Archived: Hardwick Close

The service was registered to care for eight people with learning disabilities; there were seven people living there on the day of the inspection. Many of the people had complex health needs as well as a learning disability and had very little or no speech. This made it difficult to obtain direct quotes from them; however, we were able to gather evidence of their experience by observations and talking with the staff who cared for them.

There was a registered manager in post. 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 were safe living at Hardwick Close. Staff were trained and understood their responsibility to keep people safe from harm or abuse. Some staff were not clear what the emergency evacuation procedures were for people who required assistance to transfer; and the registered manager said they would review this with staff. Medicines were managed well and there were processes in place to support staff with this.

Staff had the knowledge, skills and confidence to care for people with complex needs. Training was available to keep staff updated with current best practice and staff explained how they benefited from the training they had received. Staff sought consent before they cared for people. People were supported to maintain a healthy diet; and were encouraged to make their own choices. People were supported to attend health appointments in order to maintain their general health.

Staff had positive, caring relationships with people who used the service. Staff were kind and compassionate and took time to listen to people and understood their needs and wishes. Staff promoted peoples independence and demonstrated respect for individuals and their human rights. Staff cared for people with dignity and privacy was respected. People were supported to maintain relationships with friends and family, and visitors were encouraged. People were supported to attend events or activities where they could meet people.

Care plans were person centred and staff clearly knew people’s individual needs, wishes and preferences. People were supported to maintain their interests and participate in activities of their choosing. There was a complaints policy in place in an easy read format; and people or their families were encouraged to share any concerns and make suggestions for improvements to people’s care. The provider conducted annual surveys; and sent newsletters to inform people and staff of recent developments or improvements.

There was visible management and leadership of the service. Staff spoke positively of the support provided by the registered manager; and we could see that people were comfortable in their presence. The registered manager completed audits of processes in the service; and provided data to the provider which fed into their monitoring process. Staff meetings and supervisions took place regularly and areas for improvement were identified and discussed with the team; along with feedback from the provider of the results of their monthly monitoring. The manager responded positively to areas we highlighted during our inspection and said they would include them in their development plan.

We last inspected this service on 29 October 2013. At that time we found that people were not fully protected against the risks associated with administering medicines through lack of training and safe procedures. At this inspection we found that staff training was up to date and procedures had been updated and were being followed. A summary of what we found is set out below.

We used the evidence we collected during our inspection to answer five questions.

Is the service safe?

We spoke with a healthcare professional who was visiting someone in the home. They told us they had been visiting the home for several years.They said the service very rarely contacted them when it was appropriate to do so and told us they had a good relationship with care staff. They said they had no concerns about the quality or safety of the service.

We spoke with three care staff who understood the systems in place to protect people who received care from abuse or neglect. They told us they received training in how to protect people.

We saw individual evacuation plans were posted inside each person's room. These identified the level of support the person needed to evacuate the building in an emergency for example a fire.

One person required the use of a sling to support them when the transferred from the bed to their wheelchair. We saw the sling was checked by care staff twice each day. Care staff had recorded the checks in a register which was kept in the person's room.

Another person experienced seizures. We saw there was a plan displayed prominently in the person's room describing what staff should do if the person had a seizure. The plan had been developed by a healthcare professional who specialised in supporting people with this condition.

There were no Deprivation of Liberty Safeguards (DoLS) in place at the time of our inspection. The Deprivation of Liberty Safeguards are a legal framework designed to ensure that the care people receive does not unlawfully deprive someone of their liberty.

The service had policies in place for managing medicines safely. Care staff followed these and they were audited and checked.

Is the service effective?

We saw one person had a 24 hour positive care passport. The person had a condition which affected their mobility. The positive care passport had been developed for the person by an occupational therapist.

We saw another person had been provided with a communication aid by a speech and language therapist. The 'Smart Speak' aid had electronic buttons illustrated with pictures of what the person wanted to say. When the person pressed the buttons the aid verbalised the person's request.

One person was unable to eat normally and was fed through a tube. We saw there was a procedure in place which staff followed to ensure the person received their food safely. The person had to be fed every few hours. A plan was displayed in the kitchen to remind staff when the person required food.

Peoples, needs were assessed and care plans were reviewed monthly. Care staff reviewed the support provided and identified if any changes to care plans were needed. Risk assessments had been carried out and were reviewed regularly. Care was adjusted if a person's condition meant they required more support.

Care staff had the appropriate training and experience to enable them to carry out their role effectively. Care staff told us they received regular supervision and appraisal. Care staff training was up to date.

Is the service caring?

One person we spoke with showed us photographs of a trip they had made to Disneyland in Paris. They told us it was something they had always wanted to do and care staff at the home had supported them to go.The trip had happened a few months before our inspection but the person was keen to tell us about their experience. They showed us their room which had many souvenirs they had bought there.

People told us they had chosen the d'cor for their rooms and we saw they were decorated according to people's individual taste.

We observed care staff providing support for people. We saw they had a good rapport with people. Care staff we spoke with told us ensuring people were fulfilled was important to them.

Is the service responsive?

The service had obtained advice from a range of professionals at a centre which specialised in supporting people with a learning disability. The service had used the advice provided to develop care plans to support people with complex needs. Specialist healthcare professionals had also trained care staff to care for people with complex needs. These included plans to support people's physical and behavioural needs.

Is the service well-led?

Care staff told us their manager was supportive and approachable. They said the was an open culture and they were able to raise issues for discussion. The manager told us they could access advice from a nurse employed by the provider who had experience of supporting people with a learning disability. They also told us they received advice on health and safety matters when they submitted accident or incident reports.

The manager carried out checks and audited processes for example the management of medicines. When an error occurred they analysed the causes, identified and put in place actions to reduce the risk of a similar error occurring. If an error occurred staff received additional training and their competency was reviewed.

The people and relatives told us that people were involved in choosing their food and drink and their special dietary needs were catered for. One person told us that the food was, 'very nice', and added, 'I help with cooking cakes and buns and chopping up vegetables.' We noted, from reading records and our observations, that people's nutritional needs were being met.

People felt safe and confident with staff administering their medication and said they received their medicines when they were needed. However, systems to ensure the safe management of medicines were not fully adequate.

The people and relatives we spoke with thought that staff had been recruited safely. One relative told us, '[The staff] obviously care for [my relative]. There's a stable staff group.' We found that appropriate checks were undertaken before staff began work.

People told us they knew how to make a complaint and would feel comfortable in doing so. One person said, 'I'd tell staff. I've not been unhappy.' Staff were able to describe how people's changes of behaviour and facial expressions showed if they were unhappy.

The relatives we spoke with said that people's privacy and dignity was respected at Hardwick Close. One relative told us, 'staff give [the person] their [personal] space.' People and their relatives were involved in planning their care. Staff respected people's personal preferences and we were told, and we observed, that people's needs were being met. One relative said to us, 'Nothing is too much trouble for any of the staff'they are wonderful.'

The relatives we spoke with told us they thought that people were safe at Hardwick Close and were well treated by staff. Staff had received training that kept people safe. They, and relatives, told us that staff were well trained to meet people's needs. Records we saw supported this.

People and their relatives were asked for their views, and comments that they made were acted on. One relative told us that staff, 'go above and beyond to meet [the person's] needs.'