HF Trust - Lympne Place (High Trees and The Beeches)

High Trees and The Beeches are two residential care homes. The services are registered as one location to provide accommodation and personal care for up to 12 people who have a learning disability and other complex needs. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. 12 people were living at the service at the time of the inspection and each had their own personalised bedroom. In both High Trees and The Beeches, people had access to a lounge, dining room, a kitchen, bathrooms and gardens.

The service had a registered manager in post. A registered manager is a person who is 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 2008 and associated Regulations, about how the service is run.

We last inspected HF Trust – Lympne Place (High Trees and The Beeches) in August 2016 when two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. We issued requirement notices relating to safe care and treatment, good governance and a lack of notifications.

At our inspection in August 2016, the service was rated 'Requires Improvement'. We asked the provider to take action and the provider sent us an action plan. The provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. Improvements had been made. We made two recommendations to improve people’s care and support, however, all of the breaches had now been met.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. However, best interest decisions regarding people’s finances had not been recorded. We made a recommendation about this. There was some confusion amongst staff regarding the provider’s policy on supporting people to eat out. Staff had an understanding of The Mental Capacity Act (2005) and any restrictions on people’s liberty had been legally authorised.

There was an open culture and people were encouraged to be as independent as possible. Staff and the registered manager had a good understanding regarding supporting people with learning disabilities. However, the principles regarding person-centred planning (a way of helping a person to plan their life) had not always been followed. Staff had not always recorded goals for people to work towards and did not consistently record what people did or their achievements. We made a recommendation regarding this.

Medicines were now managed safely and stored in people’s individual rooms. Senior staff undertook regular checks and audits of medicines to reduce the risk of errors occurring.

Any risks relating to people’s care and support had been assessed and any action needed to reduce these risks were clearly recorded. When incidents had occurred the registered manager had analysed them and taken action to ensure they would not happen again. Staff knew how to keep people safe and any potential safeguarding incidents had been reported to the local authority safeguarding team. Lessons were learnt when things had gone wrong.

People’s preferences regarding their care and support had been recorded. Staff knew how to support people in the way they preferred. Some people had health conditions such as diabetes and epilepsy and these were stable and managed well.

Staff had an understanding of people’s equality and diversity needs and told us they would challenge discrimination in any form. Staff knew people well and supported them to make their needs known. Some people required assistance to communicate and staff knew how to interpret people’s non-verbal communication. All complaints had been documented and responded to in line with the provider’s policy.

Staff treated people with dignity and respect. People told us that staff were kind and caring. When people’s loved ones had died staff had supported people compassionately.

People had been involved in making decisions about the design and décor of the service. People were able to access their kitchens, whenever they wanted and were supported to prepare meals and drinks of their choosing. People were supported to eat a healthy and balanced diet. Some people required a specialist diet, and this was provided at each meal time. People were supported to keep the service clean and wiped down the surfaces of the kitchen during the inspection.

There was enough staff to keep people safe. Some people received one to one support and this was always provided. People were able to go out and do the things they wanted throughout the inspection. They took part in a range of activities both inside and outside of the service. Staff had received essential training and told us they felt well supported by the management team. Staff had received training in topics related to working with people with learning disabilities. Staff had been recruited safely.

The registered manager was experienced in working with people with learning disabilities and providing person centred care. Staff and the registered manager consulted with other professionals regarding people’s care and received support from the provider to provide consistent care. The service worked in partnership with a range of other agencies such as the local authority safeguarding and commissioning team.

The registered manager had a good knowledge of the regulatory requirements and had informed CQC of any important events that occurred at the service, in line with current legislation. The provider had displayed their rating clearly and legibly on their website and at the service.

The registered manager regularly carried out audits to identify any shortfalls and ensure consistent, high quality, personalised care. Regular health and safety checks were undertaken to ensure the environment was safe and equipment worked as required. Regular fire drills were completed.

People’s relatives, staff and other stakeholders were regularly surveyed to gain their thoughts on the service. These were collated and analysed and the results were displayed within the service so everyone could read them. When areas of improvement were identified, these were acted on and people’s views were listened to.

High Trees and The Beeches are two residential care homes within HF Trust’s Lympne Place grounds. The services are registered as one location to provide accommodation and personal care for up to 12 people who have a learning disability and other complex needs. 12 people were living at the service at the time of inspection and each had their own personalised bedroom. In both High Trees and The Beeches, people had access to a lounge, dining room, a kitchen, bathrooms and gardens.

The service had a registered manager who was present throughout the inspection. 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.

Medicines were not always managed safely or administered in line with current guidance. People received their medicines when they should.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Some people at the service had been assessed as lacking mental capacity to make complex decisions about their care and welfare. At the time of the inspection the registered manager had applied for DoLS authorisations for people who were at risk of having their liberty restricted, some of these had been authorised. The registered manager had not notified the commission of all of these, as is a statutory requirement.

Quality assurance audits were carried out to identify any shortfalls within the service and how the service could improve. Following a restructure of staffing levels by the provider, there was insufficient senior or deputy manager support for the registered manager to have a good oversight of both services, this resulted in shortfalls and gaps.

People’s records were well maintained although not always easy to navigate as they often contained repeated information that could result in staff not fully reading the guidance.

People were supported in a safe environment and risks identified for people were managed in a way that enabled people to live as independent a life as possible. People were supported to maintain good health and attended appointments and check-ups. Health needs were kept under review and appropriate referrals were made when required.

A system to recruit new staff was in place. This was to make sure that the staff employed to support people were fit to do so. There were sufficient numbers of staff on duty to make sure people were safe and received the care and support that they needed.

Staff had completed induction training when they first started to work at the service. Staff were supported during their induction, monitored and assessed to check that they had attained the right skills and knowledge to be able to care for, support and meet people’s needs. There were staff meetings, so staff could discuss any issues and share new ideas with their colleagues, to improve people’s care and lives.

People were protected from the risk of abuse. Staff had received safeguarding training. They were aware of how to recognise and report safeguarding concerns. Staff knew about the whistle blowing policy and were confident they could raise any concerns with the provider or outside agencies if needed.

Equipment and the premises received regular checks and servicing in order to ensure it was safe. The registered manager monitored incidents and accidents to make sure the care provided was safe. Emergency plans were in place so if an emergency happened, like a fire, the staff knew what to do.

Staff encouraged people to be involved and feel included in their environment. People were offered activities and participated in social activities when they chose to do so. Staff knew people and their support needs well. The care and support needs of each person were different, and each person’s care plan was personal to them. People had detailed care plans, risk assessments and guidance in place to help staff to support them in an individual way.

Staff were caring, kind and respected people’s privacy and dignity. There were positive and caring interactions between the staff and people and people were comfortable and at ease with the staff.

People were encouraged to eat and drink enough and were offered choices around their meals and hydration needs. Staff understood people’s likes and dislikes and dietary requirements and promoted people to eat a healthy diet.

Staff told us that the service was well led and that they felt supported by the registered manager to make sure they could support and care for people safely and effectively. Staff said they could go to the registered manager and senior management at any time and they would be listened to. Overall, the registered manager had good oversight of the services and was able to assist us in all aspects of our inspection.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this report.

On the day of our visit there were 12 people residing in the homes, which was its maximum capacity. All the people had varying learning disabilities and autism. We were met by the registered manager for the Beeches, who also managed High Trees.

We looked at whether people and their relatives were able to give consent to care and

treatment, and found that with some limitations people were able to give some consent, and that their relatives were also able to do so. People told us they were happy with the activities they did in the home.

We looked at the care of people in the home and found that people were generally happy with their care, that there was an effective care planning process in place.

We looked at the management of medicines in the home and found an effective process in place to enable the safe provision of medicines.

We looked at how the provider supported the workers and found the provider ensured the staff were trained effectively to carry out their roles. We found that the provider ensured the staff received regular supervision and appraisals.

We looked at the complaints system. We found this to be an effective procedure enabling the provider to manage and respond to any concerns and complaints.