Archived: Hoffmann Foundation for Autism - 18 Marriott Road

The Hoffmann Foundation for Autism – 18 Marriott Road is a residential care home registered to provide accommodation and personal care support for up to six people who have a learning disability and may have autism, Asperger's Syndrome or display characteristics that fall within the autistic spectrum. At the time of our inspection, five people were living at the service.

The Hoffmann Foundation for Autism – 18 Marriott Road is a ‘care home’. 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.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a registered manager in place. 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.

Relatives of people who used the service told us people were safe and there were enough staff. However, staff told us there were not enough permanent staff and found difficult to work with different agency staff. There was a lack of continuity for people who used the service.

Staff knew how to identify and report abuse, and escalate concerns outside the service where necessary.

Staff were recruited appropriately to ensure they were safe and suitable to work with people who were vulnerable. People’s medicines were managed safely. Staff maintained clear safeguarding and incidents records. The management learnt and shared lessons with staff to improve when things went wrong.

There were systems in place to assess people’s needs before they moved to the service. People’s needs were met by staff who were appropriately trained. Staff received regular supervision to do their jobs effectively. People’s dietary needs were met and were supported to access ongoing healthcare services. The building was not suitable for people due to accessibility issues and the provider was in the process of moving people to a more appropriate setting. The provider sought people’s consent to care and treatment in line with the legislation and guidance.

Relatives told us staff listened to people and were caring. Staff encouraged people to express their views and supported them to be as independent as they could be. People’s cultural and religious needs were identified, recorded and met by staff. Staff were knowledgeable about the importance of maintaining people’s confidentiality.

People’s care plans were in accessible format and gave staff sufficient information to provide personalised care. People’s care was reviewed regularly and relatives were involved in the process. There were systems and processes in place to respond to complaints and concerns in a timely manner. The provider’s end of life care policy did not include how to assess and support people with their end of life care wishes.

Staff were trained in equality and diversity and treated people without discrimination. The provider welcomed lesbian, gay, bisexual and transgender people to use their service.

The provider had effective monitoring, auditing and evaluating systems and processes in place to ensure the quality and safety of the service.

People’s relatives spoke positively about the registered manager and they told us they were happy with the service. However, staff told us there was lack of management presence and they did not always feel valued.

The provider sought feedback from people, relatives, and the management worked in partnership with other organisations to improve the care delivery and people's experiences.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 18 Staffing. We have made recommendations in relation to end of life care planning and staff recognition.

You can see what action we told the provider to take at the back of the full version of the report.

There was not a registered manager in place at the time of inspection. The 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. There was a manager at the service. They were registered for two other services for the provider but were not registered for Hoffmann Foundation for Autism -18 Marriott Road. We found there had not been a registered manager since November 2016. This did not assure us that the service was well-led.

The service was previously inspected on 25 April 2016 where the service was rated Requires Improvement overall when we found two breaches of regulations. Firstly in relation to staffing as there were at times shortages of staff and the staff team was mostly bank staff. During this inspection people’s relatives told us there had been a number of staff changes throughout the year. We found there were staff to meet the needs of the people using the service and more permanent staff had been recruited and where bank staff were used they were mostly familiar with people and their support needs.

Secondly at the previous inspection the service had not had a robust environmental risk assessment and some window restrictors had been missing. This had been addressed following our inspection. During this inspection people had robust risk assessments in place and staff could tell us how risks to people were managed. However we found one risk assessment that had been reviewed but still contained out of date information. This was addressed by the management team immediately.

We found during this inspection that some health care monitoring records were not completed and contained significant gaps. Therefore there was not an effective overview of people’s health conditions. Although audits had taken place on a monthly basis the above concerns had not been identified. This was a breach of good governance.

Staff told us they felt well supported and received supervision sessions. Staff had received training and supervision to undertake their role and could demonstrate to us they understood their responsibility under the safeguarding adults, Mental Capacity Act 2005 and Deprivation of Liberty Safeguards legislation to protect people’s welfare.

Staff had received training to administer medicines appropriately, there were clear medicines guidelines and people’s medicines records were completed without omission or errors.

People had person centred care plans that detailed the support they required to eat and drink healthily and to support them in the activities of daily living. People’s care plans contained their long and short term goals and people’s relatives contributed to their care planning at review meetings.

Staff were described as caring and we saw caring interactions between people and staff. Staff told us how they ensured people’s privacy and dignity.

People’s relatives told us they could complain to the service and found the provider Hoffmann Foundation for Autism approachable and responsive to concerns.

The provider told us following our inspection that Hoffmann Foundation for Autism -18 Marriott Road will be closing and people are being moved to an identified purpose built, one level location that will meet people’s increased mobility needs as they age. People’s relatives had been informed of the future plans.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 17 Good Governance.

You can see what action we told the provider to take at the back of the full version of the report.

There is 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Relatives told us staff were approachable and health and social care professionals described staff as respectful and professional. We observed staff were friendly and spoke respectfully towards the people using the service.

On the day of our visit there were sufficient staff to meet people’s needs. However there had been a recent turnover of staff that had caused disruption to the established staff team so there was a high use of bank and agency staff. The registered manager had taken measures to recruit new staff. The service had a recruitment policy but had not carried out all the necessary Disclosure and Barring Service (DBS) checks for some staff. This meant the service could not be sure if the employee had a criminal record or not.

The service had individual and environmental risk assessments in place to minimise the risks to people however although environmental hazards had been identified some window restrictors were missing and this put people at risk.

There were a number of gaps in staff training in particular report writing, food hygiene, fire awareness, manual handling and health and safety. Not all staff had received training to manage the behaviours of people who challenged the service.

Staff had received training in safeguarding adults and were able to describe what measures they would take to safeguard people. Staff had received training to administer medicines and the service had systems in place to ensure the safe administration of medicines.

The registered manager understood his responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards had been applied for appropriately.

People were supported to access health and social care services by staff who were well informed about the people they supported. People had person centred plans that detailed their likes and dislikes and identified future goals. People’s family were involved in their care planning and reviews.

Relatives told us they felt when they raised complaints these were addressed by the registered manager and we saw complaints were responded to in a transparent and open manner.

The registered manager and the provider undertook regular audits of the service however they had not been effective in identifying the lack of valid DBS checks for some staff, the missing window restrictors and the gaps in training.

The service was quality assured by the registered manager held regular relatives meetings and sent out yearly surveys to obtain feedback on the quality of the service given.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to staffing and risk assessments .

You can see what action we told the provider to take at the back of the full version of the report.

Overall, people we spoke with were satisfied with the care provided and said that people were treated with respect and dignity. One relative told us 'the home is A*' and 'staff always treat people respectfully and are very polite'. Another relative said 'people are very well looked after and I have no complaints'.

Relatives we spoke with told us that they had been consulted and kept informed about the welfare and progress of their relatives. Relatives were positive about staff and said that staff were very caring and knew people who used the service very well. Relatives also said that if they had any concerns or queries, they felt able to raise these with management at the home.

Care records we looked at indicated that the needs of people had been attended to.

The provider had taken steps to provide care in an environment that was suitably designed and adequately maintained.

Staff we spoke with told us that they enjoyed working at the home and felt supported by the team and management. Staff told us that usually there were enough staff on duty.

Records we looked at were mostly up to date and could be located promptly.

People who use the service had been provided with a range of activities organised by the home and by community services. This ensured that they were kept stimulated and occupied.

Relatives who spoke with us stated that people who use the service had been treated with respect and dignity and their personal, social and healthcare needs had been attended to. They had been consulted and kept informed regarding the welfare and progress of their relatives.

Relatives spoke well of staff and indicated that staff were professional and knew what they were doing. They had confidence in the management of the home and felt that the quality of care provided was of a high standard. Their views can be summarised by the following comment, 'honestly, I am very happy with the care. I have no complaints.'