Holkham House

Whilst the environment wasn’t developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance, people’s care was. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People at Holkham house lived their life’s as full as possible and had control over what they did and how they were involved in decisions about their care and the service.

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

The ethos of the organisation was to enable people to have as much independence, choice and control as possible. We saw many examples of people leading the life of their choice and being able to influence that on a daily basis. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent. Any communication challenges were seen as an opportunity to support someone to have a voice and still have control of their life. We saw staff used a range of innovative methods to communicate with people. For example, videos, audio minutes, pictorial and easy read versions of some procedures.

When we arrived at the service the atmosphere was busy and friendly. We met everyone living at the home, spoke with some and observed care. Staff were supporting people coming in from various outings and planning a visit out to attend a party in the service next door. Staff were encouraging people with meal planning and preparation while some people were doing craft work.

People’s relatives said they felt their loved ones were safe with the staff supporting them. Two people told us they felt safe. Systems were in place to safeguard people. Staff had completed safeguarding training and were confident any concerns would be dealt with. When people were at risk of harm, assessments were in place alongside guidance for staff on how to mitigate the risk.

People received their medicines safely in the way prescribed for them. Infection control measures were in place to prevent cross infection. Staff were suitably recruited. Staffing levels were flexible to enable the service to provide a bespoke service to people to meet their needs.

People were supported by staff who completed an induction, training and were supervised. The support required by people with health and nutritional needs was identified and provided.

Relatives agreed the staff were kind and caring. Their privacy and independence were promoted. Systems were in place to deal with concerns and complaints. This enabled people to raise concerns about their care if they needed to.

People’s care records were detailed and personalised to meet individual needs. Staff understood people’s needs and responded when needed. People were not able to be fully involved with their support plans, therefore family members supported staff to complete and review people’s support plans. People’s preferences were sought and respected.

People had staff support to access activities and holidays. This was flexible and provided in response to people’s choices. People’s communication needs were known by staff. Staff had received training in how to support people with different communication needs.

People were supported by a service that was well managed. Records were accessible and up to date. The service was audited, and action taken to address any areas identified that needed improving. Relatives were complimentary of the management of the service with one commenting; “Always very approachable and seems to have a genuine sense of care for the residents.” Staff were committed to providing good 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 and update

The last rating for this service was good. (Report published 28 September 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.

Holkham House is a 10 bedded care home for adults with a learning disability. At the time of our inspection there were nine people living at the service. The premises are spacious and comprise ground floor and first floor accommodation.

There was a registered manager in post, who has managed the service for three years. 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.

There were systems in place to protect people from harm or abuse. Staff had received appropriate safeguarding training and understood how to protect people. People’s care and support plans showed that risks to their safety were identified and plans were put in place to mitigate the risks.

We observed that there were sufficient numbers of staff deployed to support people with their personal care and social interests at home, and to go out for activities. Robust recruitment practices were used to ensure that staff had suitable qualifications and experience to meet the needs of people who use the service.

Medicines were stored, administered and disposed of safely. Staff received medicines training and understood their responsibilities in relation to the safe management of prescribed medicines.

Arrangements were in place to make sure that people were provided with a comfortable, hygienic and safe home. This included up to date risk assessments for the environment and regular checks to ensure that equipment was in good working order.

People were supported by staff with suitable knowledge and skills to meet their needs. Staff were provided with training sessions and one to one supervision, which included training and guidance about how to meet people's individual needs.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS), and to report on our findings. We found that the management team had received applicable training and presented a competent understanding of the MCA and (DoLS). Staff had also received training and demonstrated an awareness of the principles of MCA. People’s rights were protected by staff who ensured that any restrictions on people’s freedom and liberty were in accordance with legislation.

People were offered choices about their food and drinks. The care and support plans demonstrated that people were supported to meet their nutritional needs, and follow instructions from dietitians and speech and language therapists where applicable. People were promptly referred to healthcare professionals and supported to attend appointments and treatments.

People had developed positive relationships with staff, who showed a proficient understanding of people’s individual and complex needs. Staff spoke with people in a gentle and kind manner, and respected their rights to privacy and dignity.

Care and support plans reflected people’s needs, interests and wishes, and were regularly reviewed. People were supported to be as involved as possible in the planning and reviewing of their care and support plans, and relatives confirmed they were consulted about their family member’s care and support. People were offered a varied range of activities at home and in the wider community.

Systems were in place to encourage people to express their views, concerns and complaints about the quality of their care and support. People told us they would tell the registered manager and/or a staff member if they were not happy about their care and support, and relatives said they were confident that the registered manager would take any complaints seriously.

People told us they were happy living at the service and relatives commented favourably about how the service was managed. The provider held a clear vision and values that was understood by relatives and staff. There were systems in place to listen to the views of people who use the service and their representatives. The provider continuously monitored the quality of the service and identified areas for improvement.

We therefore found that before people received any care or treatment they were asked for their consent and where people did not have capacity the provider acted in accordance with legal requirements.

People told us they liked the staff, got enough food and could choose what they wanted to eat. One person said they didn't like the food.

People also told us they liked the home and their rooms. They said their rooms were warm enough and their taps worked properly.

One of the people who use the service showed us their room and how they had individualised it.

Other people who use the service wanted to be involved in the inspection and were supported by staff to do so where appropriate, for example, showing us their diet plan and progress or a photograph of a meeting, or how shopping was decided.

A relative of people who use the service told us they thought their relative got enough food and had put on weight and that the building and bedroom was suitable. They said the staff kept their relative stimulated and entertained and that they knew their relative was happy at Holkham House because they were always happy to return there after visits.

Staff offered choices and sought consent before offering care and information was included in formats and languages people would understand better so the person's consent would be better informed. However, where people did not have capacity to consent the provider did not always act in accordance with legal requirements.

We saw that people were supported to be able to eat and drink sufficient amounts to meet their needs.

We found that people who use the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.