Archived: The Holt

The Holt is a care home providing care and support for people who are living with autism. At the time of our inspection 6 people were using the service.

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

There was a welcoming environment. We saw many positive interactions between staff and people. Relatives we spoke with told us they were confident that people were safe living at the service.

People had significant communication needs. People used body language, gestures, sounds or pictures to communicate, some people could use a few key words to communicate their needs. Staff knew and met people's individual communication needs well.

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.

Medicines were managed safely by suitably trained staff. There were effective systems in place to protect people from harm and staff understood their responsibilities to report any concerns. There were sufficient numbers of staff to respond promptly to people’s support needs. Recruitment processes enabled the provider to make safe recruitment decisions.

Staff felt supported and received training to ensure they had the skills and knowledge to meet people’s needs. People were supported to maintain a healthy diet and had a choice of different meals. Where special dietary requirements were needed staff followed recommendations made by healthcare professionals.

There were a range of individualised activities available to people. Care plans contained information that enabled staff to meet people’s needs and value people as individuals. People were confident to raise concerns. All complaints were dealt with in line with the provider’s policy.

The management team and provider promoted an open culture that valued everyone. Staff felt valued and were positive about the improvements that had been made at the service. There were effective systems in place to monitor and improve the service.

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 28 June 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.

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.

The provider had moved their registered managers around their services. The new manager was registered at another of the provider’s services and was in the process of becoming the registered manager of the Holt and deregistered for the other service. They had worked at the service since January 2017. Throughout the report, we refer to the new manager as the manager.

People had significant communication needs. People used body language, gestures or sounds or pictures to communicate, some people could use a few key words to communicate their needs. Staff knew and met people’s individual communication needs well.

There were sufficient staff to keep people safe. There were recruitment practices in place to ensure that staff were safe to work with people.

People were protected from avoidable harm. Staff received training in safeguarding adults and were able to demonstrate that they knew the procedures to follow should they have any concerns.

People's medicines were administered, stored and disposed of safely. Staff were trained in the safe administration of medicines and kept relevant and accurate records.

There was information about risks to people and how to manage these. Risk assessments were in place for a variety of tasks such as personal care, use of equipment, health, and the environment and they were updated regularly. The manager ensured that actions had been taken after incidents and accidents occurred.

People's human rights were protected as the manager ensured that the requirements of the Mental Capacity Act 2005 were followed. Where people were assessed to lack capacity to make some decisions, mental capacity assessments and best interest meetings had been undertaken. Staff were heard to ask people’s consent before they provided care.

Where people's liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person's rights were protected.

People had sufficient to eat and drink. People were offered a choice of what they would like to eat and drink. People's weights were monitored on a regular basis to ensure they remained healthy.

People were supported to maintain their health and well-being. People had regular access to health and social care professionals.

Staff were trained and had sufficient skills and knowledge to support people effectively. There was a training programme in place to meet people's needs. There was an induction programme in place which included staff undertaking the Care Certificate. Staff received regular supervision.

People were well cared for and positive relationships had been established between people and staff. Staff interacted with people in a kind and caring manner.

Relatives and health professionals were involved in planning peoples care. People's choices and views were respected by staff. Staff and the registered manager knew people's choices and preferences. People's privacy and dignity was respected.

People received a personalised service. Care and support was person centred and this was reflected in their care plans. Care plans contained sufficient detail for staff to support people effectively. People were supported to develop their independence.

There were activities in place which people enjoyed.

The home listened to staff and relative's views. There was a complaints procedure in place. There had been four complaints since the last inspection which had been resolved.

Staff told us they felt supported by the manager and felt the management was approachable and responsive.

There were robust procedures in place to monitor, evaluate and improve the quality of care provided. Staff were motivated and aware of their responsibilities. The manager understood the requirements of the Care Quality Commission (CQC) and sent in appropriate notifications.

People had their needs and wishes assessed and recorded in order to ensure that the home met their individual needs.

Each person had a detailed person centred plan of care in place. The plans included people's individual needs and choices and also recorded their health and emotional healthcare needs.

We spoke with staff and reviewed records that showed us that there were processes in place to identify and report any suspected abuse and care was being planned and delivered in a safe manner.

The staff team were properly trained to meet the needs of the people they were supporting. They were supervised and appraised and were well supported by the manager.

Comments from staff included. "Our job is to support people well and keep them safe and happy. We work as a team and know the people we are supporting very well."

There were procedures in place to audit the quality of care being provided and families told us that they were involved in the process.

Comments we received from family members included. "X is very happy indeed. I like the fact that it feels like a proper home. The people living with my daughter are a good mix and they have lots to do'.

Care plans provided clear details about the care and support each person needed which included individual choices of each person.