Hawthorn House

The service has not been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. The property was larger than recommended having been built to accommodate up to ten people. Although this is larger than current best practice guidance, this was mitigated as the building was integrated into a housing estate. The registered manager and staff team ensured there were enough staff to ensure people received highly personalised care and could access the local community when they wanted. The registered manager had also engaged with the local community to ensure excellent links were in place.

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

People received a highly personalised service from exceptionally caring staff. The registered manager and staff were extremely passionate and motivated to provide high-quality, person-centred care. Relatives valued the service and praised staff for their commitment to people. One relative commented, “I think it is an excellent service … In my opinion they should be outstanding.”

The registered manager demonstrated especially strong leadership and had been proactive in driving forward service improvement for the benefit of people staying at Hawthorn House. Quality assurance was fully embedded into service delivery to ensure standards remained consistently high.

The service went above and beyond to ensure people’s needs were met and they achieved their goals. Staff endeavoured to provide people with an enjoyable stay that was focused around their hobbies and interests. Staff were dedicated to caring for people living at the service. This ensured people received a unique service which met their needs. Staff excelled in working in partnership with professionals to ensure people’s health and wellbeing were prioritised.

People were safe at Hawthorn House. Relatives confirmed the service was a safe place. Staff knew how to report safeguarding and whistle blowing concerns. The provider had enough staff on duty to meet people’s individual needs. New staff were recruited safely. The registered manager investigated incidents and accidents logged. People received their medicines safely. Staff completed various risk assessments and health and safety check to enhance people’s safety.

Staff were very well supported and received the training they needed. Staff supported people to have enough to eat and drink. 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.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Hawthorn House provides a short break service for up to ten people who have a learning disability, some of whom may also have a physical disability. On the day of our inspection there were three people using the service however there were 70 people in total who used the respite service.

The service did not have a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (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 of the service had applied to become registered with CQC and the application was in progress at the time of the inspection.

Hawthorn House was last inspected by CQC on 10 March 2016 and was rated Requires Improvement in two areas. We checked these areas at this inspection and the found necessary improvements had been made.

Accidents and incidents were appropriately recorded and risk assessments were in place. The manager understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vulnerable adults.

Appropriate arrangements were in place for the administration and storage of medicines.

The home was clean, spacious and suitable for the people who used the service and appropriate health and safety checks had been carried out.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. At our last inspection we found that appropriate recruitment checks were carried out to ensure that staff were suitable to work with vulnerable people. We did not check staff recruitment records at this inspection because there had been no new staff recruited.

Staff were suitably trained and received regular supervisions and appraisals.

The registered provider was working within the principles of the Mental Capacity Act 2005 (MCA) and was following the requirements in the Deprivation of Liberty Safeguards (DoLS).

People were supported with their health care needs and care records contained evidence of consultation with health care professionals.

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Family members were complimentary about the standard of care provided by staff at Hawthorn House.

Staff treated people with dignity and respect and helped promote people’s independence.

Care records showed that people’s needs were assessed before they started using the service and care plans were written in a person-centred way. Person-centred is about ensuring the person is at the centre of any care or support plans and their individual wishes, needs and choices are taken into account.

Activities were arranged for people who used the service based on their likes and interests and to help meet their individual needs.

The registered provider had an effective complaints procedure in place however there had been no formal complaints recorded at the service.

Staff felt supported by the management team and were comfortable raising any concerns. People who used the service, family members and staff were regularly consulted about the quality of the service.

Hawthorn House is a purpose built single storey building which provides a short break service for up to ten adults aged 18 and above who have a learning disability, some of whom may also have a physical disability. It is located on the outskirts of Durham City.

The home had a manager who was not yet registered with the Care Quality Commission. 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 manager told us they were in the process of completing their application to become the registered manager.

The manager and staff showed that they had an understanding on the Mental Capacity Act (MCA) 2005. MCA is legislation to protect and empower people who may not be able to make their own decisions, particularly about their health care, welfare or finances. Professionals had completed capacity assessments on people who used the service; however decision specific assessments of capacity were not available on care records we looked at. Best interest decisions were not always recorded.

Staff had received regular updates on their training to enable them to carry out the duties within their role; however the training chart needed further development to detail the dates of staff training and all the training staff had completed.

People were protected by the service's approach to safeguarding and whistle blowing. Staff were aware of safeguarding procedures, could describe what they would do if they thought somebody was being mistreated and said that management acted appropriately to any concerns brought to their attention.

Appropriate checks of the building, equipment and maintenance systems were undertaken to ensure health and safety.

Risks to people’s safety had been assessed by staff and records of these assessments had been reviewed. Risk assessments had been personalised to each individual and covered areas such as choking, mobility, community participation and behaviour that challenges amongst others. This meant staff had the written guidance they needed to help people to remain safe.

We found that safe recruitment and selection procedures were in place and appropriate checks were completed before staff started work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people. Sufficient staff were on duty to ensure people’s needs were met.

Appropriate systems were in place for the management of medicines so that people received their medicines safely. Regular temperature checks were made of the room in which medicines were stored and on some occasions the room temperature was too warm. This meant that some medicines could deteriorate and be ineffective. The manager said they would monitor temperatures and take action if needed.

Staff told us that they felt supported. There was a programme of staff supervision in place. Records of supervision were detailed and showed that the manager had worked with staff to identify their personal and professional development goals. Staff had received an annual appraisal.

We saw that people were provided with a choice of healthy food and drinks which helped to ensure that their nutritional needs were met.

People were supported to maintain good health and had access to healthcare professionals and services.

There were positive interactions between people and staff. We saw that staff treated people with dignity and respect. Staff were attentive, patient and interacted well with people. Observation of the staff showed that they were caring and knew the people very well. Relatives told us that they were happy with the care and service received.

People were assessed and care plans were in place. Relatives told us they were involved with developing the care plans. Care plans described the level of support and care the person needed and likes and dislikes were also recorded. This helped to ensure people received the care and support in the way they wanted. Staff at the service were in the process of reviewing, updating and re-writing all plans of people. At the time of the inspection they had completed 17 of the 72 plans of the people who used the service during the course of the year.

People’s independence was encouraged and their hobbies and leisure interests were individually assessed. There were activities and outings for people.

The registered provider had a system in place for responding to people’s concerns and complaints. Relatives said that they would talk to the manager or staff if they were unhappy or had any concerns.

We looked at the arrangements in place for quality assurance and governance. Quality assurance and governance processes are systems that help providers to assess the safety and quality of their services, ensuring they provide people with a good service and meet appropriate quality standards and legal obligations. The service manager visited the service on a regular basis and completed audits on a monthly basis. The manager also completed an in house audit of care records, but did not always keep a written record of this.

The service manager told us that commissioners completed an annual survey with people and relatives to seek their views on the care and service provider. Commissioners did not share the result of this audit with participants or staff. This meant the management and staff were unaware if improvements were needed.

The manager provided good leadership who provided an emphasis on teamwork. Morale was good and staff were well supported in carrying out their responsibilities.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we took at the back of the full version of this report.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with dignity and respect by staff. Systems were in place to make sure that the acting manager and staff learned from events such as accidents and incidents, complaints, concerns and investigations. This reduced the risks to people and helped the service to continually improve.

The home had proper policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards although no applications had needed to be made. Relevant staff had been trained to understand when an application should be made and how to submit one. This meant people were safeguarded as required by the law.

Staff recruitment practice was safe and thorough. This meant only suitable people were employed with the right skills and experience.

Is the service effective?

People's health and care needs were assessed with them. Specialist dietary, social, mobility, equipment and needs in relation to their learning disability had been identified in care plans where required.

Is the service caring?

People were supported by kind and attentive staff. We saw that support workers showed patience and gave encouragement when supporting people. Relatives had commented 'Name of person seems to have settled well' and 'All staff were exemplary and could not have been more helpful.'

People's preferences, interests, likes, dislikes and different needs were written down in their support plans. This helped to make sure support was provided in accordance with people's wishes.

Is the service responsive?

People completed a range of activities in and outside the service. The home had its own adapted minibus which helped people become involved with the local community.

The home had an effective complaints procedure. We looked at how complaints had been dealt with and found that responses had been open, thorough and timely. People could therefore be assured that complaints were investigated and action taken as necessary.

Is the service well-led?

The service worked well with other agencies, such as social workers, to make sure people received their care in a joined up way.

The service had a quality assurance system. The records we looked at showed any shortfalls were addressed quickly. This helped to ensure that people received a good quality service at all times.

People who used the service were protected from the risk of abuse or harm. This was because staff understood about the risk of abuse and what to do should they suspect or see this happening. People told us 'I would talk to the staff if I was unhappy.'

We found staff were properly trained and supported and understood the care and welfare needs of the people they supported.

The manager and senior staff carried out regular checks to make sure good standards of care were provided to people.