Archived: Henshaws Society for Blind People - 45 Yew Tree Lane

The previous inspection took place on 10 September 2014. At that inspection we found the service was meeting the regulations we looked at.

Henshaws Society for Blind People (Henshaws) runs a home for up to six people at 45 Yew Tree Lane, in Northern Moor in south Manchester. There were five people living in the home at the date of the inspection. The people living there were young men who mostly had a visual impairment, and also had other complex care needs. They each had a bedroom, and shared a communal living area and dining area.

At the date of this inspection the registered manager was just about to leave, after six years in post. There was a process ongoing to appoint a new 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.

We found an allegation of abuse which had been investigated internally but had not been reported as a safeguarding incident.

We found the home was a safe environment for people with visual impairment, three of whom could walk around the house freely. We pointed out a couple of trip hazards.

At the time of this inspection there was someone living in the home on a temporary basis with a view to a permanent placement. His needs and abilities were different from those of the other people in the home. The behaviour that partly resulted from the inability to meet this person’s needs at the service had caused the others to become inhibited about moving around.

Staffing levels were appropriate to meet the basic care needs of people living at the home however at times more staff were needed to support people with their planned activities. One person required one to one support which meant there were fewer staff available for activities with the others. When there was one fewer staff working, as happened on the first morning of our inspection, activities had to be cancelled.

There had been no staff recruited from outside Henshaws for three years. This created the benefit of continuity but also the risk of staff being too comfortable in their routines.

Medicines were ordered, stored, administered and recorded in safe ways. However we found improvements were needed because the instructions for PRN or ‘as required’ medicines needed to be clearer, and the cabinet for controlled drugs needed to be made secure.

Fire precautions were in place and equipment was serviced. There were individual plans for evacuation, but the person who had arrived in July 2016 did not yet have one in place.

We were told that training took place but there was no record of training available, so the provider was unable to demonstrate that all staff training was up to date. We requested the training record be forwarded to us after the inspection but did not receive it. This was a breach of the regulation regarding training of staff. There were some records of supervision but not of annual appraisals.

The service was applying the Mental Capacity Act 2005 (MCA) and had carried out mental capacity assessments on all the people living in the home. Applications under the Deprivation of Liberty Safeguards (DoLS) had recently been made for four people, but not for one person on respite, although he had been in the home for two months. This was a breach of the regulation relating to protecting people from an unlawful deprivation of liberty.

Food was cooked by staff. We did not see people involved in helping to prepare meals. The menus were similar from one week to the next. People’s diets were monitored.

The service ensured that people were registered with a GP and kept appointments with medical professionals.

The view of families and professionals was that the home was a very caring environment. Staff were most often kind to the people they were supporting. People were encouraged to be independent, although that had been affected by the current situation in the home.

People received appropriate help with their personal care. People got up quite late in the mornings, but this was their choice (except for one person). Those who could took part in chores around the home.

Confidentiality of people’s personal information was respected.

Care records were very detailed to the extent that it was difficult to find specific information in them. There was some obsolete information. We found little evidence that people had been involved in the writing or review of their own care plans.

One person was not receiving much attention or stimulation even though he was receiving one to one support. He spent a long time in bed in the morning and also in the afternoon. Staff appeared uncertain how to respond to or help him manage any behaviours that challenged staff and others. This was a breach of the regulation relating to meeting people’s needs. We considered that the impact on others in the home represented a breach of the regulation relating to respect and dignity.

Activities did take place although on the day of our visit they were cancelled due to staff sickness. Some people engaged in a variety of activities each week, others less so. There had been a holiday in September 2015 and another one was being planned. One family member expressed the view there were fewer activities than they expected. This was a further breach of the regulation relating to meeting people’s needs.

There was a complaints policy and log. A recent complaint had not been recorded, but had received a detailed response.

The registered manager of the service was about to leave and be replaced. The staff were nearly all long –serving and offered consistency of care.

The aim of the provider organisation was to enable people with visual or other disabilities to exceed expectations. We found this was the aim of the service, but that there were times when people were sitting listening to the TV with no purposeful activity.

The registered manager told us that lessons had recently been learned about a poor pre-admission assessment process. However, the decision had impacted on the quality of life in the home. Along with examples of poor records, this was a breach of the regulation relating to good governance.

There was a range of audits carried out. Reviews and audits of care plans needed to be more thorough and address the content of the care plans. Staff from the provider visited to carry out assessments.

Staff meetings took place. The minutes suggested that these were used as a means of reminding staff of their duties and obligations. It was less clear they were an opportunity for staff to raise issues themselves.

We found breaches of five regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the end of the full version of the report.

The people living at Henshaws at Yew Tree Lane had various degrees of learning disability as well as visual impairment. We spoke with four out of the five residents; the fifth person was unable to communicate with us. We also interviewed three members of staff in addition to the deputy manager. We looked at a variety of files including care files, staff training files and records of complaints.

We considered all the evidence we had gathered. We used the information to answer the five key questions we always ask:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found:

Is the service safe?

The building and environment were designed to be safe for people who were blind or visually impaired to move around in safely, while allowing them maximum independence. Staff levels were high; there was usually a staff to resident ratio of 1:1. This meant that people could be accompanied by staff on individual trips out e.g. to the gym, maximising their safety.

Staff had been trained in safeguarding and knew what to look our for and how to report any concerns. We saw that safeguarding concerns were usually reported and we knew that Henshaws contributed positively to safeguarding meetings held by the local authority and took lessons on board. We found that one safeguarding matter had not been reported to us as it should have been under the regulations.

Is the service effective?

The range of activities available had increased since our previous inspection in July 2013. Activities were geared to the needs and abilities of the various people living there.

Staff received training and in most areas most people were up to date. We saw from the training spreadsheet that there were some gaps and some areas that needed updating.

Is the service caring?

Most of the staff had worked at Yew Tree Lane for many years and had built up an affectionate rapport with the young people living there. The people had a variety of needs, and we witnessed the staff supporting them in a friendly way, while keeping appropriate boundaries. Their physical needs were met, while staff encouraged their independence for example by helping with shopping, food preparation and clearing up after a meal.

We read an assessment by a social worker of one person living in Henshaws, which said: "X enjoys living in Yew Tree Lane and they call it their 'forever home'."

Is the service responsive?

The service responded to issues raised by families in the annual quality assurance questionnaire. We saw that changes had resulted from comments made about activities. We also saw that the service had responded to comments in our previous report.

Henshaws were now holding more frequent student meetings at which the people living there could express their views about their preferences.

One such preference was the desire for another holiday like one that had been held in September 2013; this had not yet been organised but we were told it was the intention to do so.

Is the service well-led?

The service had a manager who had been registered since 2010, and a deputy manager. We did not meet the registered manager on this inspection but she supplied information afterwards. It was clear to us that both the managers took a very close interest in the welfare of people living in the home, and were 'hands on' in their style of running the service. They had a close-knit staff team, some of whom indicated to us that they felt their suggestions were not always taken on board. For example they had requested training tailored to the needs of individuals within the home; this had only recently been provided.

The service responded well to complaints and showed flexibility in adapting to the changing needs of people living in the home.

We visited the home again in August 2013. We did not speak to people living in the home as the issue did not directly concern them. We spoke to the deputy manager and two members of staff.

This inspection was in response to information that we had received about one individual living in the home.

This information stated that this person had received care which might not have met their needs.

We visited the home on 21 August and were given an explanation of why the care had been given in the way it had. Later on 30 September the manager supplied a detailed written account of the events in question.

We were satisfied that there were good reasons for the actions of the staff, and that they had acted in the individual's best interests. We found that the home was compliant with the standard relating to people's care, safety and welfare.

We found that the staff allowed the young people as much independence as possible, while ensuring that they were safe. We saw evidence that the young people engaged in a variety of activities, both in and outside the home.

We found that the house was well designed and equipped for the needs of the people living there. We examined the staff rotas and considered that there were sufficient numbers of staff on duty and that there were arrangements to cater for unexpected staff absence.

We found that there were systems in place to monitor the quality of service and there was a willingness to make improvements when needed.