H M T Care - 48 Albany Drive

HMT Care – 48 Albany Drive is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

H M T Care - 48 Albany Drive provides a specialist service for people diagnosed with neuro-disabilities, specifically Huntington's Disease. There were seven people living at the service at the time of inspection. The service is a large Victorian detached house in a residential area of Herne Bay. The service was set out over three floors. On the first two floors there were communal areas and people's bedrooms. Each person had their own bedroom which contained their own personal belongings and possessions that were important to them. On the third floor was the company office. There was a passenger lift for people who could not use the stairs.

At the last comprehensive inspection in February 2017 the overall rating for the service was Requires Improvement. One breach of regulation of the Health and Social Care Act 2008 (Regulated Activities) 2014 was identified. The provider failed to deploy enough staff to meet people’s needs.

Following the last inspection we asked the provider to complete an action plan to show what they would do and by when to improve the key question Safe to at least Good.

At this inspection improvements had been made and the breach in regulation met. No further breaches were identified.

A registered manager worked at the service each day. A registered manager is a person who has registered with 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.

People told us and indicated they felt safe living at the service. People were protected from the risks of abuse, discrimination and avoidable harm by staff who were trained and knowledgeable in their roles. Accidents and incidents were recorded and reviewed and action was taken to refer people to the relevant health care professionals when needed. People’s medicines were administered safely and given on time.

People and their relatives said there were enough staff to support them when they needed anything. Staff had been recruited safely and were coached and mentored by the provider and registered manager. The provider and registered manager worked closely with the Huntington’s Disease Association to keep up to date with best practice.

The building and grounds were clean and well maintained. People’s rooms were personalised with their own pictures, photographs and ornaments to help them feel at home. People had access to communal areas and the garden.

People were supported to eat healthily. Staff liaised with health care professionals, such as dieticians and speech and language therapists and followed any advice given to help them stay as healthy as possible.

People were supported to have maximum control of their lives and were supported in the least restrictive way possible; the policies and systems in the service supported this practice. People’s physical and mental health needs and their social and cultural preferences were assessed and reviewed. People and their relatives and had been involved in planning and making decisions about their care.

Staff supported people to move into and out of the service, working with local authorities and health care professionals to make sure that any move was co-ordinated well. People had developed strong relationships with the provider, registered manager and staff. Staff were kind, patient and caring and people and their relatives had no complaints about the quality of service delivered. People’s privacy was respected and their dignity was promoted. People’s end of life preferences were discussed and recorded to ensure staff could follow their wishes. People took part in a range of activities both inside and outside of the service.

People, their relatives and the staff felt the service was well-led and that the registered manager was approachable and accessible. There was an open and inclusive culture and people were encouraged to suggest any improvements that could be made. Regular checks and audits were completed to monitor the quality of service and any shortfalls were actioned.

All services that provide health and social care to people are required to inform CQC of events that happen, such as a serious accident, so CQC can check that appropriate action was taken to prevent people from harm. The registered manager notified CQC and the local authority in a timely manner.

H M T Care - 48 Albany Drive provides a specialist service for people diagnosed with neuro-disabilities, specifically Huntington's Disease. There were six people living at the service at the time of inspection. They had complex communication and mobility needs.

The service is a large Victorian detached house in a residential area of Herne Bay. Some people had lived at the service for a long time and were becoming increasingly frail. Due to the deterioration in their condition the amount of personal care and support they needed had increased.

The service was set out over three floors. On the first two floors there were communal areas and people's bedrooms. Each person had their own bedroom which contained their own personal belongings and possessions that were important to them. On the third floor was the company office. There was a passenger lift for people who could not use the stairs.

There was a registered manager working at the service and they were supported by an assistant manager. They were also the registered manager of another service close by. 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.

On the day of the visit the registered manager was there for part of the inspection. The assistant manager, staff and the provider supported us throughout the inspection. The registered manager had been in charge at the service for a long time. They knew people and staff well.

The assistant manager spent more time at this service managing it on a day to day basis and the registered manager spoke with the assistant manager daily and came to the service when needed but spent more of their managerial time at the provider's other service.

At the last inspection in January 2016 we found breaches of regulations. At this inspection some improvements had been made but further improvements in some areas, were needed.

At the previous inspection there had been a breach of regulations related to managing risks to people. Staff did not have clear guidance about what to do in the event of someone choking or what signs to look for if people’s skin was at risk of becoming sore. Improvements had been made and staff had guidance about supporting people if they should choke and what to look for if people’s skin was at risk of becoming sore.

When we last inspected the service there had been a breach of regulations related to staff not receiving the supervision they needed. At this inspection improvements had been made, staff had received regular one to one supervision meetings and annual appraisals. Informal meetings with staff had not always been documented and this was an area for improvement.

At the last inspection there had been a breach in regulations related to people not receiving person centred care and treatment and care plans not being reviewed or updated. At this inspection improvements had been made, people’s care plans were reviewed and updated more regularly. The care plans gave details of what was important to people and how they liked to be supported.

At the previous inspection there was a breach of regulation relating to quality assurance audits not identifying shortfalls in the service. Systems to identify and assess risks to the health and safety or welfare of people were not detailed and the provider had failed to ensure that records were accurate.

At this inspection some improvements had been made, regular audits had been completed and covered a range of areas. Records were completed and information was accurate and provided enough detail to identify issues and any actions taken. However not all of the shortfalls we found at this inspection had been identified by the provider’s quality audit systems.

There were was no formal process to determine how many staff were needed on each shift to meet people’s needs, and the provider told us it was decided based on ‘their experience.’ On the day of the inspection one staff member was off sick and at times people had to wait for support.

Staff knew people well and interacted with them in a natural and caring way. Staff took time to give people choices and let them know what was happening. People were supported to maintain relationships with families and friends. Each person had a keyworker who co-ordinated their care and support. Some activities took place for people to take part in but these were limited. The registered manager agreed this was an area they could develop.

Staff knew how to recognise and respond to abuse. The registered manager was aware of their responsibilities regarding safeguarding and staff were confident the registered manager would act if any concerns were reported to them.

The management team had identified environmental risks and put measures in place to manage these risks. Fire drills were completed and people had a personal emergency evacuation plan (PEEP) in case of a fire.

Some people had eating and drinking guidelines in place from speech and language therapists (SALT). Staff followed these guidelines and food and drinks were served at the correct consistency. People received the support and supervision they needed to eat safely.

Staff were effective in monitoring people's health needs and seeking professional advice when it was required. People received their medicines safely and when they needed them and they were monitored for any side effects. When people needed medicines on a 'when required' basis there was guidance for staff about when to give the medicines and the maximum doses people could have.

Staff completed basic training in topics such as safeguarding, mental capacity and first aid. Staff had also completed training relating to people’s specific needs, such as Huntington’s disease awareness and how to support people safely with eating and drinking. There was no system in place for measuring staff competency following training, the registered manager agreed this was an area for improvement.

Staff told us how they supported people to make their own decisions and choices. Staff had received training on the Mental Capacity Act (MCA) 2005. The MCA provides the legal framework to assess people's capacity to make certain decisions, at a certain time.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. The requirements of DoLS were met.

There was a complaints policy in place and staff knew what to do if anyone complained. When complaints were made they were documented and investigated in line with the provider’s policy. The CQC had been informed of any important events that occurred at the service, in line with guidance.

Staff understood the need for confidentiality and records were stored securely.

Staff told us that the registered manager and assistant manager were approachable and supportive. Staff understood the values of the service, which were to support people to remain as independent as possible for as long as possible. Annual questionnaires were sent out to people, their relatives, staff and other stakeholders so they could give their views about the service, responses were analysed and action taken if required.

The registered manager and provider had links to the Huntington’s association and ran a local support group. They also worked closely with the specialist medical team for Huntington’s and shared information from this team with the staff team and people’s families.

We found a breach of regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

H M T Care - 48 Albany Drive provides a specialist service for people diagnosed with neuro-disabilities, specifically Huntington's Disease. There were seven people living at the service at the time of inspection. They had complex communication and mobility needs.

The service is a large Victorian detached house in a residential area of Herne Bay. Some people had lived at the service for a long time and were becoming increasingly frail. Due to the deterioration in their condition the amount of personal care and support they needed had increased.

The service was set out over three floors. On the first two floors there were communal areas and people’s bedrooms. Each person had their own bedroom which contained their own personal belongings and possessions that were important to them. On the third floor was the company office. There was a passenger lift for people who could not use the stairs.

There was a registered manager working at the service and they were supported by a deputy manager. They were also the registered manager of another service close by. 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. On the day of the visit the registered manager was not available. The deputy manager, staff and the provider supported us throughout the inspection.

The registered manager had been in charge at the service for a long time. They knew people and staff well. The deputy manager spent more time at this service managing it on a day to day basis and the registered manager supported her two days a week but spent more of their managerial time at the provider’s other service.

The deputy manager and staff did not fully understand how the Mental Capacity Act (MCA) 2005 was applied to ensure decisions made for people without capacity were only made in their best interests. They did consider people’s abilities to give consent to complex decisions but there were some areas of people’s treatment when their ability to consent had not been fully considered. This was an area for improvement. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm. DoLs applications had been made to the relevant supervisory body in line with guidance.

The care and support needs of each person were different and each person’s care plan was personal to them. Parts of the care plans recorded the information needed to make sure staff had guidance and information to care and support people in the safest way. People indicated they were satisfied with the care and support they received. However, some parts of the care plans did not record all the information needed to make sure staff had guidance and information to care and support people in the way that suited them best and kept them safe. Potential risks to people were identified but full guidance on how to safely manage the risks was not always available. This left people at risk of not receiving the interventions they needed to keep them as safe as possible.

Staff were caring and respected people’s privacy and dignity. There were positive and caring interactions between the staff and people and people were comfortable and at ease with the staff. Staff were kind and caring when they were supporting people. Some people were unable to communicate using speech so staff anticipated or interpreted what they wanted and responded quickly. The way that people communicated was not recorded in their care plans to guide and inform staff, for example one person raised their arm to say ‘yes’ this detail was not recorded in their care plan. Information was not presented in ways people found meaningful and accessible.

People were supported to have a nutritious diet. People, because of the condition they were living with, required a lot of extra calories throughout the day. Staff made sure people received all the food and drink and that they needed. Care and consideration was taken by staff to make sure that people had enough time to enjoy their meals. Meal times were managed effectively to make sure that people received the support and attention they needed.

People were supported to go out and about but activities, when at home, were limited. People were not fully involved in everyday tasks when at home so there was opportunity to increase people’s levels of involvement and engagement. Staff did things for people rather than with them, so missed opportunities to empower people to do things for themselves so they maintained as many independent skills as possible.

The staff were effective in monitoring people’s health needs and seeking professing advice when it was required. People received their medicines safely and when they needed them and they were monitored for any side effects. When people needed medicines on a ‘when required’ basis there was no guidance so that they were given consistently. People’s medicines were reviewed regularly by their doctor to make sure they were still suitable. The provider was going to consider reviewing where medicines were stored.

People felt safe in the service. Staff understood how to protect people from the risk of abuse and the action they needed to take to report any concerns in order to keep people safe. Staff were confident to whistle-blow to the registered manager if they had any concerns and were confident appropriate action would be taken. The registered manager responded appropriately when concerns were raised. They had undertaken investigations and taken action. The registered manager followed clear staff disciplinary procedures when they identified unsafe practice. Accidents and incidents were recorded and appropriate action had been taken. The events had been analysed to look for patterns or trends to prevent further occurrences.

A system to recruit new staff was in place. This was to make sure that the staff employed to support people were fit to do so. There were sufficient numbers of staff on duty throughout the day and night to make sure people were safe and received the care and support that they needed. There was enough staff to take people out to do the things they wanted to. New staff had induction training which included shadowing experienced staff, until they were competent to work on their own. Staff had core training and more specialist training, so they had the skills and knowledge to meet people’s specific needs. Staff fully understood their roles and responsibilities as well as the values of the service.

Staff were receiving support from the registered manager or deputy manager through one to one meetings but the frequency of the meetings were not in line with the provider’s supervision policy. Staff did not have the opportunity to regularly privately discuss any issues, their performance and identify any further training or development they required. Yearly appraisals were being held to make sure staff had the opportunity to review the first year and set work based goals for the next year.

There was a complaints procedure available. The complaints procedure was not produced in an accessible or easy read format that may be more suitable for people’s needs.

There were quality assurance systems in place. Audits and health and safety checks were carried out but some shortfalls had not been identified and action had not been taken. The registered manager had formally sought feedback from people, their representatives and staff about the service. Their opinions had been captured and analysed but there was no action plan to show how the provider intended to address issues and suggestions to drive improvements within the service.

On the whole staff told us that the service was well led and that the management team were supportive and approachable and that there was a culture of openness within the service.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

People's hobbies and interests were supported and people had support to keep in touch with their family and friends. People's needs were assessed and detailed in care plans that provided staff with clear guidance. Staff understood people's needs especially relating to Huntington's Disease.

People maintained good physical and mental health because the service worked closely with health and social care professionals. The home was safe, well maintained and suited people's needs. Each bedroom was single were personalised with people's own photographs and pictures.

Staff were supported and supervised and there was enough skilled and experienced staff to meet peoples' needs. Staff worked together as a team with each shift planned in advance so that staff knew their roles and responsibilities. Staff engaged with people in a calm, respectful and reassuring manner.

We found that people who had communication difficulties were able to express their wishes with support of staff, involvement of relatives and outside agencies. Staff understood their roles and responsibilities and all pre- employment checks were completed before starting work.