptly and effectively.

Staff applied the provider’s values in their work with people. The culture of the service was person centred, and it was clear that people’s experience of care was a priority for the provider, the registered manager and staff.

The registered manager was visible, gave clear direction and was supportive to the staff team. They ensured that staff were supported by a well-managed supervision and appraisal system. The provider worked closely with the registered manager and the rest of the management team to ensure that the service was working as well as it could and that high quality care was being delivered to people.

Processes were in place to seek feedback on the quality of the service provided and the provider was proactive in implementing systems to monitor and improve the quality of the service provided. The registered manager was quick to implement changes in response to concerns to improve experiences for people.

Observation during the inspection showed staff supporting people to make their own choices about what they had for lunch and what activities they took part in. Staff knew exactly how each person communicated which meant people's wishes were understood and respected.

We observed that staff asked people about how and when they wanted their care and support. This indicated that people were involved in planning their care on a daily basis. During the inspection we observed staff supporting one person to prepare the evening meal for the rest of the house.

People chose how to occupy themselves in the service. We observed that people were spending time in the communal areas watching television and interacting with staff. During our inspection we observed staff spending time with two people providing foot massages, manicures and pedicures.

We observed staff spending the majority of their time with people who used the service, going swimming, feeding the ducks and listening to audio books. They frequently checked on them to ensure they were alright when spending time on their own.

Staff demonstrated a good understanding of how people in their care communicated and a lot of thought and consideration had been given about how people's needs could be met and how they could be kept safe. Staff liaised appropriately with health care professionals when they needed to and followed advice given. Effective training enabled staff to fulfil their role. The management team regularly monitored and supervised staff to ensure that they had the necessary skills and knowledge to support people who lived in High Hurlands Community Homes.

The service had very comprehensive systems in place to help them to monitor the quality of the care and support that they provided. There were regular and detailed audits of policies and procedures. These helped to ensure that the service remained compliant with the Health and Social Care Act 2008. All evidence that we found during this inspection was consistent with the services own findings.