Harefield Lodge

We found the following examples of good practice.

Opportunities for people to have visits with their loved ones were available. The registered manager told us people were encouraged to use alternative communication such as telephone calls and online video calls to keep in contact with people who were important to them.

People were supported to understand information about the pandemic using easy read information which was prominently displayed in the service.

Records showed that the provider understood and implemented national guidance to support safe admissions to the service.

We observed the home was clean and staff completed regular cleaning activities which were recorded. Consideration was also given to ensure the service remained well ventilated in line with best practice guidance.

Staff had access to ample supply of appropriate personal protective equipment (PPE), and we observed this was used in line with national guidance. Staff had received updated training in the appropriate use of PPE and infection prevention and control (IPC). We received positive feedback from other health professionals that the service engaged well in the training opportunities offered.

We reviewed the homes IPC policies and procedures. We found these were regularly updated and included appropriate reference to national guidance and publications. Information included relevant signposting to service specific best practice guidance for people with a learning disability and or autism.

People and staff had access to regular testing in line with national guidelines. Staff and people were also encouraged to participate in the national COVID-19 vaccination programme.

Harefield Lodge is registered to accommodate up to seven adults, who have a learning disability or an autistic spectrum disorder. At the time of our inspection there were five people there. The home consisted of a main building with bedrooms, offices, a kitchen, a dining area and lounges. There were sensory areas and quieter places for people to spend time in if they wished. To the rear of the property there were self-contained flats where people could live and be supported by staff to live as independently as they could.

The service had 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.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained good overall and had become outstanding in response to the question, “Is the Service Responsive?”

Harefield Lodge had a 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.

The service had an open, supportive and person-centred culture with good relationships amongst people and staff.

Most of the people who lived at Harefield Lodge communicated with nonverbal gestures, sounds and by touch. We spoke to one person who told us they enjoyed living at Harefield Lodge and liked everyone who lived and worked there. We received positive feedback from relatives and health professionals who visited the home regularly.

People were supported by appropriate numbers of trained, experienced, skilled staff who knew the people who lived at Harefield Lodge very well. Staff supported people to ensure they lived their lives the way they chose. Communication styles and methods were tailored to individual people and staff supported people to understand the choices available to them.

The service had carefully considered people's individual needs through the adaptation, design and decoration of the premises, indoors and outdoors. The garden was in the process of being adapted to reflect people’s preferences with plans to include sensory areas, quiet reflective areas and containers and vegetable growing sections where people could take part in growing and tending to their own vegetables and plants.

There were elements of outstanding practice in relation to providing person centred care that met people's individual needs. People received outstanding person-centred care from a staff team that showed innovation and tenacity to ensure people received care and support tailored to their specific needs to enable them to live fulfilled lives. People were encouraged and supported to take part in a wide range of activities, music therapy, sensory sessions and visits to places that gave them enjoyment. Activities were adapted according to people’s individual needs to ensure they got the most benefit and enjoyment from the activities. People and staff told us they really enjoyed their activities which promoted their independence and maintained their sense of wellbeing.

Staff understood how to identify and report abuse and were well supported in their roles. Staff received up to date training on all core subjects as well as ad hoc training for subjects that interested them such as autism and specialist medicine training.

People were supported to take their medicines safely by staff who had received the appropriate levels of training.

People were supported by staff to make their own choices about how they spent their day. Staff had a good knowledge and understanding of the Mental Capacity Act 2005 (MCA) and promoted people's independence and choice in their day to day living. Where people might lack capacity to make a specific decision staff acted in accordance with the MCA.

People were enabled to have choice and control of their lives and staff supported them in the least restrictive way possible, the systems in the service supported this practice.

People's health care needs were met and staff supported people to see healthcare professionals when appropriate. Staff were proactive in recognising people’s changing health needs and acted quickly to ensure people received specialist health care when they needed it.

People were treated with kindness, dignity and respect by a staff team who knew them very well. People’s privacy was respected at all times.

There was a clear complaints policy and relatives told us they knew how to make a complaint if the needed to and felt any concerns would be taken seriously and action straight away.

There were quality assurance systems in place to drive continuous improvement and ensure the home offered a safe, effective, caring and responsive service.

Further information is in the detailed findings below.

Harefield Lodge provides care and support for seven people, who have a learning disability or an autistic spectrum disorder. The home consisted of the main building where three people lived and contained offices and a communal kitchen and living area. To the rear of the property four people lived in self-contained flats and they were supported by staff to live as independently as they could.

The home did not have a registered manager; however, a manager had been appointed who had applied to become the 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.

People were kept safe as the provider had policies and procedures in place to protect them from abuse. Staff were aware of their responsibilities in respect of safeguarding. They had received training which enabled them to know how to report concerns and who they had to report this to.

Risks were assessed as part of the care planning process. Action was taken to mitigate the risks and enable people to receive care safely. There were plans in place to respond to all emergencies.

There were sufficient staff to deliver care safely to people. People’s support needs were assessed and the provider identified when people required more support.

Medicines were managed efficiently and safely. Areas for storage of medicine were secure. Staff were trained and assessed as competent to administer medicines.

Care staff knew people’s needs and how they communicated. They knew how people liked to be supported. Staff received adequate training and supervision to enable them to deliver care effectively.

Staff were aware of the Mental Capacity Act and their role in supporting people who could not make decisions for their own care. Staff ensured peoples’ consent was given before delivering any care.

People were supported to eat and drink healthy and well balanced options. Staff were aware of how people demonstrated they liked particular foods and knew what their favourite meals were.

People accessed local health care and were registered with GP services near to the home. Specialist health care support was sought when required.

Staff demonstrated kindness and compassion when assisting people. People showed they were comfortable with staff supporting them and chose when they wanted to spend time with staff. Where possible people were involved in their care planning and attended reviews where appropriate.

People’s privacy and dignity was respected by staff when they delivered care, This was done by knocking on people’s doors and delivering personal care to people in their bedrooms or bathrooms.

Care plans were personalised and contained information on what was important to the person. People were supported to be involved in a range of activities both within the home and in the community. Concerns and complaints were listened to and views of people, relatives and staff were encouraged and listened to.

There was a positive culture within the home and clear values that staff were aware of. People and staff were involved in developing the service. Management within the home were approachable and staff felt they could talk to the manager about any concerns they had.

The provider had a comprehensive quality monitoring process which identified where the service needed to improve. The manager prepared an action plan to show how they responded to issues raised within the quality audit.