Henshaws Specialist College

Henshaws Specialist College is a residential further education college specialising in support for young people. Most of the young people attending college are between 16 and 25 years of age and have a physical or learning disability or autism. Our inspection looked at the residential accommodation, healthcare provision and care and support for young people outside their educational curriculum.

At the time of this inspection, there were 34 young people accommodated in four residential houses. Another 14 young people were receiving registered healthcare provision as day students.

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

Young people received highly personalised care. We found young people took part in a range of fun activities and experiences, which helped to build confidence, increase self-esteem and gave young people a sense of achievement. Feedback was entirely positive with comments from relatives including, “Overall, I just think they are doing a fabulous job” and “The aim of the course is to make [Name] as independent as possible, they (and we) want them to graduate as independent as they can be into society.”

Careful pre-admission assessments and planning made sure young people’s care needs including healthcare and behaviour needs were fully considered. Staff received relevant training and could meet these needs effectively. The hospital learning disability liaison nurse was also made aware of new admissions, so in the case of hospital treatment they could help organise their care. This had led young people to having more positive experiences when medical treatment was required.

Thorough risk management processes focused on people’s abilities and how staff could support them to try new things safely. This had led young people with very complex needs to achieve goals for the first time, including sailing, kayaking and rock climbing. In their written feedback about a recent trip, one young person had said, “I loved it. I like the zip wire the best.” Other young people had begun new enterprises and were looking at their future plans on graduation.

Staffing was organised around people’s assessed care needs and staff were recruited safely. Feedback about staff was positive. People said staff were caring and compassionate. One young person said, “Staff are lovely, they care for me.” Relatives told us, and we observed, people were treated with dignity and respect, and staff promoted young people’s independence.

The service was well-managed and organised. Effective management systems were in place for managers to assess and monitor the quality of care provided to young people and drive continuous improvement. Managers and staff were highly motivated to develop the service and provide young people with the best care possible.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensured young people who used the service lived as full a life as possible and achieved the best possible outcomes that included control, choice and independence.

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.

For more details, please see the full report which is on the Care Quality Commission website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 16 January 2019). Since this rating was awarded, the provider has registered to provide nursing care. At the time of the inspection, a total of 20 young people were receiving nursing interventions as either residential or day students. This is the first inspection of the healthcare provision provided at Henshaws Specialist College.

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.

People’s experience of using this service: Since our last inspection the provider had appointed an acting manager, interim principal and interim head of care. They had worked together as a strong team to mentor and empower the staff to make improvements to the support young people received.

Quality assurance systems were in the process of development and although these were not yet fully established they were having a positive effect on the outcomes for young people. While management checks had identified some areas for improvement such as the frequency of supervisions they had not picked up on other areas. For example, we identified risk assessments were not yet fully established or working effectively to ensure risks were always identified and appropriate safety measures put in place. Checks had not always highlighted areas for improvement. These systems needed to work better to ensure safety and quality for people.

However, staff told us they felt more confident in the leadership and management of the service. Staff morale was good and demonstrated a commitment to ensure young people received high-quality care and support and enhance their prospects and wellbeing.

Young people told us they liked being at college and making friends. They felt staff listened to what they wanted and helped them to achieve their goals and aspirations. Staff were committed to supporting young people to gain their independence and develop their skills. Use of technology enabled young people to access information and to be fully involved in their care and support. Young people were encouraged to develop and maintain positive relationships with friends and family.

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.

Young 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. Staff worked together in a positive way to support people to achieve their identified goals.

A full description of our findings can be found in the sections below

Rating at last inspection: Requires improvement. (published 21 June 2018).

Why we inspected: This was a planned inspection based on the rating of the last inspection.

At the last inspection in March 2018, we asked the provider to act to make improvements to safe care and treatment, employment of fit persons and governance. Following that inspection, we met with the provider’s representatives on two occasions to discuss the required improvements and to monitor their progress.

At this inspection we found improvements however the provider needed to be able to demonstrate improvement over a sustained period to ensure young people receive safe, consistent care. This means the rating remains requires improvement. This is the second consecutive time the service has been rated Requires Improvement.

Follow up: We will continue to work with the provider following the publication of this report to understand and monitor how they will make changes to ensure the service improves to at least Good. We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

The residential part of Henshaw’s College Harrogate is registered as a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premise and the care provided, and both were looked at during this inspection. The service is arranged over three purpose built units. Each unit has smaller self-contained houses of no more than 12 bedrooms.

The service can support younger adults from the age of 16 years old who may have a sensory impairment, physical disability and or learning disabilities or autism spectrum disorder. Up to 65 young people can be supported. At the time we visited 37 young people were using the service. Some young people lived on the premises all of the time, some stayed during term time or during the college week, whilst others used the service for respite.

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 life as any citizen. The service met the principles of ‘Registering the Right Support’.

A registered manager was 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.

During the inspection we found multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safe care and treatment, employment of fit persons and overall governance of the service. You can see what action we told the provider to take at the end of this report.

Since the last inspection the provider had started to deliver support to young people with complex needs whereby they required nursing care. The provider had not recognised the tasks they expected staff to perform were nursing. The provider is not registered with the CQC to provide such care. This is an issue which is being dealt with outside of the inspection.

The provider used an agency care worker to perform the clinical procedures and then to carry on and competency check their own staff. No checks were performed to ensure the agency care worker had the skills and qualifications to carry out this role.

Where young people required specific interventions to support their safety or monitoring of their well-being we found at times they had not happened or that staff did not have the correct information to follow. This placed young people at risk of harm. We made a recommendation that the provider ensure each young person has a robust care plan in relation to health.

The provider and registered manager demonstrated their lack of understanding of social care provision and the regulations associated with delivering a social care service. The governance and quality assurance systems did not ensure staff had appropriate policies to follow. Robust checks were not made to ensure safety and to check young people received a quality service.

The provider and registered manager responded positively to the feedback they received and immediately implemented an improvement plan. They focused on ensuring support was safe immediately. We feel confident they now understand the regulations and responsibilities better. They are committed to improving the service.

Appropriate safety checks of the environment and equipment had been made. Safe systems to manage medicines were found. Young people told us they enjoyed spending time in their ‘Houses’ and said they had been supported to personalise their own room with pictures and their own belongings. Young people were regularly asked their views about the service they received and they told us they felt confident to speak up. Young people felt safe and well cared for. The relatives agreed.

Young 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.

Each young person had their own way of communicating and staff were aware of this. Young people told us they were treated with respect and dignity. This is something we also observed. Young people enjoyed a varied range of activities based on their own preferences. Staff knew young people very well and understood how they wanted to be supported. Young people received a person-centred service.

A new approach to supporting young people who displayed behaviours that challenge the service had been implemented. This has seen a reduction in young people experiencing anxiety or distress and an increase in staff confidence and knowledge.

Young people were supported to develop their skills to be independent around every day living tasks, such as cleaning, cooking and laundry. Young people told us they appreciated this support and wanted to develop to become more independent.

Staff received appropriate support and training and had opportunity to raise concerns or ideas via regular meetings. Staff worked as a team and displayed commitment to continuously improving the service for young people.

Henshaws College Harrogate is part of Henshaws Society for Blind People. It is registered with the Care Quality Commission (CQC) to provide personal care and accommodation for up to sixty-five younger adults who have a learning disability and complex physical care needs.

There was a new manager in place who had applied to be registered with the CQC. A registered manager is a person who has registered with the 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.

The manager and staff knew about safeguarding procedures and followed these in order to protect people. Safeguarding issues were discussed at student meetings and people knew who they should speak with if they were upset or worried. Information was produced in easy read formats and displayed in college and in the individual houses where people were accommodated.

The service had an in-house HR department who followed appropriate recruitment checks to help ensure suitable staff were recruited to work with people who used the service. There were sufficient numbers of staff on duty to make sure people got the help and support they needed in a timely way.

Risk assessments were used to identify risk and action was taken to reduce the risks identified.

Arrangements were in place to make sure people received their medicines safely.

We found that staff received appropriate training, supervision and support to carry out their roles effectively. This helped to ensure people were cared for by knowledgeable and competent staff.

People were supported to make choices in relation to their food and drink, maintain good health and they had access to local healthcare professionals and services when needed.

People who used the service and relatives were involved in decisions about their care and support needs. People’s support plans were personalised and clearly set out people’s needs, wishes and aspirations. We saw that people had opportunities to take part in activities of their choice inside and outside the service. People were supported and encouraged with their hobbies and interests.

People and relatives we spoke with knew who to speak with if they had any worries or concerns. Staff told us that they were also alert to people’s moods and any changes in behaviour which could indicate someone needed more support.

The staff told us managers were approachable and they felt well supported by the organisation. Staff meetings took place regularly and staff told us they were encouraged to share their views and managers acted upon what they said. .

Managers and staff carried out audits so they could identify any shortfalls in the service and ensure that action was taken to improve the service. People who used the service were encouraged to give their feedback informally, through the weekly house meetings or via the student council.

We found that effective managements systems were in place to safeguard people and promote their wellbeing.

During our inspection we looked at students' care plans. We saw that students were supported to live as independently as possible. The college had carried out an assessment of the needs of each student prior to them starting college, and kept this under review, to enable appropriate care and support to be given.

Students were protected from risks of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We reviewed the recruitment and selection processes for new staff and found them to be robust. This ensured that students were supported by suitably qualified, skilled and experienced staff. Records we looked at also confirmed that staff received good training in areas such as safeguarding adults. Staff we spoke with told us that they received good support from their line manager.

The college had systems in place to make sure students were safely cared for. This included policies and procedures and quality monitoring systems.

We spoke with students about meals at the college. They told us that the food was very good. Students made comments to us such as 'I always choose my food' and 'Menus are always discussed at house meetings and you get to decide what you would like to eat at weekends.'

Everyone we spoke with said that if they were upset or had a complaint they would either speak to a member of care staff or tutors at the college. One student said 'If I had a complaint I would speak to a member of staff or anyone in the college.' Students were able to tell us about the systems the college has put in place, where they are able to make a complaint or raise any concerns they may have. The college has recently introduced a new system to enable students to voice concerns anonymously if they so wish.

We spoke with the Local Authority Contracts Officer who informed us that they did not have any concerns about this service.