Archived: Care Management Group - 16 Hawthorn Crescent

The service had a registered manager in post. The current manager was registered in May 2016. 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.

16 Hawthorn Crescent is a 'care home.' People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home is situated in a residential area of Worthing, adjacent to another service run by the provider. The two services share a garden to the rear of the property.

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.

16 Hawthorn Crescent is registered to support up to four people with learning disabilities, physical disabilities or other complex needs. At the time of the inspection there were four people living at the home. The home provided personal care and support to male adults of various age groups.

16 Hawthorn Crescent is a detached property with a communal area over one floor. There was a large kitchen and dining area that also served as a communal area for people who used the service. There was a small purpose-built extension adjacent to the kitchen that served as an office for the registered manager. The property held four ensuite bedrooms, a laundry room and staff bathroom.

At the last inspection on 29 March 2016, the service was rated as good in the areas of Effective, Caring and Responsive and Well-led. The service was rated as requires improvement in the area of Safe but the overall rating for the service was Good. Following the last inspection on 29 March 2016, we asked the provider to complete an action plan to show us what they would do and by when to improve the key question of Safe to at least good. At the last inspection we found that the provider was not fully mitigating the risks to people’s wellbeing and safety, specifically around bowel monitoring. We also found that some information relating to each person’s needs and risks to their health had not always been consistent and up-to-date. The provider had sent us an action plan as to how they intended to improve this area. At this inspection we found the evidence continued to support the overall rating of Good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People received safe care and treatment with risks to their health and safety being properly assessed and mitigated.

People’s medicines were well managed by staff at the service.

Staff knew people well and had a good understanding of their needs and how best to support these to achieve the desired outcomes. We saw staff treating people with dignity and respect and being patient and considerate when providing different elements of care.

People were involved in their care and support and were encouraged to be active in the running of the service.

People’s health needs were monitored well and staff were responsive in seeking treatment and maintaining regular health appointments.

People were supported to have sufficient food and drink and were involved in the decisions about the food they ate.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible, the policies and systems support this practice. Staff understood how people's capacity should be considered and had taken steps to ensure that their rights were protected in line with the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS).

The service was well led by the registered manager who has support from the provider in ensuring that quality assurance systems were effective.

Care Management Group - 16 Hawthorn Crescent is a residential care home that provides care and support to a maximum of four people who have learning and physical disabilities. The home is situated in a residential area of Worthing, adjacent to another service run by the provider. The two services share a garden and minibus. At the time of this inspection there were four young adults living there.

The service did not have a registered manager in post. Although the registered manager had left, they had not yet applied to deregister with the Commission. A new manager had started in post at the end of October 2015 and was in the process of registering with us. 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.

People did not always receive safe care and treatment because recorded information on risks to their health was not always consistent and staff lacked guidance on how to mitigate known risks in relation to constipation.

People received their medicines safely, but some liquid medicines and creams had not been dated on opening. This was quickly addressed before we left the service.

People felt safe at the home. There were enough staff with the skills and experience to support people safely. Pre-employment checks were completed before new staff began work. All of the staff we spoke with told us they enjoyed their work and felt well-supported by the manager.

Staff knew people well and helped them to make decisions relating to their care and support. We observed staff took time to discuss options with people and respected their wishes. Staff understood how people’s capacity should be considered and had taken steps to ensure that their rights were protected in line with the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). People were involved in deciding the menu and getting the weekly shop. Each person was supported to eat a healthy and balanced diet that reflected their individual needs. The manager had ensured that people had access to regular healthcare support such as the dentist and chiropodist.

People were involved in determining the support they received and worked closely with their keyworkers to make plans for future activities and goals they wished to achieve. Staff took prompt action when there were changes in a person’s support needs or behaviour. There were also plans to make improvements to the premises, such as installing a new kitchen, to make it easier for people to participate in everyday tasks. There were regular residents’ meetings where people were able to share ideas and make suggestions. There was a friendly and upbeat atmosphere at the service. The manager and staff team were approachable and people told us they could speak up if they were worried.

The manager and provider had a system to monitor and review the quality of care delivered and the safety of the service. Where improvements had been identified, action plans were in place and demonstrated that audits had been used effectively to make improvements to the quality and safety of the service.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

We met three people and talked with one person, who told us it was 'good here, I like the staff'. We spoke with a visiting Qualifications and Credit Framework (QCF) assessor, who said 'They are really helpful here. They get people using the service involved.'

We spoke with the manager and two staff. One member of staff said 'It's open and relaxed. People have shaped their own lives themselves.' Another told us 'The staff are really motivated. There is a lot of activity for people.'

We reviewed care records for two people using the service. Care and support were planned and delivered so as to ensure the welfare of people using the service and to meet their individual needs.

People were supported appropriately with their nutritional needs and were helped to make choices.

We found that people were protected from the risk associated with unsafe management of medication because there were effective systems in place.

People using the service benefited from a staff team who were well trained to do their job. Staff had not had regular recorded supervision.

In this report a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still on our register at the time.

People had personalised plans of care and support, while lacking capacity people were supported in decisions about their care and support. We saw records that showed plans were followed on a daily basis, and that interventions were informed by up to date guidance and best practice. There was clear guidance to support staff dealing with emergency situations.

People told us they felt safe at the home. Staff had been trained in safeguarding and had a good understanding of adult protection issues related to the needs of service users.

Good relations were observed between staff and residents. Staff said they felt well supported and valued by the organisation running the service.

There were good arrangements in place to monitor and assess the quality and safety of the service. There were a range of methods to engage service users, families and other stakeholders in the running of the home. There was a complaint procedure and staff and management were supportive toward complainants.