HF Trust - Hollycroft

HF Trust- Hollycroft is a residential care home providing accommodation and personal care for 7 people with learning disabilities and/ or autism aged 18 and over at the time of the inspection. The service can support up to 8 people.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 8 people. This is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

The provider had not ensured that there were always adequate staffing levels to ensure people were safe and their needs were met. During weekends there was often only one staff supporting up to seven people one of who required one to one support.

Staff did not always ensure food safety processes were followed, we found that food was not stored safely in communal fridges and food labels did not display when food had to be used by.

Incident records were unclear and staff were not aware of any policy to follow in relation to recording and reporting incidents and accidents. Incident and accidents were not clearly analysed and assessed to reduce risk and improve care for people.

People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. The provider was not following guidance in relation to making decisions for people who were unable to make decisions for themselves. Where people were found to lack capacity to make a decision regarding the care they received, best interest discussions or meetings did not take place to ensure decisions made for people were in their best interests.

Audit systems within the home were not effective in identifying areas of concern and where areas had been identified action was not taken in a timely manner to improve the service of care for people. Care people received was not outcome based and their care was not effectively reviewed to improve where necessary.

People had care records in place for staff to follow however it was unclear when records had been reviewed and updated and many staff had not read people’s care plans since they started working for the service up to 5 years ago. This meant that the provider was not ensuring staff were following consistent approaches and keeping up to date with peoples needs, wishes and preferences.

People were positive about their care. One person told us, “I love it here, my favourite thing is the staff.”

People were supported with kindness, respect and compassion by a staff team who knew and treated people as individuals. There was a focus on people making choices about their support and the staff team promoted people to be as independent as possible. People received personalised care and were communicated with in their preferred communication methods.

People were supported to take part in community-based activities and to take part in daily living skills in the home. Staff members encouraged people to try new things and to be involved in choosing how they spent their time.

People were protected from harm and abuse, by systems put in place at the service. People had assessments in place which enabled them to take positive risks.

People's care was based on an assessment of their needs and their choices. Staff had access to training and support. People were supported to regularly access health care services to maintain their wellbeing.

People were positive about the way they were supported with food and drink, and how they were involved in cooking and preparing meals. People were supported to see health care professionals where this support was needed.

People and their relatives were encouraged to feed back about their care and support and were involved in the service delivery. The registered manager and the staff team worked with other organisations to ensure good outcomes for people using the service. People were positive about the management of the service.

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 27 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the governance of the service and in the way that staffing levels are being managed at this inspection

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

HFT Trust Hollycroft provides accommodation and personal care for up to eight people with learning disabilities. At the time of the inspection, there were seven people being supported by the service.

The service has a registered manager in place. 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.

There were risk assessments in place that gave guidance to staff on how risks to people could be minimised and how to safeguard people from the risk of possible harm.

The provider had effective recruitment processes in place and there were sufficient staff to support people safely. Staff understood their roles and responsibilities and would seek people’s consent before they provided any care or support. Staff received supervision and support, and had been trained to meet people’s individual needs.

People were supported by caring and respectful staff who knew them well. Relatives we spoke with had described the staff as kind and caring. People were supported to go into the community and pursue their interests.

People had been assessed, and care plans took account of their individual needs, preferences, and choices. Staff supported people to access health and social care services when required.

The provider had a formal process for handling complaints and concerns. They encouraged feedback from people and acted on the comments received to continually improve the quality of the service. The provider also had effective quality monitoring processes in place to ensure that they were meeting the required standards of care.

Below is a summary of what we found based on the evidence gathered during our inspection carried out on 15 April 2014. This included speaking with people who used the service and members of staff who supported them and by looking at records. The detailed evidence that supports our findings can be read in the full report.

Is the service safe?

People were provided with care and support in a way that promoted their dignity and independence. One person who lived at the home told us, 'They [staff] help me learn and do things for myself. They help me do things I want to do. They helped me to use the bus. Once I got on the wrong one and went round and round for two hours. My phone was off so they [staff] couldn't ring and help me. I learnt a lesson from that and keep my phone on now.'

We saw that staff treated people with respect and kindness while delivering appropriate levels of care and support that met their individual needs and welfare requirements.

We found that appropriate standards of cleanliness and hygiene had not been maintained in all areas of the home. We saw that carpets in some areas and toilet bowls located in bathrooms and toilets on the first floor were poorly maintained and had not been cleaned properly. This meant that people had not been protected against the risks associated with health care related infection.

We checked records which showed that effective recruitment policies and procedures were in place to ensure that staff employed at the home were of good character and appropriately skilled to meet people's needs. This included carrying out appropriate checks before staff began work.

Is the service effective?

People's health and care needs had been discussed with them and they were involved in the planning and delivery of the care and support they received.

Everybody we spoke with told us they were happy living at the home and with the levels of care and support provided. One person said, 'I like living here. They [staff] are really nice. They help me go to the dentist and doctor if I need them. They are good. They take me shopping and help me with house jobs and cooking. They help me with the oven.'

Is the service caring?

We saw that staff treated people who lived at the home with respect and dignity. People were provided with appropriate levels of information and support to help them express their views and make decisions about the care they received.

We looked at care records and support plans which showed that people's needs and preferences had been assessed, documented and reviewed. They were personalised and gave staff clear guidance about the care and support people needed.

Is the service responsive?

We looked at care records which showed that people's views and preferences had been taken into account in the planning and delivery of the care and support they received. One person who lived at the home said, 'I can do what I want. I can use the computer or do stuff in my room or go out.'

We saw that people had been supported to access a wide range of facilities and activities appropriate to their needs in the local community. These included enrolment on college courses and regular visits to leisure, resource and activity centres where they were encouraged and supported to take part in activities of their choice. This meant that care and support had been planned and delivered in a way that took account of people's individual needs and personal circumstances.

The provider had a complaints and compliments policy and procedure in place. We saw that people who lived at the home had been provided with guidance about how to make a complaint. The information provided was in an 'easy read' format with words, symbols and pictures appropriate to their communication needs. People told us they knew how to make a complaint if the need arose.

Is the service well led?

Staff told us they were clear about their roles and responsibilities. They were knowledgeable about the care and support needs of people who lived at the home.

We saw that people had been supported to access other health care facilities in their local community wher necessary and appropriate. This included supporting people to make appointments with and to attend GP's, dentists and chiropodists.

We found that the provider had put systems in place to assess and monitor the quality of services provided and to identify, assess and manage risks posed to the health, welfare and safety of people who lived at the home.

We found people's needs had been assessed and appropriate support plans and risk assessments were in place. We found people's support plans were reviewed regularly and when people's needs changed. Where necessary, they were appropriately referred to other health and social care professionals.

People's nutritional needs were met and their choices were respected. The provider had effective medicines management systems in place. The provider had effective staff support and training processes.

However, we found some areas of the home were not sufficiently clean to protect people who used the service from the risks associated with the spread of infection.

Records showed that people, or their representatives, had been as involved as they wanted to be, or were able to be, in making decisions about how they lived their lives, and about how the home was run. Care records showed evidence that people had been involved in making decisions. However there was insufficient evidence that people's decision making capacity had been formally assessed as required by the Mental Capacity Act 2005.

Care and support plans showed that the person was at the centre of their care and support. The plans gave staff detailed guidance on the ways in which each person preferred to be supported. Assessments of any risks to people were carried out so that people were supported to be independent but kept as safe as possible. Each person's healthcare needs were met.

The premises were maintained well and records showed that safety, in particular fire safety, was closely monitored.

The provider had a complaints procedure in place. People told us they would be happy speaking with staff or the manager if they wanted to complain, but two people we spoke with told us they had never needed to.