1 & 2 Hedgerows

Hedgerows is a residential care home that provides short stay accommodation and personal care support for up to five adults with learning disabilities and/or autism. The service provides planned respite care and emergency short stays for people when required. At the time of our inspection there was no one booked to use the service. There are approximately 40 people who use the service as and when required.

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.

People’s experience of using this service

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. There was a strong and visible person-centred culture within the staffing team, with staff going above and beyond their roles to ensure people were treated equally and fairly. Staff supporting people and had a genuine passion for the care and support they provided. They demonstrated an in-depth knowledge of the people they supported and were fully aware of people's likes, dislikes and preferences. An equality, diversity and human rights approach to supporting and caring for people was evidently well embedded in the service and staff exceeded their roles to promote this. People were treated exceptionally respectfully and without discrimination.

Relatives spoke highly of the service and the care and support provided. People were protected from avoidable harm and abuse and relatives told us they felt their loved ones were safe and well supported. Safeguarding and whistleblowing policies and procedures were in place and staff were aware of the procedures and how to keep people safe. Risk assessments enabled staff to manage identified risks whilst ensuring people’s rights and independence was promoted and respected. Positive risk taking was supported and encouraged in line with the principles of Registering the Right Support (RRS) to help people learn new skills and enjoy accessing community services.

There were arrangements in place to manage medicines safely and staff followed appropriate infection control practices to prevent the spread of infections. Appropriate recruitment checks took place before staff started work. There were sufficient staff available to meet people's needs. Staff had good skills, knowledge and experience to support people appropriately. Staff were supported through induction, training and supervision and personal professional development was supported.

People were supported to meet their nutritional needs and to maintain a balanced diet ensuring continued well-being. 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 support this practice.

The home environment was clean, homely and suitably adapted to meet the needs of the people using the service. People had access to health and social care professionals as required. People were supported to access community services and to participate in activities of their choosing that met their needs.

Complaints were managed and responded to appropriately in line with the provider’s policy. There were systems in place to assess, monitor and improve the quality of the service. The register manager and staff demonstrated a strong commitment to provide person centred and high-quality care driven by good engagement with relatives and working cohesively with health and social care professionals to achieve best outcomes for people.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: Good (Report was published on 12 December 2016).

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.

This service was previously inspected on 3 October 2013 where we found it to be compliant with all areas inspected.

The service had 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.

Staff demonstrated good knowledge of safeguarding adults and could identify what action they needed to take if they suspected abuse. The provider had ensured that appropriate employment checks had taken place so that staff were safe to work with people at the home. There were sufficient numbers of staff to keep people safe. The provider gave staff appropriate training to meet the needs of people.

Medicines were being safely administered and stored securely by staff that had received appropriate training and were assessed as being competent to do so. Two staff were checking medicine stocks on a daily basis. Information provided on people’s medicines was up to date and gave clear guidance.

The principles of the Mental Capacity Act 2005 (MCA) were applied. People were being assessed appropriately and best interests meetings took place to identify the least restrictive methods. Staff had received training on MCA and had good knowledge. The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people's freedom had been submitted and the least restrictive options were considered as per the Mental Capacity Act 2005.

People's needs had been assessed and detailed care plans had been developed. Care plans contained risk assessments for daily living needs that were personalised for the people staff supported. People were given options on what they would like to eat.

Relatives spoke positively about staff. Staff communicated with people in ways that were understood when providing support. People’s private information was stored securely and discussions about people’s personal needs took place in a private area where it could not be overheard. People were free to choose how they lived their lives. People could choose what activities they took part in and would decorate their bedrooms according to their own tastes.

The provider had ensured that there were effective processes in place to fully investigate any complaints. Records showed that outcomes of the investigations were communicated to relevant people. People and their relatives were encouraged to give feedback through resident meetings and yearly surveys.

Relatives and staff spoke positively about the management team. The registered manager had an open door policy and all people we spoke with told us that if the registered manager was not at the service she was very easy to get hold of. Staff were able to discuss concerns with the registered manager at any time and had confidence appropriate action would be taken. The registered manager was open, transparent and responded positively to any concerns or suggestions made about the service. The registered manager had informed the CQC of all notifiable events detailed in the regulations.

The registered persons had not carried out full and robust auditing. A quality assurance audit took place in January 2016, but, at a time when there were no people staying at the service. Policies and procedures updated by the provider were not always being communicated to staff. Monthly checks were not always being completed due to a lack of auditing. We have made a recommendation about this in our report.

We spoke with five people who used the service, three members of staff and a member of staff from a day service that some people attended.

We saw that people had care plans that reflected their individual needs and preferences. Other records showed that people were supported in line with their care plans and that information about their needs was reviewed regularly.

People made choices about what they did when they stayed at the service; they chose what meals to eat and what they would like to do during evenings and weekends.

The service worked in cooperation with providers of other services that people used. A member of staff from a day service told us 'I have had no problem with them at all, communication is good'.

The service was clean and well maintained. People told us they could choose which rooms to stay in and two people showed us the rooms they had chosen.

People said they liked the service and chose what they wanted to do in their leisure time. They told us 'it's nice here' and 'I can go to my day centre when I am here'. One person told us 'we like to watch the soaps' and 'I go to the Gateway Club'.

We observed that staff had good relationships with people and that staff were respectful towards them. Staff were well supported and had the training they needed for their roles.

People were involved in decisions about their care and were given the opportunity to make choices about things in their daily lives. People told us they were listened to. The service was managed in a way that recognised the importance of people as individuals. Staff knew how to communicate with people in a way they would understand. This sometimes involved the use of pictures and photographs.

People that used the service had their needs met and were supported to be as independent as possible. There were opportunities for people to go out in the local community for social and leisure activities. Where they needed support to attend health appointments this was provided. People were helped to eat healthy foods when they wished.

Staff working in the service knew how to protect people from abuse. People that used the service said they felt safe. Everyone knew how to make a complaint if they needed to and they were confident that their views were be taken seriously.

The service employed enough skilled staff to meet people's needs. We saw that staff treated people with respect and understood how to provide their care in the way they preferred. People told us they liked the staff that supported them.