Hammonds

About the service

Hammonds is a West Sussex County Council in-house residential care home supporting people who have learning disabilities, physical disabilities and autistic people. Hammonds can support up to 20 people and 16 people were living there at the time of the inspection. Hammonds accommodates people across three separate buildings, each of which has separate adapted facilities. One of the buildings had four rooms for people who stay at the home for short breaks. There is also an administration building which houses offices, a catering kitchen and shared area for group activities.

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

Right Support

Staff did not always support some people to have the maximum possible choice, control and be independent and they had limited control over some areas of their own lives. Some people had limited opportunities to build skills and participate in individual activities. Staff were trying to be more focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life, some work had begun with some people but we were told there were not enough staff to provide this support consistently for everyone. Each person had their own rooms, which were generally personalised to meet their needs and preferences. People had shared bathrooms in two of the houses and only one person held keys for their own room, one other person requested staff to lock and unlock their door. People did not have alternative and accessible door locking systems. The home had outside shared space for group activities but this was not always accessible to everyone and was in places, unkept. For example, the courtyard area was cluttered and some parts of the garden were not accessible to people. The registered manager told us of plans to make the rear garden accessible. At the time of inspection the indoor shared space in the administration building was being used as a staff changing area and storage while a new floor was being laid.

The layout of the service did not promote person centred support, for example main meals were cooked in an area that people did not have access to. People went in and out of other’s homes uninvited, limiting people’s ability to enjoy their home without interruption.

The service worked with people to plan for when they experienced periods of distress so that their freedoms were restricted only if there was no alternative. Staff did everything they could to avoid restraining people. Staff learned from those incidents and how they might be avoided or reduced.

Staff enabled people to access specialist health and social care support in the community. Staff supported people to make decisions following best practice in decision-making.

Right care

People experienced mixed quality of care, some staff spoke over people and talked to each other about people in the presence of others. Not all staff respected people’s dignity, this was something raised in the last inspection and was still happening at this inspection. In contrast most staff were delivering kind and compassionate care. Staff understood how to protect people from poor care and abuse. The service worked with other agencies to do so. People’s care, treatment and support plans reflected their range of needs and this promoted their wellbeing. Staff and people cooperated to assess risks people might face. Staff had begun to encourage people to take positive risks.

Right culture

People did not always lead inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the provider, management and staff. There was mixed understanding or opportunities to apply active support approaches. The provider had not fully considered people’s needs and wishes in the planning and deployment of staff. Some improvements had been made towards person centred support, with more choices being offered and developed understanding of people’s communication needs. Managers and staff were trying to further develop these areas locally within the limitations of the layout and staffing structure of the service.

People received good quality health care, support and treatment because trained staff and specialists could meet their needs. Most staff knew and understood people well but there was a reliance on agency staff who did not always know people.

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 requires improvement (published 20 August 2019) and there were two breaches of regulation. Regulation 9 (Person centred care.) The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, enough improvement had been made and the provider is no longer in breach of that regulation. At the last inspection the provider was in breach of regulation 10 (Dignity and Respect). At this inspection the provider remained in breach of this regulation. At this inspection the provider was in breach of Regulation 17 (Good governance) the provider had failed to assess and monitor the service to include the quality of the experience of people receiving the service. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support right care right culture.

Follow up

We will request an action plan from 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.

Hammonds is a residential care home providing personal care to 14 people who live with a learning disability and/or other health conditions. The service can support up to 20 people.

Hammonds accommodates 14 people across three separate buildings, each of which has separate adapted facilities. One of the buildings had four rooms catered for people who stay at the home for short breaks on a respite basis.

The principles and values of Registering the Right Support (RSS) and other best practice guidance ensure people with a learning disability and or autism who use a service can live as full a life as possible and achieve the best outcomes that include control, choice and independence. The provider had not always consistently applied these values.

The service was a large home and was registered for the support of up to 20 people. 14 people were using the service, two of which were staying for a short break. The numbers accommodated are not in line with 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.

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

Hammonds requires further development to be able to deliver support for people that is consistent with the values that underpin RRS. For example, people did not always identify, review or develop individual support outcomes and aspirations or take part in meaningful activities. People's communication needs were not fully supported to enable them to have maximum control of their lives. There were limited opportunities for independence and community inclusion.

People were not always receiving respectful or dignified support. However, people and relatives spoke fondly about the staff and we observed some positive interactions between staff and people.

People received care and support that was safe. One person said, "I feel safe. Staff help me stay safe. The staff are perfect, I like [registered manager]. If I needed help I would talk to him.” One relative said, “I think [person] is very safe. They have been here over 20 years. I think they (staff) are absolutely wonderful with him. He likes the men especially. I am very, very happy that [person] is there.”

Improvements had been made to the management of medicines and risk assessments around people’s health needs. People were supported by staff who received training and were able to identify and respond appropriately to abuse. There were sufficient staff to meet people's needs.

Training and observation of staff practice ensured staff were competent in their roles. People were supported to have 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.

People enjoyed a healthy, balanced and nutritious diet based on their preferences and health needs. One relative said, “It looks nice. No complaints. It’s food he can eat and digest. He’s put on weight and looks good.”

Many staff had worked at the service for a long time. Staff told us they felt they were overall well supported by the management and worked together effectively as a team.

A system of audits monitored and measured aspects of the service and were used to drive improvement. The management team worked proactively with the NHS and Social Services to proactively meet peoples care needs.

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 requires improvement (published 22 August 2018) and there was one breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, enough improvement had been made and the provider is no longer in breach of that regulation. However, two new breaches of regulation were found at this inspection. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to person-centred care, dignity and respect at this inspection. Please see the action we have told the provider to take at the end of this report.

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.

Hammonds is registered to provide residential care for up to 20 people who live with a learning disability and/or other health conditions. Accommodation is provided for 16 people on a permanent basis; four rooms cater for people who stay at the home for short breaks on a respite basis. At the time of the inspection, there were 14 permanent residents and two people staying on a respite basis. The home provides accommodation in three separate units which are linked by a courtyard and external walkways. A unit called The Lodge accommodates people for short breaks, each room has en-suite facilities and overhead tracking for safe moving and handling. Each unit has a lounge and dining area and kitchen facilities. There is a small sensory room. Some people have lived at Hammonds for many years.

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 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.

Hammonds is a service for people with a learning disability including autism. The care service has not been developed and designed in line with the values that underpin the Registering the Right Support CQC Policy and other best practice guidance. It is very difficult for large services to meet these standards. However at Hammonds we observed that the service had a good understanding of person-centred care and how this was provided for people living at the home. We have made a recommendation for the home to familiarise themselves with the Registering the Right Support CQC Policy. You can see what action we told the provider to take at the back of the full version of the report.

During the inspection, we saw that CQC had not been notified of some incidents and of DoLS authorisations. Following the inspection the registered manager acted swiftly to submit the DoLS authorisations to the CQC. This is a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

During our visit the registered manager told us that risk assessments are going to be improved. We told the registered manager we saw an overstock of medicines and identified medicines records need to be better. Although we saw improvements were needed to be made to risk assessments and medicines we did not see this having an impact for people living at Hammonds. We have made recommendations about the management of medicines and risk assessments. You can see what action we told the provider to take at the back of the full version of the report.

During the inspection the service was found to be very caring and staff knew people very well. Staff knew how to support people and encouraged people to pursue activities and interests. The premises were adapted to keep people safe and personalised to reflect their interests and likes such as decoration of people’s rooms. Staff told us they felt supported by management however supervision was not done regularly in accordance with their policy. We have made a recommendation for the home to follow their supervision policy. You can see what action we told the provider to take at the back of the full version of the report.

We saw that people's consent was sought, wherever possible, before offering care and support. We observed that the care given was safe and appropriate and based on effective care planning and risk assessments. This meant that people's individual needs were met and preferences were taken into account.

People were protected from the risks associated with poor medication management. We saw that medicines were properly handled and administered in line with the providers policy. We noted that there were enough skilled and experienced staff to do this and to deliver effective care. We also found that systems were in place to make a complaint about the service if people needed to.

A Health Professional we spoke with told us 'staff are very empowering I really like this home '.

We saw that people's privacy and independence were respected, people experienced safe and effective care based on detailed care plans and risk assessments that documented people's preferences and met individual needs.

People using the service were protected from abuse as they were supported by a staff team who had appropriate knowledge and training on safeguarding adults. We saw policies on whistle blowing and safeguarding.

We saw evidence that staff received ongoing training and supervision which provided them with the skills and knowledge to meet the needs of the people they were supporting.

The Provider had effective systems in place to monitor quality assurance and compliance.