We carried out a review of the data available to us about Hemlington Hall on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Hemlington Hall, you can give feedback on this service.
Hemlington Hall is a residential care home providing accommodation to people who require personal care to. The service provides support to younger adults with a learning disabilities or autistic spectrum disorder. Hemlington Hall consists of a main house, which can accommodate up to 6 people, and 2 self-contained bungalows within the grounds, which can accommodate 2 people. At the time of our inspection there were 7 people using the service.
People’s experience of the service and what we found:
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessment and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
Right Support
Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life. The service worked with people to plan for when they experienced periods of distress so that their freedoms were restricted only if there was no alternative. Staff supported people to take part in activities and pursue their interests in their local area. The service supported people to have the maximum possible choice, control and independence be independent and they had control over their own lives. Care and support was provided in a safe, clean, well equipped, and well-maintained environment that met their sensory and physical needs. Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcome.
Right Care
Staff promoted equality and diversity in their support for people. They understood people’s cultural needs and provided culturally appropriate care that was kind and compassionate. Staff protected and respected people’s privacy and dignity. They understood and responded to people’s individual needs. Staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse and they knew how to apply it. The service had enough appropriately skilled staff to meet people’s needs and keep them safe. People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs. People received care that supported their needs and aspirations, was focused on their quality of life, and followed best practice. People could take part in activities and pursue interests that were tailored to them. The service gave people opportunities to try new activities that enhanced and enriched their lives. Staff and people cooperated to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks.
Right Culture
People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff. People were supported by staff who understood best practice in relation to the supporting people with a learning disability and/or autistic people. This meant people received compassionate and empowering care that was tailored to their needs. Staff turnover was very low, which supported people to receive consistent care from staff who knew them well. Staff placed people’s wishes, needs and rights at the heart of everything they did. People and those important to them were involved in planning their care. Staff evaluated the quality of support provided to people, involving the person, their families and other professionals as appropriate. Staff valued and acted upon people’s views. People’s quality of life was enhanced by the service’s culture of improvement and inclusivity.
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 21 October 2019).
Why we inspected
The inspection was prompted in part due to concerns received about care, support and staffing. A decision was made for us to inspect and examine those risks.
We undertook a focused inspection to review the key questions of safe, caring, responsive and well-led only. For those key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
We found no evidence during this inspection that people were at risk of harm from this concern.
You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Hemlington Hall on our website at www.cqc.org.uk.
Follow Up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Hemlington Hall is a large detached house set in its own grounds and support six people in the main building. There are a further two cottages attached to the main building where two people live.
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, Right Care, Right Culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.
The service was able to demonstrate how they were meeting the underpinning principles of Right Support, Right Care, Right Culture. The Registered Manager had adapted how the service operated during the pandemic. Staff ensured they continually maximised people’s choice, control and independence in a safe and inclusive environment whilst also following national infection prevention and control (IPC) guidance. Each person had their own individual, person centred Covid-19 care plan and risk assessment which promoted their rights, privacy and dignity.
Managers, staff and people living at the service had worked together to ensure the service remained an enjoyable and empowering experience for everyone. People were involved in all aspects of the service including discussions around Covid safe activities and making the environment safe for everyone.
We found the following examples of good practice.
• Systems were in place to prevent people, staff and essential visitors from catching and spreading infections. The service had adapted how it supported people, as far as possible, to socially distance.
• Staff had undertaken training in putting on and taking off PPE, hand hygiene and other Covid-19 related training. The registered manager monitored staff practices to ensure high standards and correct procedures were followed. Additional cleaning of all areas and frequent touch surfaces was being carried out.
• The home was following national guidance for admitting people to the care home. Staff supported people to understand the procedures in place to keep them safe and the required, isolation procedures.
• Staff supported people’s social and emotional wellbeing. People were involved in planning safe activities within the service. Staff were supporting people to maintain contacts with their relatives and friends through a range of different format. For example, use of FaceTime.
• Infection control audits and checks were carried out. The registered manager spoke positively about the hard work and commitment staff had shown, which had helped to minimise the impact of the pandemic on people’s health and wellbeing. The provider continuously passed on important information about Covid-19 to staff.
Hemlington Hall is a care home providing accommodation and personal care support for up to eight younger adults with learning disabilities and/or autism. The home is made up of one large house, where six people live and two separate bungalows where two other people live. At the time of inspection, the home was fully occupied.
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.
Thematic Review
The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.
The service used some restrictive intervention practices as a last resort, in a person-centred way and in line with positive behaviour support principles
People’s experience of using this service and what we found
People told us they liked living at the service. Feedback from relatives and visiting professionals was very positive regarding the level of care and support people received.
People told us they received safe care. Appropriate personal risk assessments were in place to keep people safe. Medicines were handled safely, and staff had received appropriate training in this area. The provider continued to have a robust staff recruitment in place.
People’s needs were fully assessed prior to living in the home. Staff received training to support them in their role. Staff told us they felt supported by the registered manager. They described the registered manager as open and approachable. Staff felt the registered manager welcomed their feedback. Staff shared with us how
People were supported to maintain a healthy and balanced diet. People were involved in menu planning and they enjoyed their food. Where necessary, people were quickly referred to other healthcare professionals to support their health and well-being.
People told us staff supported them in a very caring way. They also told us staff listened to them if they had any concerns.
People were encouraged and supported to participate in various activities, to maintain and form new friendships and to gain a greater level of independence. Staff also supported people to achieve their own personal goals. For example; one person had been trained on how to complete quality audits. The outcome of which, was this person was now completing audits on behalf of the provider within their other services in the region.
The provider welcomed feedback through various sources. They sent out questionnaires to gather people’s opinions, which they used to further improve the level of care and support provided. In addition, the registered manager and provider carried out a range of monthly quality checks.
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 CQC website at www.cqc.org.uk
Rating at last inspection (and update)
The last rating for this service was good (published 28 February 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 in February 2015, the service was rated 'Good'. At this inspection we found the service remained 'Good'.
Staff understood the procedure they needed to follow if they suspected abuse might be taking place. Risks to people were identified and plans were put in place to help manage the risk and minimise them occurring. Medicines were managed safely with an effective system in place. Staff competencies, around administering medication, were regularly checked.
There was sufficient staff of duty. On the day of inspection there was one senior and two carers in the main house and three carers supporting people who lived in the annex buildings. Staff were available to provide one to one support and with visits out in the community.
People were supported by a regular team of staff who were knowledgeable about people’s likes, dislikes and preferences. A comprehensive training plan was in place and all staff had completed up to date training. 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. People were able to choose meals of their choice and staff supported people to maintain their health and attend routine health care appointments.
Care plans detailed people’s needs, wishes and preferences and were person-centred. Care plans were reviewed on a regular basis to ensure they contained up to date information that was meeting people’s care needs. People were actively involved in care planning and decision making and this was evident in signed care plans and consent forms. People who used the service had access to a wide range of activities and leisure opportunities. The service had a clear process for handling complaints which the registered manager had followed.
Staff told us they enjoyed working at the service and felt supported by the registered manager. Quality assurance processes were in place and regularly carried out by the registered manager and registered provider, to monitor and improve the quality of the service. The service worked with various health and social care agencies and sought professional advice to ensure individual needs were being met. Feedback was sought from people who used the service through regular ‘resident meetings’. This information was analysed and action plans produced when needed.
Further information is in the detailed findings below:
We inspected Hemlington Hall on 27 February 2015. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.
Hemlington Hall is a large detached house set in it's own grounds. It has en suite accommodation for six people in the main building. There is further accommodation for two people within a separate annexe. Hemlington Hall provides support for up to eight people who have a learning disability.
The home had a registered manager in place who commenced working at the home in February 2014. 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 living at the home required staff to provide support to manage their day-to-day care needs; to develop impulse control; as well as to manage their behaviour and reactions to their emotional experiences. We found that the registered manager had taken appropriate steps to ensure staff reviewed their behaviour; analysed what worked or what didn’t; and provided consistent responses when people’s needs changed to ensure that staff could continue to meet the individual’s needs.
We observed that staff had developed very positive relationships with the people who used the service. We saw that the staff effectively assisted people to manage their anxiety. Interactions between people and staff were warm and supportive. Staff were kind and respectful. People told us that they made decisions about what they did throughout the day.
Staff had received Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards training and understood the requirements of the Act. Where people had difficulty making decisions we saw that staff gently worked with them to work out what they felt was best. We saw that when people lacked the capacity to make decisions staff routinely used the ‘Best Interests’ framework to ensure the support they provided was appropriate. This meant staff worked within the law to support people who may lack capacity to make their own decisions.
People told us they were offered plenty to eat and assisted to select healthy food and drinks which helped to ensure that their nutritional needs were met. We saw that each individual’s preference was catered for and people were supported to manage their weight and nutritional needs.
People’s needs were assessed and care and support was planned and delivered in line with their individual care needs. The care plans contained comprehensive and detailed information about how each person should be supported. We found that risk assessments were very detailed. They contained person specific actions to reduce or prevent the highlighted risk.
We reviewed the systems for the management of medicines and found that people received their medicines safely.
People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff or relatives to hospital appointments. We found that staff worked well with people’s healthcare professionals such as consultants and community nurses.
People and the staff we spoke with told us that there were enough staff on duty to meet people’s needs. People told us they found the staff worked very hard and were always busy supporting people. The registered manager, a deputy manager, a senior care staff and five care staff were on duty during the day and a senior care staff member on sleep over and two staff were on duty overnight. We found information about people’s needs had been used to determine that this number of staff could meet people’s needs.
Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work. The checks included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.
Staff had received a wide range of training, which covered mandatory courses such as basic food hygiene as well as condition specific training such as working with people who lived with Autistic Spectrum Disorders. We found that the provider not only ensured staff received refresher training on all training on an annual basis but offered staff regular access to a wide range of course and educational material.
We found that the building was very clean and well-maintained. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. All relevant infection control procedures were followed by the staff at the home. We saw that audits of infection control practices were completed.
We saw that the provider had a system in place for dealing with people’s concerns and complaints. People we spoke with told us that they knew how to complain and but did not have any concerns about the service.
The provider had developed a range of systems to monitor and improve the quality of the service provided. We saw that the registered manager had implemented these across the service. This had enabled the manager to identify areas for improvement and make the necessary changes. We found that the registered manager constantly critically reviewed the service and looked at what more could be done to make sure people lived fulfilling lives and assist them to reach their full potential. The systems being used were extremely effective and the service was well-led.
The service had a registered manager in post. The management of the home was good and we saw strong leadership and a positive environment for people and staff. Staff spoke highly of their manager and the support which they received.
Records showed that CQC had been notified, as required by law, of all the incidents in the home that could affect the health safety and welfare of people.
During the inspection, the inspector worked to answer five key questions which are outlined below.
If you want to see the evidence that supports our summary please read the full report.
Is the service safe?
People told us they felt safe and secure. Good protocols were in place to maintain people's safety at the home and out in the community. All staff we spoke with were confident about the action they needed to take to keep people safe and were able to describe the procedures which they needed to follow if they became concerned.
The home was clean and well-maintained. We saw that some work needed to be carried out and plans were in place for this.
We found gaps in some of records during our inspection. The manager said they will take action to address this.
CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand where an application should be made, and how to submit one.
Is the service effective?
Care plans were specific to people and clearly detailed people's daily routines, how and when to support people and the action needed to be taken to manage people's risk. Regular reviews of people's records were in place and detailed the people involved in those reviews.
People had access to a range of health care professionals, some of which visited the home. Staff and / or relatives escorted people to health care appointments. People had information packs available about their health and care needs and took these to appointments with them. This gave professionals unknown to people guidance on how to offer support.
Staff knew the people who they cared for well and were quick to respond to changes. People we spoke with were happy with the care which they received.
Is the service caring?
People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People were given the time they needed to make decisions.
Care plans were very detailed and provided the information needed to meet people's specific care needs.
Staff training was up to date. This meant staff had the necessary skills to provide care and support for people's specific health and care needs.
Is the service responsive?
Since the new manager took over they had worked hard to respond to the needs of people and staff at the home. They had introduced changes which meant that people and staff were happier living and working at the home.
People had good links with the community and participated in activities specific to their individual care needs. People also participated in activities with each other, both at the home and out in the community. People were supported by staff to participate and attend activities and events which increased their social contact.
Regular care plan reviews were in place, were planned in advance and detailed the people involved in their reviews.
People, relatives and staff knew how to make a complaint if they were unhappy. Staff were knowledgeable about the action which they needed to take if they received a complaint.
Is the service well-led?
The home maintained good links with health and social care professionals. This meant that people received the care and support which they needed.
The new manager had ensured that staff appraisals, supervision and staff meetings were up to date. This meant that staff felt supported and felt able to approach their manager when needed.
People and staff told us that they had confidence in their new manager. Staff felt that they were now working well as a team and morale had increased. Staff were happy with the changes which had been made.
What people said
People who were able to express their views told us they were satisfied with the care and support they received. One person told us, 'I am happy here. I like my room.' Two people we spoke with told us about their day and where they had been. People spoke positively about the activities which they had been involved in that day.
Staff spoke positively about the home and the people who they cared for. One staff member told us, 'It's a friendly happy home. We all have a laugh. Staff are very happy.'
All the people we spoke with were satisfied with the service they received. We found that people had their needs assessed and that care plans were in place. Staff responded quickly when people needed support and people were provided with the care they needed.
We saw that staff worked in collaboration with other health and social care professionals.
People who used the service were protected from the risk of abuse and told us they felt comfortable and safe with staff.
We found there was a recruitment procedure in place and appropriate checks were carried out on staff before they started work.
The quality of the service was monitored and reviewed on a regular basis.
We found that records within the service were accurate, reviewed regularly and easily accessible to staff, thus ensuring that people received appropriate care and support.
People who used the service had their physical and mental health needs met by staff who had the relevant skills and experience to do so. They were able to engage in activities within the community and within Hemlington Hall. People were protected from inappropriate use of restraint because the advice and guidance of health professionals had been sought and staff were all trained in when restraint should be used.
People who used the service were protected from the risk of abuse because there were systems in place to identify the risks of abuse and manage them correctly.
Staff were up to date with mandatory training and received regular supervision and support from the service managers. This made sure that any concerns about people's performance were addressed quickly. Staff were supported in their role and encouraged to develop their skills and knowledge.
The service had systems in place to monitor the quality of services provided and where incidents occurred, to learn from them and change practice to ensure the risk of them happening again was minimised. This meant that people were supported by a service that checked the quality of support it delivered and made improvements when these were identified as needed.