Archived: Henshaws Society for Blind People - 66 Hookstone Chase Harrogate

66, Hookstone Chase is a residential care home providing personal care and support to five younger adults with visual impairment, learning disabilities, or associated conditions. There were five people using the service at the time of inspection.

People’s experience of using this service and what we found

The principles and values of Registering the Right Support and other best practice guidance ensure people with a learning disability and or autism who use a service can live as full a life as possible and achieve the best outcomes that include control, choice and independence. At this inspection the provider had ensured they were applied.

The vision of the service reflected these principles ensuring people with learning disabilities have opportunities and choice and are supported to achieve their aspirations. Staff adopted the ethos to provide person-centred care that enabled individuals to develop skills and behaviours to live more independent lives, whatever the level of need.

The service was provided from one house and was registered to support five people. It therefore conformed with current best practice guidance. The service was managed in a way that ensured people received person-centred care and were supported to maximise their independence, choice, control and involvement in the community. Areas of the building were showing signs of wear and tear. We received an action plan after the inspection with plans for improvement.

Staff upheld people's human rights and treated everyone with respect and dignity. Communication was effective and staff and people were listened to. Staff were well-supported and were aware of their rights and their responsibility to share any concerns about the care provided. Staff told us they received training and support to help them carry out their role.

People felt safe and were positive about the care provided. Detailed care plans were in place that documented how people wished to be supported. Risks to people's safety including any environmental risks were well-managed. People were well-cared for, relaxed and comfortable. Staff knew the people they were supporting well and care was provided with patience and kindness.

People enjoyed their meals and their dietary needs had been catered for. People were supported to receive their medicines and manage their finances safely.

We have made a recommendation about the management of people’s finances.

Regular audits and checks were carried out. A more robust quality assurance system had been introduced by the provider that had identified areas for improvement.

There were opportunities for people, relatives and staff to give their views about the service. Processes were in place to manage and respond to complaints and concerns. People were supported to follow their interests, hobbies and to be part of the local community.

Information was accessible to involve people in decision making about their lives. 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.

People and staff were positive about the management of the service and felt valued and respected. Staff supported people to ensure they received care that helped them develop. There were enough staff available to provide individual care and support to each person.

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 September 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.

At the last inspection on 15 and 21 December 2016 the service was in breach of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 10, Person-centred care; Regulation 13, Safeguarding service users from abuse and improper treatment; Regulation 15, Premises and Equipment; Regulation 16, Receiving and acting on complaints; Regulation 17, Good governance; and Regulation 18, Staffing.

After the inspection the provider submitted an action plan telling us the action they would take to make the required improvements.

At this inspection on 26 July 2017 we found the provider was no longer in breach of the previously identified regulations and they had made significant improvements to the service and the care people received.

Henshaws Society for Blind People - 66 Hookstone Chase Harrogate is registered to provide personal care and accommodation for up to five people with a learning disability who may have an associated sensory impairment and physical disability. When we inspected there were four people living at the service.

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.

People spoke positively about the staff and we observed that staff were caring and compassionate in the interactions we observed.

Staff had received safeguarding training and had followed local safeguarding protocols appropriately.

Action was taken to identify risks and action was taken to minimise any identified risks.

The provider followed safe recruitment practices to make sure only suitable people were employed.

There were sufficient staff employed to provide timely assistance to people. Staff received appropriate training and support for their roles.

Effective systems were in place to store and administer medicines.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People spoke positively about the quality of the food provided and people were encouraged to help with meal preparation.

People received care and treatment from external health care professionals when needed.

Staff knew people well and offered people the opportunity to take part in activities.

People reported improvements in the management and leadership and they told us that action had been taken to improve the service over the past six months.

Management process including audits and checks were in place and the service’s premises and equipment were maintained and were in safe working order.

The arrangements for quality assurance and leadership within the service had improved. We did not improve the rating for well-led from 'requires improvement', because to do so requires consistent good practice over time. We will check this during our next inspection.

This inspection took place on 15 and 21 December 2016. On the first day of our inspection we gave short notice of our visit the morning we visited. We arranged to visit on the second day when the registered manager would be available to speak with us.

The service is registered to provide personal care and accommodation for up to five people with a learning disability who may have an associated sensory impairment and physical disability. When we inspected there were five people living at the service.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager registered with the Care Quality Commission CQC. 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 reviewed the progress made by the registered provider in making sure people were kept safe from the risks associated with medicines management. Improvements had been made to the recording and storage of the systems with regard to managing people’s medicines. This meant that the previous breach of Regulation 12 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

During our inspection we identified six breaches in regulations. This related to safeguarding people from abuse and improper treatment, repairs and cleanliness of the premises, staff training and supervision, dignity and respect, the need for consent and the overall governance of the service.

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

Although management systems were in place to assess and monitor the service, these had not been completed consistently. They were not recorded in a format which could be easily referred to for progression and improvement. The registered provider had failed to make improvements based on recommendations made at our last inspection in relation to safeguarding practice and house repairs.

The registered provider did not have effective systems in place to monitor the care being delivered to people. We found record keeping was inconsistent and management oversight at the service was not effective in ensuring that people were provided with safe, person- centred and inclusive care. Staff did not have a comprehensive understanding of what constitutes abuse and poor practice; they were not applying the principles of the Mental Capacity Act 2005, to ensure that people’s rights were protected.

When we visited there were not sufficient numbers of staff on duty to meet people’s individual needs, and to allow people to undertake their chosen activities. We have made a recommendation about reviewing staffing provision to ensure sufficient levels on each shift to meet people’s care and social needs.

Staff recruitment was seen at our last inspection to be robust and no issues of concern were raised at this inspection.

A new care planning format was in the process of being implemented when we visited. Records contained information about people’s needs, their likes and dislikes and their social history. However, at the time of our inspection information was not being provided in a format that people could easily read or understand. We identified that monthly reviews were not up to date.

People's nutritional needs had been assessed and they were encouraged to help with food shopping and meal preparation. Some people prepared some of their own meals with minimal supervision from staff; they had been provided with specialised equipment to help them to do this safely.

Systems were in place to seek feedback from people who lived at the home, relatives and staff.

There was a complaints procedure. However, we identified that care and welfare issues raised with the registered manager had not been investigated using the complaints procedure. This also raised concerns about the registered manager’s leadership and lack of action. We have made a recommendation about the management of complaints.

Following our inspection we met with the nominated individual and the registered manager to discuss our findings and to ascertain the improvements they planned to make to improve the service and ensure the provision of high quality, safe care.

The service is registered to provide personal care and accommodation for up to five people with a learning disability and sensory impairment, and on the day of the inspection there were five people living at the home. The home is located in Harrogate, in North Yorkshire. It is close to town centre amenities and on good transport routes.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager registered with the Care Quality Commission [CQC]; they had been registered since June 2015. 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 our inspection we identified a breach in regulations. This related to the proper and safe management of medicines. You can see what action we told the provider to take at the back of the full version of the report.

People told us that they felt safe living at 66 Hookstone Chase and we saw that internal areas of the home were being maintained in a safe condition. However, some external repairs had been required for several months and had not been carried out. We have made a recommendation about this in the report.

We found that people were protected from the risks of harm or abuse because the registered provider had effective systems in place to manage any safeguarding issues. Staff were trained in safeguarding children and adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm, although some clarification was required in respect of submitting notifications to the Care Quality Commission. We have made a recommendation about this in the report.

We noted that people were encouraged to make their own decisions and when they needed support to make decisions, these had been made in their best interests. People told us that staff were caring, kind and supportive.

Staff confirmed that they received induction training when they were new in post and that they shadowed experienced staff before they worked unsupervised. Staff told us that they were happy with the training provided for them. The training record evidenced that most staff had completed training that was considered to be essential by the home.

New staff had been employed following the home’s recruitment and selection policies to ensure that only people considered suitable to work with vulnerable people had been employed. We saw that there were sufficient numbers of staff on duty to meet people’s individual needs, and to allow people to undertake their chosen activities.

All staff at the home had responsibility for the administration of medication and the registered manager told us that they had completed appropriate training. However, there was a lack of evidence of medication training for two members of staff. Some minor improvements were needed to the systems and procedures in place to ensure that the storage and recording of administration of medication was robust.

People’s nutritional needs had been assessed and were recorded in their care plans, along with their likes and dislikes in respect of food and drink. Some people prepared some of their own meals with supervision from staff; they had been provided with specialised equipment to help them to do this safely.

There had been no formal complaints made to the home since the previous inspection but there was a process in place to manage complaints if they were received. There were systems in place to seek feedback from people who lived at the home, relatives and staff.

Quality audits undertaken by managers were designed to identify any areas of improvement to staff practice that would promote safety and the care provided to people who lived at the home. Staff told us that, on occasions, the outcome of surveys and audits were used as a learning opportunity for staff and for the organisation.

People who lived at the home and health and social care professionals told us that the home was well managed. One health care professional said, “The service appears to be able to manage the needs of our client sufficiently well.”

We considered our inspection findings to answer 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?

Is the service safe?

All the people we spoke with told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported. One person told us, 'I feel safe here.' A relative we spoke with said, 'My relative is absolutely safe, I have no concerns. If I did I would speak with the manager.'

Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager understood the home's responsibilities under the Mental Capacity Act 2005 and DoLS. No deprivation of liberty application had been submitted to the local authority. Following a recent court ruling regarding DoLS in care settings, the provider may wish to review people's living arrangements to check whether their circumstances amount to a deprivation of liberty, according to the revised definition.

We saw the service was safe, clean and hygienic. The home had an effective infection control system. Equipment was well maintained and serviced regularly, so preventing any unnecessary risks. All the staff told us how they worked to prevent infection and told us how they would manage an outbreak at the home so that the risk of infection spreading could be reduced.

Is the service effective?

Comments from people included, 'I am happy here.' Two relatives we spoke with were satisfied with the service. One of whom told us, 'I am more than happy with the care here. There are yearly reviews which I always attend. The staff are very good.'

People explained how their care and welfare needs were met. People told us they had support with health appointments and felt the service was flexible. One person told us, 'When I am not feeling well I ask the staff to call my doctor.' All the relatives we spoke with told us they were all kept informed about people's care and they felt the service was good. All the people we spoke with told us staff always asked them if they needed help or assistance and provided it when necessary.

Each staff member we spoke with told us they felt supported in their work. They told us they received a full training programme and had regular supervision and appraisals.

Is the service caring?

We saw staff treated people with respect and dignity. All the people we spoke with told us they were very happy with the care they received. One relative told us, 'We are so happy with the care here. We know we don't have to worry and the staff are so good.'

We saw staff communicated well with people and were able to explain things in a way that could be easily understood. People were not rushed when care was delivered and we saw how staff interactions with people were caring.

Is the service responsive?

All the people we spoke with told us staff would respond to any of their requests for support. One person told us, 'I like to go out often.' All the relatives told us they were very happy with the service.

All people we spoke with told us they were involved in decisions about their care. They said staff were flexible and responded to their requests promptly. We saw staff responded to people's requests for help in a timely manner.

People's care needs had been reviewed at least every six months. We saw when people's requirements had changed the provider had responded appropriately and altered the care and support they delivered in line with these changes. Care records had been updated to reflect the person's current needs.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service well-led?

The service had a registered manager. They showed us there was an effective system to regularly assess the quality of service people received. We found the views and opinions of people, relatives and staff had been regularly gathered, recorded, analysed and responded to.

We saw the home had systems in place which ensured managers and staff learnt from any accidents, complaints, whistleblowing reports or investigations. This helped reduce the risks to people and helped the service to continually improve.

Staff told us they understood their roles and responsibilities. Staff had a good understanding of the ethos of the service and quality assurance processes were in place. This helped to ensure people could receive good quality care at all times.

During our inspection we looked at how people were respected and involved in the service. We looked at care records and found people had been involved in deciding what support would work for them and how that support would be delivered.

We saw from people's care plans that people were supported to live as independently as possible. The home had carried out an assessment of the needs of each person, and kept this under review, to enable appropriate care and support to be given.

People who lived at the home were protected from risks of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. The staff we spoke with had received training in safeguarding adults.

We reviewed the level of staffing for the home. People told us that there was always enough staff to support them with their care needs.

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