4 August 2017
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection visit took place on 22 and 28 February 2017 and was unannounced on the first day. The inspection was carried out by one adult social care inspector. Prior to the inspection we reviewed the information we had about the home, including notifications of events the home is required by law to send us.
During the inspection we spoke with or spent time with nine people who lived in Hannahwood Transitions. We also spoke with the registered manager and seven members of staff, including a deputy manager, a nurse and the activities coordinator. We spoke with six people’s relatives and although we sought feedback from a number of healthcare professionals we only received detailed feedback from one of them.
One person who lived at the service was able to communicate with us in detail about their experience of the home. Other people had communication difficulties. On this occasion we did not conduct a short observational framework for inspection (SOFI) during our inspection. SOFI is a specific way of observing care to help us understand the experience of people who could not talk to us. We did not do this as people were coming in and out of the service on a regular basis taking part in their daily lives. We did however use the principles of SOFI when carrying out observations in the service.
We looked around the service, spent time with people in the main building and two bungalows. We spent time with people within their homes, in the kitchens, living rooms and in their bedrooms where we were invited. We observed how staff interacted with people throughout the inspection. We spent time with people over the lunchtime and evening meal periods.
We looked at the way in which people were being supported and looked at the way in which medicines were recorded, stored and administered to people. We also looked at the way in which meals were prepared and served. We looked in detail at the care provided to five people, including looking at their care files and other records. We looked at the recruitment files for three staff members and other records relating to the operation of the home such as risk assessments, policies and procedures.
4 August 2017
Hannahwood Transitions is a residential care service providing accommodation and support to young adults with physical disabilities and associated sensory, communication and learning difficulties.
The service is registered to provide support with accommodation and nursing care for a maximum of 23 people within five purpose built bungalows. Hannahwood Transitions is located on the same site as Dame Hannah Rogers’ school and is run by the Dame Hannah Rogers Trust which is a charity organisation supporting children and adults with physical and learning disabilities.
The home had a registered manager. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
We carried out a previous inspection of this service on 13 October 2014 where we rated the service as ‘good’.
This inspection took place on 22 and 28 February 2017 and was unannounced for the first day of the inspection. At the time of our inspection there were 13 people living in Hannahwood Transitions. The service met people’s different needs by offering full time residential care, including some nursing care, temporary respite care and day services. People using the services had a range of needs. All the young adults who were living at Hannahwood Transitions at the time of our inspection had learning disabilities and complex physical disabilities. Some people required more significant support than others and almost all people were wheelchair users. People living at the service were widely referred to by relatives, staff and the registered manager as ‘young adults’ and we have therefore used this on a number of occasions through the report.
Strong values underpinned the work carried out at Hannahwood Transition. The Trust’s mission statement was “Our mission is to empower, advocate and enrich the lives of children and adults with disabilities”. Their core values included “Providing education, training, advocacy, work opportunities, care and other support services for children, young people and adults in needs, their families, carers and associated professionals”.
Some comments made by relatives included “It couldn’t be any better” and “Dame Hannah Rogers is an amazing place for young adult with complex needs, (Name of loved one)'s life has just taken off since (they) went to live there, (they) absolutely love all the opportunities, the great staff & the bungalow & other young people” and “As a parent this is a wonderful comfort to know that your child is cared & looked after as you would do yourself is a peace of mind one can only imagine”.
The service achieved these values through the constant striving for excellence and improvement, through continually seeking people’s views and enabling people to have happy lives filled with activities and the promoting of skills development. The service had cultivated a warm, welcoming and inclusive culture where people and staff felt encouraged to express themselves and share their views. All levels of staff focussed on delivering a clear vision of working alongside people to enrich their lives.
The Trust worked hard to create strong links with the local community in order to increase awareness and integration. The Trust held strong values relating to providing people with disabilities with as many opportunities as possible in order to improve their lives. For example, they had identified a lack of opportunities in relation to the education of young adults with physical and learning disabilities so had worked with the head teacher of the school on site to design a teaching package bespoke to these people’s needs. This package was available for people who had either finished the available college courses or who were not accessing them. This enabled people to continue in education, challenge themselves intellectually, learn new skills and improve on existing skills. The package was named ‘Hannah’s Living Learning and Moving on Education Provision’ and had been accredited by Asdan Personal Project Programme which was a Curriculum Development Organisation and Awarding Body. This package explored key issues for people living with learning and physical disabilities and enabled people to broaden and inform their adult view on life. For example, people undertook lessons in their rights and responsibilities in the world, democracy, family, the environment and the world of work. People highly enjoyed undertaking this package and had made strong community links through it. For example, they had worked with a local food bank in order to support families and children with little extras at Christmas and Easter. This had been hugely successful and had resulted in press coverage for the learning group and their work.
Dame Hannah Rogers Trust used innovative methods to ensure people’s needs were met when at the service, but also within the wider community. One of the mission statements of the Trust was to improve public knowledge and understanding about disability. People and staff were encouraged to join and influence a number of community programmes in order to ensure people’s needs were understood and met wherever they were. For example, one of the occupational therapists for the service, alongside a person who lived at the service, had joined the sustainable transportation group. The person had been supported to speak at a meeting about the limitations of travelling around the local area of Ivybridge with a wheelchair. As a result the council widened a number of pavements and put in more crossing points for wheelchairs. This hugely benefited people who used the service as well as any other people who may have disabilities who lived in or visited the area.
Every person, relative and healthcare professional we spoke with expressed how impressed they were with the exceptionally caring nature of the staff and their attitudes. They all spoke of the staff with high admiration and praised them for the caring ways in which they supported people. Comments from people included “It’s almost like going out with your friends. They’re lovely, really really lovely”. Comments from relatives included “The staff are so caring” and “We are so impressed with the kind, caring, young and vibrant staff”. Staff told us that being caring and kind was a fundamental requirement of their job and was their focus. During our inspection we saw positive and caring interactions between people and staff. Staff knew people’s needs, preferences, likes and dislikes and spoke about people with respect and admiration.
The Trust and Hannahwood Transitions worked hard to ensure people felt empowered and involved in all aspects of their care. The service was continually working towards improving the service and making it more person centred. They had recently introduced a number of projects, procedures, forms and meetings focussed on gaining people’s views about the service. People were also involved in the recruitment of staff and creating a monthly newsletter which celebrated people’s interests and achievements. A strong focus was on improving people’s skills, enabling their independence and empowering them to have a voice. People were supported to understand and make decisions through the use of different communication methods and devises.
Staff knew how to recognise possible signs of abuse which also helped protect people. Staff knew what signs to look out for and the procedures to follow should they need to report concerns. Safeguarding information and contact numbers for the relevant bodies were accessible. Staff told us they felt comfortable raising concerns.
People were protected from risks relating to their health, mobility, medicines, nutrition and behaviours. Staff had assessed individual risks to people and had taken action to seek guidance and minimise identified risks. Where accidents and incidents had taken place, these had been reviewed and action had been taken to reduce the risks of reoccurrence. Staff supported people to take their medicines safely and as prescribed by their doctor.
Recruitment procedures were in place to help ensure only people of good character were employed by the home. Staff underwent Disclosure and Barring Service (police record) checks before they started work in order to ensure they were suitable to work with people who were potentially vulnerable.
Staffing numbers at the service were sufficient to meet people’s needs and provide them with the care and support they required. Staff had the competencies and information they required in order to meet people’s needs. Staff received thorough and ongoing training as well as regular supervision and appraisal. The service had a strong focus on investing in staff and encouraging them to develop in their careers. Staff were provided with and encouraged to undertake further training in areas which interested them. This helped ensure each staff member was able to reach and sustain excellent standards of care for people and also ensured people who lived in the service were supported by staff who were continually enabled to learn, progress and specialise in order to help them in their daily lives.
Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and put it into practice. Where people had been unable to make a particular decision at a particular time, their capacity had been assessed and best interests’ decisions had taken place and had been recorded. Where people were being deprived of their liberty for their own safety the registered manager had made Deprivation of Liberty Safeguard (DoLS) applications to the local authority.
People were supported to have enough to eat and drink in ways that met their needs and preferences. People were supported to make choices about what