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Holcombe House Requires improvement

Reports


Inspection carried out on 25 June 2019

During a routine inspection

About the service

Holcombe House is a domiciliary care agency that supports people who have learning disabilities and/or autistic spectrum disorder and are living in their own homes.

Not everyone who used the service received personal care support. 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. At the time of our inspection, the service supported seven people with their personal care.

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

The systems to check the quality and safety of the service, had not always been effective in identifying areas for development. Actions following checks had not always been completed in a timely manner. Some elements of the safeguarding process had not been robust.

Staff had not consistently had their competency assessed or completed training on topics such as safeguarding, moving and handling practical and infection control.

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 did not always support this practice. We made a recommendation about the completion of mental capacity assessments.

People received their medicines as required. Some people had managed to reduce or stop taking medicines for periods of anxiety and distress, with the support of the staff team. People received support from a consistent team of staff, which enabled positive relationships.

People and their relatives praised staff’s approach in how they cared for people. Staff knew the needs of the people they supported and were keen to continually find ways to promote their independence. People were encouraged and supported to make their own decisions wherever possible.

People engaged in a wide variety of activities according to their own interests. Information was available to guide staff about the support people needed and wanted. People and their relatives were encouraged to be involved in writing their care plans. Support was continually reviewed to ensure it was meeting the person’s needs and outcomes.

The provider and registered manager wanted people to receive good, person-centred care; a value they shared with the staff team. The management team were approachable and ‘hands on’ in the support they provided. Staff felt supported and valued in their role.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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 26 October 2016).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach in relation to the governanc

Inspection carried out on 22 August 2016

During a routine inspection

Holcombe House is a domiciliary care agency owned by Vision Homes Association. It provides supported living services to people in their own homes. At the time of our inspection six people were receiving personal care from the agency.

The inspection of this service took place on 22 August 2016 and was announced

There was a registered manager in post and they were present at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, registered managers 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 were supported by staff who knew how to keep them safe and free from harm. They knew how to recognise and report any risks, problems or potential signs of abuse.

People were supported to live full and independent lives. Risks were assessed prior to activities taking place and guidelines were developed to ensure that people could learn new skills safely. Regular reviews ensured that risks were updated as people achieved their goals.

Some people required support to take their medicines. They were protected by safe systems in place for administering, storing and recording medicines. Robust training was in place to enable staff to safely support people to take their medicines when required.

People were supported by sufficient staff to meet their needs safely and effectively. People received flexible and responsive support. Staff were recruited through safe recruitment practices meaning that only people suitable to work in the role were appointed.

People were supported by staff who had the knowledge and skills to provide effective support. They received good training opportunities and training had been developed around the individual needs of the people who used the service. Staff competency was regularly reviewed and knowledge was updated to ensure it continued to reflect current best practices and legislation. Staff felt very well supported by the registered manager and their colleagues.

Staff understood their roles and responsibilities and worked well as a team to ensure people’s needs were met. People’s rights were protected under the Mental Capacity Act 2005 and staff understood how to protect people’s human rights. The registered manager and the staff team were committed to offering a service that was centred on meeting people’s individual needs. People were offered choices as to how they lived their lives and staff recognised the importance of people having the right information and support to enable them to make their own decisions

People received support to ensure they enjoyed a balanced and nutritious diet. Staff worked with healthcare professionals to ensure people’s continued good health and wellbeing.

People were supported by staff who were caring and understood the importance of delivering person centre care that promoted and developed people’s independence. People’s privacy and dignity was respected as was their individuality, which was recognised and celebrated. People were supported to maintain and develop positive relationships with people who were important to them.

People enjoyed living the lives they chose and this involved having active social lives. Activities were developed around individual preferences, likes and hobbies. Staff recognised the importance of social engagement and contact and encouraged it in daily planning. Staff were creative in developing activities designed around people’s abilities, cultures and preferences.

People who used the service, and their friends and relatives, shared information effectively with the registered manager and the staff team to ensure they received a responsive service. People told us they were able to raise concerns and felt these would be acted on by the registered manager. The provider had a system t

Inspection carried out on 19 December 2013

During a routine inspection

Holcombe House is the office from which Vision Homes runs its domiciliary care service for people with learning disabilities. At the time of our visit, the service was providing support for two people twenty four hours a day in their own homes.

We were not able to speak with either of the people who received a service because of their disabilities, but we did speak with the relative of one. They were very pleased with the service. They told us, “It’s as good as it gets”, and that it was, “An absolutely positive experience”.

We found that staff supported people to be as independent as possible. Staff understood the people they cared for very well and respected their decisions and choices.

Care plans were very person centred and had been produced with input from the people concerned and their relatives where appropriate. We saw good evidence of regularly reviewed risk assessments to help keep people safe.

We found that people who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent it from happening.

We saw evidence of a good induction programme for new members of staff and a comprehensive package of ongoing training for all staff.

We were satisfied that the provider had appropriate systems in place to monitor and assess the quality of the service it provided.

Inspection carried out on 26 October 2012

During a routine inspection

We visited the office and looked at records about staff and the running of the agency. We looked at records of the three people who used the service. We spoke with their representatives as people were unable to tell us their views. We spoke with three managers, the provider’s human resource department and three staff.

People’s relatives were complimentary about the service and told us that people felt safe with the staff. Relatives were involved in care reviews and meetings to make best interest decisions. They commented, “X leads an active life”, “X's home is always clean”, “The staff have a good attitude and are well trained”, and "Good financial records are kept."

Individual needs were met as people preferred, respecting their lifestyles, interests and beliefs. People’s health and wellbeing was monitored and staff had specialist training to meet people’s health needs. Managers carried out regular spot checks to ensure that people were appropriately cared for and hygiene standards were maintained.

Staff worked in dedicated teams and people helped to choose their staff. The provider made appropriate checks that staff were safe and fit for their roles before they started to work with people. Staff had ongoing training and were confident about reporting concerns of abuse should they arise, to managers and other agencies. Managers acted upon and staff learned from comments or complaints people and their representatives had made.

During a routine inspection

Due to the needs of three people using the service not everyone was able to share their experiences of the service that they receive. We spoke with one person who receives a service, two relatives of the other two people and four staff. People were very positive about the service. One person indicated that he likes the staff and they help him to maintain his independence. People we spoke with told us that a full needs assessment was undertaken prior to their relative being offered a service. They said they were fully involved in the development of the support plan, which is regularly reviewed in accordance with the person’s changing needs. One person told us, “They do a really good job. The staff team are very good and they have a great deal of expertise in my relative”. Another person said, “They are meticulous about my relatives care and diet. He is looked after absolutely fantastically. I’ve not seen him so happy in years, they are wonderful”. People confirmed that staff respect privacy and dignity when providing personal care and any concerns are swiftly dealt with in the best interests of the people using the service. They described communication between them and the agency as “excellent”. One person said, “They are very approachable, it works wonderfully. I’m chuffed to bits”.

Staff told us that they enjoy working for the service and that they are provided with lots of training opportunities to develop their skills and knowledge to effectively support people. They considered people’s needs are well met and they have sufficient time to undertake their duties. They told us that support plans are reflective of people’s needs and are regularly updated. They told us that they receive good support from the management team and have developed positive working relationships with the people they support, their relatives and professionals. One person said, “I love it, I have a fabulous job. The organisation treats individuals as individuals and support the staff to maintain that. I’m proud to say who I work for”. Another person said, “It’s the best company I have ever worked for in terms of training, which has developed my confidence. They promote independence and allow service users to take control of their own lives”.