HF Trust - Gaston House & Dolphin House

HF Trust – Gaston House & Dolphin House is a residential care home providing accommodation for up to 9 people who require personal care and have a diagnosis of a learning disability and/or autism. The location consists of 2 separate houses, Gaston House which can accommodate 5 people and Dolphin House which can accommodate 4 people. At the time of our inspection, Dolphin House was closed, and 5 people lived in Gaston House.

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 assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

People did not always receive person centred care in line with Right Care, Right Support, Right Culture.

Right Support: Although staff knew people well and made attempts to engage people in their hobbies and interests, there was little direction for staff on what they should do each day to promote people’s emotional and social well-being. Meaningful activities were completed on an ad-hoc basis rather than being planned as a regular part of people’s lives. Where people had been allocated one to one staff support to complete meaningful activities, people had not always received this support. When people were supported to pursue social interests within the community, they often had to rely on other people wanting to do the same thing and went out in pairs or as a group. People's goals and aspirations were not always identified with people or those involved in their care.

People were not always supported to have maximum choice and control of their lives, but staff supported them in the least restrictive way possible and in their best interests; the providers policies and systems supported best practice, but these were not always followed by staff.

Right Care: Overall, people received care from a consistent staff team which had the best interests of people at heart. However, there was limited consideration given to the varying ways people could be empowered to make everyday choices using different communication methods. Where people required additional aids to promote their ability to communicate, these were not always used or known by staff.

Right Culture: There had been significant changes in both the internal managers and senior managers within the provider group. Systems were not always operated effectively to identify if people were receiving person centred care in line with Right Care, Right Support, Right Culture.

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 2 October 2018).

Why we inspected

We received concerns in relation to health and safety procedures and good governance. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. Please see the safe, responsive and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for HF Trust – Gaston House & Dolphin House on our website at www.cqc.org.uk.

Enforcement

We have identified a breach in relation to good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

HF Trust – Gaston House and Dolphin House is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service is delivered from two semi-detached homes in a rural area. The homes are treated as two separate households which meant the service had been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. The service provides accommodation and personal care for up to nine people with a learning disability or autistic spectrum disorder. Eight people lived at the home on the day of our inspection visit.

There was a registered manager in post at the service. 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 last inspection in February 2016 the service was rated as Good. At this inspection we found people continued to receive a service that was safe, caring and effective. However, we found pressures on staffing levels and people's differing needs meant staff could not always be responsive to the needs of those people who benefitted from more involvement and engagement in the local community. The rating remains 'Good' overall, but the responsiveness of the service is now 'Requires Improvement'.

Risks were identified and risk management plans were in place to support staff to mitigate the risks of harm people may face at home and in the community. The provider analysed accidents and incidents to ensure appropriate action had been taken to keep people safe. Staff understood their responsibility to report any concerns they had about people's health or wellbeing.

There were enough staff to keep people safe, although staff vacancies meant some staff were regularly working extra hours to maintain safe staffing levels. Staff received an induction and training to ensure they had the appropriate knowledge and skills. Further training was being arranged so staff worked consistently to meet the complex needs of people living with autism. The principles of the Mental Capacity Act (MCA) were followed by the registered manager and staff.

People were supported to access health services when needed. Staff regularly worked with other health and social care professionals to develop care plans to ensure they met people's changing needs. Each person had information in their care plans about their diet and nutritional support which staff were aware of. Staff managed medicines safely and people received their medicines as prescribed.

People had developed positive relationships with the staff supporting them. Staff knew people’s favourite activities and how they liked to be communicated with. Relatives were kept up to date with the wellbeing of their family member. The provider had an accessible complaints procedure, but relatives told us they had no cause to complain.

The home was clean and tidy and suitable to meet people's individual needs. The provider had quality audit systems to identify where improvements were needed to improve the service.

The service provides accommodation and personal care for up to nine people with learning disabilities including autistic spectrum disorder. Care and support is provided from two adjoined houses and at the time of our visit there were four people living in Gaston House and three people living in Dolphin House.

A requirement of the service’s registration is that they have 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 and associated Regulations about how the service is run. There was a registered manager in post at the time of our inspection.

Gaston House and Dolphin House provided homely environments where people appeared relaxed. Relatives were happy with the caring attitude of staff who took time to understand their family member’s needs. Staff were patient and kind in their approach towards people and communicated effectively with them. Staff supported people to maintain relationships with their relatives who felt fully informed and consulted about their family members' care.

There were enough staff to support people safely in the home and outside in the community. Staff received an induction into the organisation, and a programme of training to support them in meeting people’s needs safely and effectively. Identified risks associated with people's care were assessed and managed in a way that supported people’s independence and safety. Staff understood their responsibilities to keep people safe and report any concerns they had about people's health or wellbeing.

The registered manager understood their responsibilities under the Mental Capacity Act (MCA) to ensure people were looked after in a way that did not inappropriately restrict their freedom. This included authorisation by the relevant authority for any restrictions to people's freedom deemed necessary to keep them safe; known as Deprivation of Liberty Safeguards (DoLS).

People were supported to choose what they wanted to eat and staff had a good understanding of any identified risks around people's nutritional needs.

People were encouraged to participate in activities and care was planned to meet people’s individual needs, abilities and preferences. Staff told us communication amongst the team was good so they were able to respond to any changes in people's needs. Staff referred people to other health professionals for advice and support when their health needs changed. People received their medicines as prescribed.

There was a stable management team who staff said were approachable and supportive. Staff were given opportunities to discuss the needs of the people living in the home in regular meetings.

The provider had processes to monitor the quality of the service provided through a system of regular checks and asking for people's views on the quality of care. Relatives felt they were listened to and any queries were responded to promptly.