All inspections: Huntercombe House - Peterlee

This inspection took place on 25 and 26 November 2015 and was unannounced. This meant the registered provider and the registered manager did not know we were carrying out an inspection.

Huntercombe House in Peterlee is registered to provide accommodation for up to 21 adults with learning difficulties. The home is on two floors. Accommodation is provided for people either in individual bedrooms on the first floor or in bedsit type accommodation known to people as ‘flats’ on the ground floor. Each person’s accommodation has ensuite facilities. There are communal sitting rooms on both floors and a communal dining room on the ground floor.

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. Following our last inspection the acting manager had been appointed as the manager and had registered with the Care Quality Commission.

We found people were protected from abuse because staff knew what to do if they had any concerns.

The registered provider had a robust recruitment and selection procedure in place and carried out all relevant checks when they employed staff.

Checks were regularly carried out on the building to ensure people were safe. These checks included fire safety, water temperatures, extractor fans and window restrictors.

We observed two lunchtime sessions in the dining room and found the atmosphere was calm and conducive to eating well. Staff ate their meals with the people living in the home and chatted to people.

We observed staff supporting people in the home and found they were skilled in working with people and could distract people from adverse behaviours as well as anticipating their needs.

We found staff were supported by a multi-disciplinary team (MDT), Staff were able to learn about people’s conditions and how they could support them from the MDT who also arranged to bring in experts to support staff.

The registered provider had adapted the home environment to meet people’s individual needs. This included changing the use of a bedroom into a quiet space and adapting a bedroom into a sensory room to meet one person’s needs who felt more comfortable in an environment designed just for them.

We found staff in the home valued and respected people.

We found people received care and support from staff who knew and understood their history, likes, preferences, needs, hopes and goals.

The registered provider had in place a training kitchen to support people to gain skills to support their independence. We observed people cooking in the kitchen and they were enjoying the activity.

We found the service protected people from the risks of social isolation and loneliness and recognised the importance of social contact and friendships.

People were supported and encouraged to engage in activities in the home and in the local community. Since our last inspection we saw activity levels had increased.

Each person was supported using a personalised intervention plan formulated at a multi-disciplinary team (MDT) meeting. Three or four people were reviewed each week and people were invited to attend their section of the meeting. The intervention plans were reviewed and updated at MDT meetings where issues or concerns about people were examined; plans were put in place to be carried out by named responsible persons with outcome measures identified.

We observed an easy rapport between staff and the registered manager, and service users and the registered manager.

Following research into ensuring people were cared for by smaller groups of staff the registered manager had arranged the service into pods. A pod consisted of three or four people who lived in the home with a group of approximately 11 staff around them. This prevented people being cared for by a large staff group and meant that staff needed to know about a small group of people in depth.

The service supported by the occupational therapist had developed an approach to promoting people’s well-being by providing a framework for staff and increasing people’s activity rates. The approach had been documented and recognised by the College of Occupational Therapists and was shared with other local service providers.

The service was the regional winner of the Great North East Care Awards, for their work in supporting a person with challenging behaviours and went on to be a finalist in the Great British Care Awards 2015. This meant the registered manager and the staff had received national recognition for their work.

The registered manager had led developmental sessions for the staff to look at their own values in the service and the service had created its own set of values building on those of the provider.

The registered provider had in place a quality audit system which measured the service. The registered manager was knowledgeable about the reasons behind what the service had scored and told us what they were doing to continuously improve the service.

The registered manager explained that in order to support staff, encourage joint and more effective working they had developed a number of keyworker roles around each person’s needs.

Huntercombe House provides accommodation to up to 21 people living on two floors. On the ground floor people were cared for in their own bedsits with each bedsit having kitchen and bathroom areas. On the first floor people had their own bedrooms with en-suite facilities. Meals were provided to people upstairs by a central kitchen. There was also a training kitchen where people could make their own meals. People who lived at Huntercombe House had learning disability and mental health needs. They were personally supported each day by one or two members of staff allocated to work with them.

This inspection was unannounced and took place over a period of two days on 2 and 13 August 2014. At our last inspection in December 2013 we found the service was compliant.

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. At the time of our inspection the registered manager was not working in the service. An acting manager had been appointed to support and run the service. The acting manager had identified a number of deficits in the services and had developed a plan to improve the service. The service is also supported by a multi-disciplinary team which includes a consultant clinical psychologist, an assistant psychologist and an occupational therapist.

We found people had care plans and risk assessments in place which reflected their individual needs. People told us they felt safe living at Huntercombe House and we found there was enough staff to meet people’s needs.

We saw some areas of the home were not clean and the risk of cross infection had not been minimised by the registered provider. We asked the registered provider to address this issue.

Staff were able to tell us about people in their care including their likes and dislikes. One relative told us they found the staff to be 'extremely helpful and caring'

We found the registered provider had responded to family concerns and had taken action when concerns had been raised. They had invited family members into the service to attend meetings and find ways of improving the service for people.

The acting manager had put into place a steering group to improve the service including the development of a new service model, recruitment of staff and staff training. The steering group had reviewed their progress and actions had been taken by group members to make progress.

We looked at three people's daily records and found not all of the daily records matched the requirements of people's care plans. We found action had been taken to put in measures which would address these shortfalls and discussion with staff had taken place to improve.

We found the registered provider did not have in place regular monitoring of people's weights to ensure their dietary requirements were effective. However, we saw they had put into place actions to support people to lose weight or eat healthily.

We recommended that the registered provider continued to explore and address the shortfalls they had identified in the service.

We found one of breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the registered provider to take at the back of the full version of this report.

During our inspection we spent time talking with people who were living and staying at Huntercombe House and watched how staff gave them support and care. We found peoples' care and welfare needs were met in a way which ensured their safety. One person told us 'The staff are very supportive and understand my needs.'

People were treated with dignity and respect. We found staff supported people to develop their independent living skills.

We found the building to be clean, well maintained and appropriately designed to meet people's needs.

We observed some medicines being administered to people living in the home. This was done in a way which maintained people's privacy and dignity.

Many of the people who use this service could not tell us about their care due to a variety of complex needs. We therefore looked at their medication records and medicine supplies.

People received their medicines at the times they need them and in a safe way.

At our last inspection in January 2013 we found the provider was not compliant with the essential standard supporting workers. This was because staff had not been provided with an annual appraisal or regular one to one meetings with a senior member of staff. This meant staff did not have the opportunity to discuss work related matters on a formal basis.

At this inspection we found improvements had been made. We found staff had been receiving regular one to one meetings with a senior member of staff. We also saw staff had received an annual appraisal where their overall performance for the previous year was discussed.

We also looked at how medicines were handled at the home during this inspection. This was because we had received concerning information from the provider about the medication practices at the home. We found people had not always been given their medicines as prescribed by their doctor.

Many of the people who lived at the home found it difficult to communicate, so could not easily share their views with us about the service. We spent time with a number of people who used the services at Huntercombe House - Peterlee. People we spoke with indicated they were happy to be living there. Those people who were able to told us they were allowed to choose what they wanted to do during the week. One person said 'I'm off to see a band soon.'

People told us they were happy with the care and support they received. One person told us "I enjoy me freedom' and other people indicated to us they were well looked after.

All of the staff we spoke with during the inspection were familiar with safeguarding procedures. They all described clearly what action they would take in the event of a safeguarding matter coming to their attention.

People who used the service were protected against the risk of unlawful or excessive control or restraint because the provider had made suitable arrangements.

People were cared for by staff who were trained to deliver care and treatment safely and to an appropriate standard, however some staff required their training around care and safety updating. We also found staff had not received support in the form of appraisals.

People's complaints were fully investigated and resolved, where possible, to their satisfaction.

Many of the people who lived at the home had significant communication needs, so could not share their views about the service.

We spent time with three of the people who lived at the home. We saw that every person had at least one-to-one support from individual staff. This meant people had daily opportunities to go out individually to wherever they chose.

One person told us, 'I don't know which staff are coming on each day, but I know all my key workers. Staff take me shopping and to my mum's house at the weekend.'

Another person told us, 'I've got a list of my key workers in my room. I like to go out and staff help me to go shopping and to the local pub.'

Archived: Huntercombe House - Peterlee

All Inspections

25 and 26 November 2015

During a routine inspection

12, 13 August 2014

During a routine inspection

17 December 2013

During a routine inspection

20 August 2013

During a routine inspection

3 June 2013

During an inspection looking at part of the service

25 January 2013

During a routine inspection

30 November 2011

During an inspection in response to concerns