We carried out a review of the data available to us about Hurst House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Hurst House, you can give feedback on this service.
Hurst House is a residential care home providing personal care to adults living with learning disabilities and autism. The service can support up to 10 people and was fully occupied at the time of the inspection.
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
We received extremely positive feedback about the exceptional care and how the support people received positively impacted on their lives. People, relatives and professionals all were extremely positive about the caring and responsive approach of the staff. There was evidence that people achieved good care outcomes and we were provided with numerous examples of this.
People received exceptionally personalised care and support which met their needs, reflected their preferences and promoted their wellbeing. People's care and support had been planned and developed in partnership with them. People were regularly consulted about their views of the service. People were supported by staff who knew them very well. Staff were exceptionally skilled in understanding how to support people to maximise their communication and opportunities. People's independence and right to privacy were consistently respected. People and their relatives expressed they were very happy with the care and support people received. Staff spoke with passion about the people they supported, and were committed to deliver good care.
We found people were confident to approach staff for support and appeared relaxed around them. Relatives told us people were safe and our observations confirmed this. Staff understood the importance of safeguarding and were able to tell us what they would do if they had concerns about a person's wellbeing. There were sufficient staff with the skills and knowledge to give people the support they needed, at the right times. People received their medicines as prescribed from appropriately trained staff. The service was very well-maintained.
People were treated with dignity and respect and their independence was promoted. People and their relatives said staff were very kind and caring. There was a happy family atmosphere at the home. People were encouraged to retain and gain independence, for example by involvement in daily living tasks where possible. People were closely involved in the development and updating of their individual care plan and met with staff on a regular basis to discuss and agree any changes.
Staff were caring and friendly and supported people with kindness and compassion. Staff had an empowering attitude to support people's personal development, and each person was supported in a way that was individual to them. Staff received training to ensure they had the skills they needed to support people with complex needs. Staff were highly motivated to access training and told us that they were well supported.
People had complex needs and demonstrated behaviour that may challenge services. People received care that was based on best practice guidelines that met their individual needs and successfully reduced instances of incidents within the service. Comprehensive assessments were made before people began using the service. Staff communicated effectively with relevant professionals to ensure people received the healthcare support they required. Staff supported people to buy, prepare and cook food. 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 supported this practice. Staff were highly motivated to access training and told us that they were well supported.
People, their relatives, and professionals felt the service was well run and commented on the positive approach of the management team. Staff told us they felt the registered manager was approachable and they felt valued. People, relatives and staff were given opportunities to share their views about the service. The provider carried out regular auditing to ensure the quality of care provided was good. There was a culture of continuous learning, which was driven by the management team.
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 11 July 2017).
Why we inspected
This was a planned inspection based on the previous rating.
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.
We carried out this inspection over two days on the 24 and 31 May 2017. The first day of the inspection was unannounced. At the last comprehensive inspection in March 2015, we identified the service was not meeting all of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service did not consistently follow safe practice around the administration, storage and disposal of medicines. People's wishes and preferences were not always being taken into account when their care was planned and people’s privacy and dignity was not fully respected. At this inspection, we found the provider had made the required improvements.
Medicines were administered safely and people received their medicines on time. There were sufficient staff available to meet people’s needs and staff were available and visible throughout our visit.
Before people moved into the home, a risk assessment was carried out to ensure any potential risks around the person’s day to day living were identified. Risk assessments and support plans to mitigate risks were regularly reviewed to ensure they were relevant and gave up to date guidance to help staff keep people safe. Staff were knowledgeable about keeping people safe and were aware of their responsibilities in protecting people from harm.
Staff received mandatory training as set by the provider and also specific training based around people’s individual needs. This enabled a person centred approach to supporting people according to their wishes and enabled positive outcomes for people. Staff received appropriate support through a system of supervision and appraisal.
We observed people were well supported with their nutrition and hydration needs and made choices about the variety of food on the menu.
People and families told us the staff were caring, attentive and respectful towards them. We observed this was the case throughout the inspection.
For each person there had been very positive outcomes with progress made in their emotional wellbeing, communication, daily living skills and independence. A social care professional told us the team at Hurst House went to great lengths to assist one person with their preferred living arrangements, to the extent that a new annexe was built onto the main house for this person to live. Due to the outstanding level of care and support people received, three people were able to stop taking medicines used to treat behavioural conditions which had a positive impact on their wellbeing.
The support and care which people received was responsive to their needs and supported people to realise their ambitions for example, one person was supported to be able to travel widely to different countries which they had always wanted to visit. People were at the forefront of decision making around their care and support and were empowered to reach their full potential. The quality of life for one person who had recently moved into the home had improved dramatically due to the support they had received. The person was now sleeping well, showering on a daily basis, going out into the community on a regular basis, enjoying shopping trips for new clothes and meals out.
The home had been refurbished throughout and gave people more usable space to meet their needs, such as a quiet room. People liked the décor and furnishing and furniture were of a good quality.
There was a system of audits in place to assess the safety of the service and quality of care which people received. People were involved and supported to express their views through a monthly meeting with their keyworker and other home meetings.
Hurst House is a residential care home providing personal care for up to ten people who have a learning disability or mental health need. At the time of our inspection there were nine people living at Hurst House.
The inspection took place on 17 March 2015 and was unannounced. The service had a registered manager who was responsible for the day to day operation of the home. 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 and associated Regulations about how the service is run. The registered manager was present on the day of the inspection.
People were not always safe. The service did not consistently follow safe practice around the administration, storage and disposal of medicines. There were some practices which we found institutionalised. This resulted in people's privacy and dignity not being fully respected. People's wishes and preferences were not always being taken into account when their care was planned.
Staff worked closely with health and social care professionals for guidance and support around people’s care needs. The care records demonstrated that people’s care needs had been assessed and considered their emotional, health and social wellbeing. People’s care needs were regularly reviewed to ensure they received appropriate care, particularly if their care needs changed.
Training was available to ensure that staff had the necessary skills and knowledge to be able to support people appropriately. There were systems in place to ensure that staff received support through supervision and an annual appraisal to review their ongoing development.
There were clear values about the quality of service people should receive and how these should be delivered. The registered manager and staff told us they valued the people they cared for and strived to provide a high quality of care.
We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. Which corresponds to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.you can see what action we told the provider to take at the back of the full version of this report.
The home ensured that the food and drink provided was nutritionally balanced and supported the health needs of people. We saw that the provider had identified people's nutritional risks and had implemented effective measures to manage them.
The provider responded appropriately to any allegation of abuse. A number of safeguarding issues had been reported since the last inspection which had been recorded and investigated thoroughly.
People told us that they knew what medicines they were taking and why. We observed medication being administered safely in a way the person chose.
We found that the provider had an effective training and supervision process. This ensured people were safe and their health and welfare needs were met by competent staff.
We read the provider's complaints policy and procedure. This showed that the provider had a clear system for receiving, handling and responding to comments. People told us they were aware of the complaints system and that this was provided in an easy to read format.
People had consented to their care and treatment. Where people did not have the capacity to consent decisions would be made in their best interests. People's needs were assessed and they had individual person centred plans to make sure that their needs were met.
Medicines were managed safely and were given to people individually so that people got the right medication at the right times. There were appropriate medication records and arrangements for obtaining and disposing of medication.
There was an effective recruitment process and all the right checks were made so that new staff were suitable to work with people. All the necessary records were kept for the running of the home and these were stored securely. The records were accurate and fit for purpose so that people received the right care and support and were kept safe.
People were well supported with their health and personal care needs. They received advice about keeping safe and staff took action which reduced the risk of people being harmed. People were given information in ways that they could understand. The home's complaints procedure, for example, had been produced in symbols as well as words.
House meetings were being held when people could express their views and talk about new things they would like to do. People could make choices, such as about the colour schemes for rooms and the meals they would like. People enjoyed watching films and they were very pleased with a new flat screen television which was installed in the home's lounge on the day we visited.