Archived: The Huntercombe Centre - Redbourne

Accommodation is provided in a large detached, two-storey building offering 14 single bedrooms with vanity units, four bathrooms and separate toilets, two communal lounges and a dining room. In addition, the service offers a training kitchen and adjoining lounge, a relaxation room and a social/education room with computer suite.

The service has extensive gardens with seating areas, a greenhouse and poly-tunnel, and off street parking. It is situated on a main road in a rural village, close to local amenities including a village shop and pub. The service has two vehicles for people’s use.

The service had a registered manager in post. 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service was last inspected on 6 October 2015 and was rated ‘Good’ overall. At this inspection we found the service remained ‘Good ‘overall and we judged the well–led domain to be ‘Outstanding’.

There was a strong person-centred culture apparent within the service with care tailored to meet the needs and aspirations of each individual. Positive risk taking was driven throughout the organisation. Staff balanced the potential benefits and risks and chose particular actions over others, in order to support people to lead fulfilling lives in as ordinary a way as possible. In delivering this consistent approach people were supported to try new things and make positive changes in their lives. The provider, the registered manager and the staff team all had an excellent understanding of positive risk management and supported people that had previously challenged services to reach their full potential.

An outstanding feature of the service was the time invested developing the service to accommodate the changing needs of the people who used the service, using innovative and flexible ways to move people forward. The registered manager demonstrated strong values and a desire to continue to learn about and implement best practice throughout the service.

We found personalised programmes and flexible staffing arrangements enabled people to learn to live fulfilled and meaningful lives. Staff knew people well and were skilled at ensuring they were safe whilst encouraging them to stretch their potential and achieve as much independence as possible. Care plans had been developed to provide guidance for staff to support in the positive management of behaviours that may challenge the service and others. This was based on least restrictive practice guidance to support people safely.

Robust systems were in place to protect people from the risk of harm or abuse. People who used the service were supported by staff who understood the importance of protecting them from harm. Staff had received training in how to identify abuse and report this to the appropriate authorities. Staff were recruited in a safe way and all checks were in place before they started work. The staff had received an induction and essential training at the beginning of their employment and we saw this had been followed by periodic refresher training to update their knowledge and skills. People were supported by sufficient numbers of staff.

The registered manager and staff team supported people to access health care professionals when needed and to have maximum choice and control over their lives. Staff supported them in the least restrictive way possible; in line with policies and systems in the service to support this practice.

The leadership, management and governance of the service were outstanding and assured the delivery of high quality, person-centred care which supported learning and innovation. The service developed and maintained strong links with external organisations and within the local community. The registered manager investigated and resolved complaints wherever possible to the complainant's satisfaction.

People who used the service, and those who had an interest in their welfare and wellbeing, were asked for their views about how the service was run and the care they received. Regular audits were carried out to ensure the service was safe and well-run.

Further information is in the detailed findings below.

We found that since our last visit, opportunities for individualised activities had been developed to enable people's wellbeing and independence to be better promoted. We saw that people's right of access to parts of building had been increased and that doors which had previously been kept locked were now open.

We observed that staff interacted with people who used the service in a friendly and supportive manner. People told us they liked the staff and felt comfortable with them.

We saw that requests had been made to the local authority for assessments of people's capacity for making informed decisions and that more training on the Mental Capacity Act, Deprivation of Liberty and Best Interest decision making had been delivered to staff.

We saw that relatives were welcomed to visit and be involved in the unit. A relative told us they visited regularly. They said that the service worked closely with them to ensure they were able to participate and be included in decisions about their member of family. The visiting relative told us that overall they were, 'Very satisfied' with the support that was provided by the service.

Patients told us about regular meetings to enable them to participate and be involved in decisions about their treatment. We saw information was provided for patients in easy read format, to help them understand decisions that were made. We observed patients appeared comfortable with staff and saw positive choices were provided about support that was delivered.

We observed the management and delivery of support was affected by lack of space within the unit, which we felt could be a potential catalyst for issues between patients. We saw some practices such as locked doors, were an accepted part of the daily routine and restricted movement around the building.

We found that whilst care and treatment was planned and delivered in a way intended to ensure patient's safety and welfare, individual risks for patients had not always been individually assessed.

Patients told us they felt safe with staff who were 'Friendly and helpful'. However we found some areas of patient decision making, in terms of their fluctuating needs, had not always been fully considered when planning their support. This meant that patients' human rights may not be properly protected.

We saw monthly reports sent to the provider to enable the quality of the service to be monitored. However we found little evidence of regular internal audits to inform future patterns of service delivery.