Archived: Horton House

Horton House provides personal care in people's own homes. At the time of the inspection the service provided personal care and support to nine people living in their own homes.

The service provided support to younger adults with learning disability, autistic spectrum disorder, sensory impairment and physical disability. Personal care was provided to people as they required it. The service also provided other forms of social care support that are not included within CQC's registration requirements for a supported living service. For example, the service assisted people with their housekeeping, shopping, attending appointments and other independent living skills.

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 and what we found

People told us they felt safe with staff who supported them. The provider had policies and procedures in place designed to protect people from the risk of suffering harm and abuse. Risk assessments were in place which identified possible risks to people living in their own homes.

People's needs were assessed before the service started to support them, to ensure their needs could be met. People's needs were met by suitable numbers of staff.

People were supported by staff who were well trained to meet their individual needs. The service worked closely with people’s families and other professionals to improve the care and support they provided.

Staff asked people for their consent before supporting them. People felt they were supported well by the staff team, who respected their choices and decisions. People were supported by staff who respected and promoted their privacy, dignity and independence.

People, and those close to them, were involved in planning and reviewing their care which meant care plans were specific to each individual. People's communication needs were identified within their care plans. People’s views were central to how the service was run.

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 was well managed; management were open and honest. There were effective systems to monitor the quality and safety of the service. There was a strong commitment to continuous improvement.

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 (Report published 8 November 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.

The service is registered with the Care Quality Commission (CQC) for the provision of personal care in people’s own homes. This includes assistance or prompting with washing, toileting, dressing, eating and drinking. We call this type of service a ‘supported living’ service. In a supported living service, people’s accommodation is provided by separate housing providers or landlords, usually on a rental or lease arrangement. This means people can choose an alternative support service provider if they wish.

The service provided support to younger adults with learning disability, autistic spectrum disorder, sensory impairment and physical disability .Personal care was provided to people as they required it. The service also provided other forms of social care support that are not included within CQC’s registration requirements for a supported living service. For example, in addition to personal care, the service assisted people with their housekeeping, shopping, attending appointments and other independent living skills. At the time of the inspection the service provided personal care and support to 14 people living in their own homes. Some people who used the service lived in a supported housing development called Morgan Court, close to where the service was based.

There was 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.

There had previously been a number of managers in post for short periods of time. People, relatives and staff welcomed the commitment and consistency of the current manager. One member of staff told us, “We have struggled due to managers, but [manager’s name] has come and stuck it out. They are good at organising, good to talk to, approachable. They’ve been doing shifts and are willing to step in”.

Regular training was provided for staff, who were knowledgeable about their roles and responsibilities, and people’s individual needs. However, many staff were not up to date with the mandatory training provided via eLearning, which meant there was a risk their knowledge and skills would not be maintained. The registered manager was aware of this, and had taken steps to address the issue with staff at team meetings and in supervision. In addition they were planning to “rota people on to do eLearning, rather than ask them to do it in their own time”.

The registered manager told us the service had been through a challenging time related to the retention and recruitment of staff, although they were confident the situation would now improve following a successful recruitment campaign. The registered manager and senior support workers had covered shifts themselves and regular agency staff provided consistency and safe staffing levels. People told us there were enough staff to meet their needs and the quality of the care they received had not been affected.

The service placed a strong emphasis on a ‘person centred approach’, and staff received specific training to support them in this. They respected people’s privacy and dignity, working in partnership with their relatives to ensure their legal rights were protected. They promoted their ability to make choices and decisions about their lives, and how they wanted their support to be provided. People told us the staff were kind and caring. One person told us, “They are very kind. I have to give them 100% for kindness”.

People were kept safe and free from harm. Systems were in place to ensure they received their prescribed medicines safely, where they needed assistance or prompting to take their medicines.

Comprehensive risk assessments identified individual risks to people’s health and safety and there was information in each person’s support plan showing how they should be supported to manage these risks. Risk assessments also supported people to take positive risks, enabling staff to promote their independence and do what they wanted to do in a safe way.

Policies and procedures ensured people were protected from the risk of abuse and avoidable harm. Staff had received a range of training and information including safeguarding adults and they were confident they knew how to recognise and report potential abuse.

People received support that met their individual needs and wishes. They and their relatives were fully involved in drawing up and reviewing their support plan which meant it accurately reflected their needs and how they wanted them to be met. An effective key worker system was in place. One relative said, “Their keyworker is absolutely brilliant, completely on the ball... taking care of things and making sure they run smoothly”.

People were supported to participate in a range of employment and activities according to their interests, and were actively involved in their local community.

Staff had a good understanding of people’s individual nutritional needs in line with their support plans. They followed recommendations from health professionals to ensure people’s nutritional and other physical needs were met safely.

The provider had a range of monitoring systems in place to check the service was running smoothly and to identify where improvements were needed. The service ensured the people using the service, and their relatives, had the opportunity to give feedback about the quality of the support they received. For example, relatives told us they were kept informed and their views sought at regular family meetings. People were recruited to be ‘quality checkers’, and annual survey forms were completed by people and their friends and relatives. People regularly attended forums such as 'Diverse Voices', and a ‘National User Panel’, where they could feedback directly to directors and the board of trustees

People said that they liked the way they had decorated their homes and that staff supported them to keep them as they wished. One person said “I enjoy art and I’ve got my pictures on the walls”. People said that staff would support them to cook their meals if they wanted and one person said “I’m a good cook”.

People who used the service were very positive and were unanimous that they were treated with respect. People told us that they were happy with their care and felt included in their care plan.

We looked at care records in people's homes and saw that care was planned to reflect individual needs. One person said "I always choose what I want to do as this is my home and my key worker helps me when I need them to".

People we spoke to told us they felt safe in their homes and were able to talk to staff if they had any concerns.

We observed that people were able to make their own choices about how to live their lives which had made them more independent. When asked what was best about having your own home one person said "It is my home and I can do what I want when I want to do it".

Staff told us that safeguarding adults from abuse was a high priority for them and they would report abuse or allegations of abuse to their manager.

Staff told us that they felt supported and encouraged to develop in their roles. One person said "they really care about us and want us to do well".