Hulse Road

Hulse Road 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 service is registered to provide support and accommodation for up to six people with a learning disability. The Royal Mencap Society is the service provider, a charity based in the UK, working with people who have a learning disability. At the time of our inspection there were four people living at the home.

There was a registered manager in post and available throughout our inspection. 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.

At the CQC inspections in October 2017 and November 2016, we rated the service as Requires Improvement. At the October 2017 inspection we made a recommendation to review staffing levels after 4pm. We also identified that areas of improvement were needed in the medicines protocol for one person, and the recording of mental capacity and consent. In addition, the managerial audits of the service were not effective. At this inspection we found that improvements had been made and the rating has now changed to Good.

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.

Staff received safeguarding training and understood their responsibilities to identify and report any concerns of abuse.

Medicines were managed safely. There were systems in place to monitor medicine administration records and medicines stock.

There were improvements to the way people were supported to communicate their choices and decisions. Information was explained in pictorial formats to support people’s needs. This included the complaints procedure, for healthcare appointments, and to help people understand when changes were taking place in the home.

A new kitchen was due to be installed one week after the inspection. This had been communicated to people using pictures and print, showing that a new kitchen would be fitted on a specific date in the calendar.

People were supported to be actively involved in choosing new bedroom furniture, furnishings and wall colours. Timelines were created to support people to understand delivery dates while they awaited the delivery of the items.

Risks to people’s safety in the home and when spending time in the community had been assessed. There were plans in place to reduce the likelihood of risks occurring, and to help people maintain their independence.

People had been supported to make healthier lifestyle choices. This included healthy menu options and being encouraged to partake in physical activities.

There were opportunities for people to attend activities in the local community, based on their personal interests. These included craft sessions, swimming, and dance exercise workouts.

There were many social activities held at the home, including themed parties. There had been a Halloween and Christmas party, as well as a ‘Reflection Day’, where friends and families were invited to attend.

A day was dedicated to reflecting upon what had been achieved in the previous twelve months. People had created photo boards and displays of their activities, events, and achievements. Family and friends were invited to join the celebrations. People and staff were presented with certificates for their achievements.

Referrals were made to health and social care professionals when required.

Compliments had been received from people’s families and one was received from a person’s GP. The GP commented that there were notable improvements in the person’s wellbeing and appearance.

New staff were recruited through recruitment processes and received a robust induction. This included in-house and external training, with new staff receiving a company induction and assessment from the area manager. This was in addition to supervision and assessment from the registered manager.

Staff were trained to meet the needs of people living at the service. Records showed that all staff training required by the provider was complete and up to date. Staff also received regular one-to-one meetings with the registered manager to discuss their performance and how they could further develop.

There was a friendly and relaxed atmosphere at the home, the staff team communicated well with one another and people were comfortable.

The registered manager had reflected upon where improvements had been required, and upon any accidents and incidents that had taken place. They had learned from these and made improvements accordingly. Staff were communicated with in the event of any updates.

We inspected Hulse Road on 5 October 2017 and this inspection was unannounced. The registered manager was approachable and available throughout our inspection. 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 home was last inspected in November 2016 and received a rating of Requires Improvement. The home was found to be in breach of Regulation 13 because people were being deprived of their liberty without the appropriate legal authorisation in place. At this inspection there were still areas to improve but the service was no longer in breach of this regulation.

The service had not always identified potential risks to people in order to take the appropriate action to keep people safe. Staffing levels dropped to one member of staff after 4pm and risks around the front door being accessible to people had not been considered. We have made a recommendation to the provider that the staffing levels after this time are reviewed.

Medicines management had improved since our last inspection; however we did observe a few areas that still needed addressing. For example one person’s medicine protocol was not specific to why this person needed to take this medicine in order for them to be supported appropriately.

We found the service to be clean and homely. We reviewed the cleaning record for communal areas but the registered manager was unable to locate the usual cleaning schedules showing which other areas of the home were kept clean and how often this was completed.

Areas of improvement were still needed around the recording of mental capacity and consent. We saw that people’s support plans did not show evidence that people had consented to live in the home and receive support. Where people may have been unable to consent to this, no mental capacity assessment had been completed.

We reviewed the training matrix online and saw that the majority of staff were up to date with their training, however there were some gaps. Staff told us they felt more enhanced communication training was need to better support people in the home.

People received care and support from staff who had got to know them well. The relationships between staff and people receiving support demonstrated dignity and respect at all times. We saw that people were very comfortable and relaxed in the home environment and in the presence of staff. One person told us “I’m happy here, staff help me get ready.” A relative commented “Staff are caring; [X] is very happy and can’t wait to get back home when we have been out. Staff are supportive, everyone loves [X], it’s a very caring home, they look out for individual needs and plan for individual needs.”

Quality assurance systems were in place to monitor the quality of service being delivered and the running of the home, however the audit processes that supported this were not effective. The registered manager recorded the date of any completed audits in the home, for example medicines, infection control or health and safety audits. However there were no audit checklists in place that the registered manager followed or that could record what areas if any were found to need improvement.

Some relatives spoke about the need for the service to communicate better with them about their loved ones commenting “Communication could be better, what people are doing, how they are, haven’t been impressed with that lack of feedback and it’s been a long term thing. We did have a yearly survey but things were not actioned or changed as a result.” The registered manager was aware that communication with relatives was an area that needed to be developed.

The service promoted a positive culture that was person-centred and people, their relatives and staff spoke warmly about the registered manager. One person told us “The manager is about, I talk to her often, she helped me book my holiday.” One relative commented “The manager has been brilliant; they try hard to support people. They encouraged [X], they don’t give up. They are doing a brilliant job and I’m very impressed with staff and the manager. People are happy” A member of staff said “The manager is amazing, the best manager we have had, she’s approachable, she listens, she cares about people and staff.”

A registered manager was not in post when we inspected the service. 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 registered manager had left the company a year ago but had not cancelled their registration with The Care Quality Commission. A new manager had been in post since July 2016 and was about to start the process to become registered manager. The manager was present and approachable throughout our inspection.

Staff knew how to identify if people were at risk of abuse and what actions they needed to take should they suspect abuse was taking place. Some people living at the service were unable to communicate verbally and staff were mindful of the signs to look for if people who could not verbalise were being mistreated.

People’s’ medicines were not always managed safely. Protocols for prescribed medicines which were taken ‘as required’ (PRN) were not made available for us to review. We looked at people’s medicine administration records and saw there was a missed signature for one person’s medicines from the previous day. This meant we did not know if the person had received their prescribed medicine at this time.

People’s care files were not kept in a secure place but left out on a table in the dining room. This meant they had access to other people’s care plans which contained private information such as medical history. The manager informed us they would be moved to a secure place.

Staffing had been variable for the service but the manager had been working to address this and ensure consistency for people living in the home. On the day of our inspection a staff member had called in sick and the manager had arranged agency cover for this. Relative’s comments included “They had a lot of problems with staff, but it has settled down now and my relative is happy” and “Lots of staff changes has an impact on people getting out and about”.

All new staff received an induction when they started working for the service, which included shadowing a competent member of staff. Staff had completed training to ensure the care and support provided to people was safe and effective to meet their needs.

Four people living in the home did not leave the home without a staff member being present. This meant they were under constant supervision and their liberty was being restricted. We looked in people’s care plans for evidence that these decisions had been made appropriately and by the correct governing body. However there was no evidence of an application or authorisation in place and the manager confirmed that these had not been submitted. This meant people had been deprived of their liberty without the legal authorisation to do.

People received care and support from staff who had got to know them well. The relationships between staff and people receiving support demonstrated dignity and respect at all times. Relatives were reassured their loved ones were well cared for commenting “We are overwhelmed at how the place treats her, it’s wonderful” and “It’s excellent care, they are all very good staff”.

During our inspection we saw that one incident that had been reported to the police had not been notified to CQC. We use this information to monitor the service and ensure they responded appropriately to keep people safe.

We found one 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 the report.

We observed positive interactions between the people using the service and the staff on duty. We saw people were comfortable in the presence of staff. One person told us they remained 'happy' living at Hulse road.

We heard staff asked one person if they would be happy to show us their support plan, which they agreed to. We saw some people had chosen to stay in bed and staff assisted with their breakfast when they were ready to get up.

Staff we spoke with told us about their involvement with other healthcare professionals. Records demonstrated best interest meetings took place when a person was deemed as not having the capacity to make a decision. Staff had received training in the Mental Capacity Act 2005(MCA).

We saw people had the opportunity to attend various activities with staff support such as bowling and flower arranging. The staff we spoke with told us there was sufficient staff on duty to enable them to support people.

We saw the home had not received any complaints since 2007. Systems were in place to support people if they wished to raise any concerns. One person told us they would go to 'any of the staff', if they were worried or unhappy.