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Inspection carried out on 11 February 2020

During a routine inspection

About the service

‘Hexham' provides care and support to people with a learning disability who live in supported living accommodation. At the time of the inspection there were 15 people using the service.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

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.

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

People were safe in the care of kind and compassionate support staff. The provider had systems in place to support safety within the service and protect people from abuse. Staff treated people with dignity and respect and helped people to remain as independent as possible.

Medicines were managed safely, although updates were required in some paperwork, but this was addressed immediately. The provider was in the process of updating their medication policy to ensure it reflected best practice.

Staff were supported and had received suitable training to ensure they could meet people’s individual needs. Enough staff were available to support people, and although agency use was higher than the provider would have liked, a recruitment drive was in place to address this.

There was a good choice of fresh food and refreshments available and people were supported to shop and prepare their own meals with support from staff if necessary. Staff ensured that people had access to a range of health care professionals.

People’s care plans described how they wished to be supported and how they liked this to take place. Likes, dislikes, goals and aspirations were discussed, and outcomes documented. People were able to follow any interests they may have and encouraged to try new ones. Local community involvement was encouraged, and the provider had set up social events so people could meet other people using their services. Positive risk taking was encouraged. 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.

A range of quality checks were carried out to monitor the service provided to people. When an issue had been identified, action was taken. The provider was in the process of updating their policies and ensuring that all care plan information was on their new IT system. The majority of staff were positive about changes within the management team and staff morale was reported to have improved.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was good (published 12 September 2017). Since this rating was awarded, the service has moved premises. We have used the previous rating to inform our planning and decisions about the current rating at this inspection. The service has retained the rating of good.

Why we inspected

This was a planned inspection based on our inspection programme.

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.

Inspection carried out on 28 July 2017

During a routine inspection

This inspection took place on 28 July 2017 and was announced. This was to ensure someone would be available to meet with us and show us records.

Hexham is a registered location for Azure Charitable Enterprises, which provides support and a wide range of services to people with learning disabilities in their own homes. On the day of our inspection there were 16 people using the service, 11 of whom were receiving support with their personal care.

The service 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 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.

We last inspected the service in July 2015 and rated the service as ‘Good.’ At this inspection we found the service remained ‘Good’ and met all the fundamental standards we inspected against.

At this inspection we visited the office and two of the houses where people were receiving care and support from staff.

Accidents and incidents were appropriately recorded and risk assessments were in place. The manager understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vulnerable adults.

People were supported in a safe environment. Health and safety checks and infection control audits had been carried out. Appropriate arrangements were in place for the safe administration and storage of medicines.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The provider had an effective recruitment and selection procedure in place and carried out relevant vetting checks when they employed staff. Staff were suitably trained and received regular supervisions and appraisals.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of people being supported during visits to and from external health care specialists.

People who used the service and family members were complimentary about the standard of care at Hexham. Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

Care records showed that people’s needs were assessed before they started using the service and care plans were written in a person-centred way. Person-centred is about ensuring the person is at the centre of any care or support plans and their individual wishes, needs and choices are taken into account.

Activities were arranged for people who used the service based on their likes and interests and to help meet their social needs.

The provider had an effective complaints procedure in place and people who used the service and family members were aware of how to make a complaint.

The provider had an effective quality assurance process in place. Staff said they felt supported by the management team. People who used the service, family members, staff and visiting health and social care professionals were regularly consulted about the quality of the service via meetings and surveys.

Inspection carried out on 17 July 2015

During a routine inspection

The inspection took place on 17 July 2015 and was announced.  We announced the inspection to make sure staff would be available at the office. In addition, people were often out in the local community and we wanted to make sure that people would be in and able to speak with us.

Azure Charitable Enterprises provides support and a wide range of services to people with learning disabilities. They also work with people with a history of mental health issues, physical disabilities, those within the autistic spectrum and people who have an acquired head injury.  The provider has four regulated services which are registered with the Care Quality Commission (CQC); Hexham, Keele Drive, Newcastle and Azure Charitable Enterprises Washington.

We inspected Hexham, Keele Drive and Newcastle services between 14 and 22 July 2015. This report only relates to our findings at the Hexham inspection. Keele Drive and Newcastle reports can be found on our website at www.cqc.org.uk.

Azure Charitable Enterprises also have a number of supported businesses that provide employment and training opportunities for people with a disability. These include a garden centre and nurseries, a printing service, a landscaping business and a community enabling support service. These services are not regulated by the Care Quality Commission because they are out of scope of the regulations.

Hexham provides personal care to people who have a learning disability; some individuals also have a physical disability. There were 15 people receiving personal care on the day of our inspection. They lived in their own homes within the Tynedale area. Hexham provides staff to support people who lived in these houses.

Hexham was last inspected on 12 November 2013. We found they were meeting all the regulations we inspected.

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 and associated Regulations about how the service is run.

People told us they felt safe. There were safeguarding policies and procedures in place. There were no ongoing safeguarding concerns. This was confirmed by the local authority safeguarding adults officer. Staff knew what action to take if abuse was suspected.

People, staff and relatives told us there were enough staff to meet people’s needs. In May 2015, there had been a change in funding which had resulted in the provider making several staff redundant. This included the deputy manager and three team leaders. Staff informed us that this did not impact upon people’s care and support.

There was a system in place to manage medicines safely. People told us that staff supported them to take their medicines.

There was a training programme in place. Staff were trained in safe working practices and to meet the specific needs of people who used the service. Many of the staff had worked at Hexham for a considerable number of years. This experience contributed to the skill which they carried out their duties.

People told us that they were happy with the service provided. We read the results from the most recent survey. All 12 people who had completed the survey stated that they were happy with the service provided. One person had written, “I would give Azure services a rate of 50 out of 10!”

We saw that people’s nutritional needs were met. People told us and our own observations confirmed that they were involved in the planning and preparation of meals.

The registered manager was aware of the Supreme Court judgement in relation to deprivation of liberty. The Supreme Court ruled that anyone who was subject to continuous supervision and not free to leave was deprived of their liberty. The registered manager was liaising with the local authority to ascertain what implications this ruling had on people who used their service.

People and the relatives told us that staff were caring. People were supported to maintain their hobbies and interests and housekeeping skills were encouraged to help promote people’s independence.

People, relatives and staff told us that they were involved in making decisions about the running of the service. They explained that there was open communication and their views were listened to and acted upon. Regular staff meetings were held. There was a complaints procedure in place. There were a number of feedback mechanisms to obtain the views from people, relatives and staff. These included meetings and surveys.

Some staff informed us that they felt frustrated by the recent changes in funding which had resulted in staff redundancies. They said that they recognised that the redundancies were not down to the provider but due to external influences and changes in funding. They said that they still felt valued by the provider. We spoke with people and their relatives and no one raised any concerns about the recent changes.

We reviewed a number of internal audits and monitoring reports which demonstrated that the provider had systems in place to assess and monitor the quality of the service they delivered. The system was being reviewed following changes in the management structure at the service.

Inspection carried out on 12 November 2013

During a routine inspection

There were 15 people receiving personal care on the day of our inspection. They lived in their own homes within the Tynedale area. Azure Hexham provided staff to support people who lived in these houses.

We spoke with four people to find out their opinions of the service. They were complimentary and one person informed us that it was a, �Really good service.�

We spoke with a care manager from Northumbria Healthcare, an occupational therapist and a speech and language therapist by phone. In addition we contacted a psychologist by email to find out his views of Azure Hexham. All health and social care professionals that we contacted were also complimentary about the service.

Our expert by experience who accompanied us on the inspection stated, �It seemed to be very person centred and they cared and respected the individual people living there.�

We found that people�s needs were assessed and care and treatment was planned and delivered in line with their care plan.

People�s health, safety and welfare were protected when more than one provider was involved in their care, because the provider worked in co-operation with others.

There was enough equipment to promote the independence and comfort of people who use the service.

Staff received appropriate training for their professional development.

People who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted on.

Inspection carried out on 24, 29 January 2013

During a routine inspection

We visited three houses and spoke with four people who used the service. We also spoke with three relatives to find out their opinions of the service. One told us, �I think we�re extremely lucky to have this service.�

Relatives confirmed that consent was gained before care and treatment was carried out. One commented, �Anything medical is always talked about.� We concluded that people were asked for their consent and staff acted in accordance with their wishes.

One relative informed us, �It is a fabulous place for care.� We concluded that people's needs were indeed assessed and care and treatment was planned and delivered in line with their individual care plans.

We concluded that people were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

Relatives did not have any concerns about infection control and the cleanliness of the environment. We found that people were cared for in a clean environment.

Relatives, with whom we spoke, told us they had no concerns about the number of staff employed to look after people. We found there were enough qualified, skilled and experienced staff to meet people's needs.

Relatives told us they felt able to raise any concerns or comments about the service. We concluded that people had their comments and complaints listened to and acted on, without the fear that they would be discriminated against for making a complaint.

Inspection carried out on 11, 17 November 2011

During a routine inspection

People using the service told us that they were satisfied with the care and support they received. We were not told of any concerns.

Inspection carried out on 18 November 2011

During a routine inspection

People using the service told us that they were satisfied with the care