We carried out a review of the data available to us about Hope House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Hope House, you can give feedback on this service.
About the service
Hope House is a care home and provides accommodation and support for up to 11 people living with a learning disability. There were seven people living at the service when we visited.
People’s experience of using this service and what we found
Right Support
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 on the whole supported this practice. People were supported safely with medicines. Staff followed Infection prevention and control good practice guidance.
Right Care
Staff promoted equality and diversity in their support for people. Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. The service had enough appropriately skilled staff to meet people’s needs and keep them safe. Where people had support, this was flexible, generally available when they needed it and to the level they needed. Staff understood and responded to people’s individual needs. Staff understood people’s individual communication needs.
Right culture
The service was open to new ways of working and ongoing improvements were introduced to promote independence and inclusivity. Staff placed people’s wishes, needs and rights at the heart of everything they did. They sought advice and feedback from everyone involved in people's care. Staff were aware of and working to best practice guidance for supporting people with a learning disability and/or autistic 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 requires improvement (published 17 December 2020). At the time we found the service was in breach of two regulations regarding infection control and the effectiveness of the service’s quality assurance systems. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
We carried out an unannounced inspection in November 2020 and breaches of regulation were found. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe, effective and well-led which contain those requirements.
We assessed whether the service is applying the principles of Right support right care right culture. 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.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hope House on our website at www.cqc.org.uk.
Hope House is a residential service providing personal and nursing care to 11 people with a learning disability. At the time of the inspection there were eight people living at the service.
Hope House provides accommodation across two buildings with a variety of self contained flats, bedrooms and communal areas.
People’s experience of using this service and what we found
Infection control processes were not embedded and staff didn’t always follow government guidance. Medicines were managed safely. Processes to safeguard people from abuse were followed and risks were effectively reviewed and managed. Staffing levels were safe and the service was working on a recruitment and retention plan to reduce the current high levels of agency staff at the home.
The service was working to ensure recording systems promoted a person centred approach. There was a new management team at the service and staff we spoke with felt they could raise issues and concerns with them. Feedback from relatives was positive relating to the care and support their loved ones received.
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, 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 providing support to people with a learning disability and/or autistic people.
The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. Language used in the provider's care record templates and quality monitoring audit referred to a medical model of care that did not reflect the community residential model being provided.
Right support:
• Model of care and setting maximises people’s choice, control and independence
Right care:
• Care is person-centred and promotes people’s dignity, privacy and human rights
Right culture:
• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives.
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 20 July 2019).
Why we inspected
The inspection was prompted in part due to concerns received about infection control practices and staffing levels. A decision was made for us to inspect and examine those risks.
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 coronavirus and other infection outbreaks effectively.
The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.
We have found evidence that the provider needs to make improvements. Please see the Safe 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 Hope House on our website at www.cqc.org.uk.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.
We have identified breaches in relation to infection control and good governance at this inspection.
Please see the action we have told the provider to take at the end of this report.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
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. At this inspection the provider had not always applied them in relation to care records.
The outcomes for people did not fully reflect the principles and values of Registering the Right Support as care records did not assist staff to support people to receive person centred care.
We have made a recommendation about care plans to ensure they are person centred.
The size of service meets current best practice guidance. This promotes people living in a small domestic style property to enable them to have the opportunity of living a full life. We discussed with the registered manager to ensure that communal areas were free from information that pertained to staff rather than people living at the home.
We received concerns in relation to the safety of people. As a result, we undertook a focused inspection to review the Key Questions of Safe, Responsive and Well-led only.
We reviewed the information we held about the service. No areas of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection. We found no evidence during this inspection that people were at risk of harm from this concern.
People’s experience of using this service: We found no evidence of unwarranted restrictive practices, although we did discuss the prolonged use of anti-psychotic medication for two people and the strategic positioning of a sofa for another. Staff were able to give a rationale for both but were also open to considering review of these practices. Debriefs for staff were well recorded.
Staffing levels were appropriate and ensured people were supported to access community facilities. People received support to take their medicines safely and as prescribed. Risks to people's well-being and their home environment were recorded and updated when their circumstances changed.
People were supported to engage in activities they enjoyed and we saw the service promoted people accessing local community facilities. People and their relatives and carers told us they knew how to make a complaint.
Systems to monitor the quality of the care provided were effective. Staff were supported by the registered manager. The service worked well with professionals and had good links with their community.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection: Good (last report published November 2017).
Why we inspected: This was a responsive inspection based on concerns raised with CQC. 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.
Hope House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Hope House accommodates up to 11 people in two adapted buildings providing support for people with learning disabilities who may also experience mental health needs. At the time of our inspection visit there were five people using the service.
The care service had been developed and designed in line with the values that underpin the Building the Right Support and other best practice guidance. It underpins principles of choice, promotion of independence and inclusion. People with learning disabilities and autism using the service were living as ordinary a life as any citizen.
The service had a registered manager in place whose registration had been completed on the day of our inspection visit. 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
We last inspected the service in March 2017 and rated the service as ‘Requires Improvement.’ At that visit we found breaches of regulations in relation to consent, use of physical intervention, person centred care and the assessment and mitigation of risks. Following the last inspection, we asked the provider to complete an action plan to tell us what actions they would take to meet the requirements of the regulations that they were in breach of. The provider sent us weekly updates of their action plan in which they set out how they would meet the regulations and we saw according to the timescales, all actions were completed by August 2017. At this visit we saw improvements had been made and the service was meeting all regulations at this time.
The service was now safe. People, staff and relatives we spoke with told us they felt safe at Hope House. Staff and people were aware of procedures to follow if they observed or were aware of any concerns. Accidents and incidents had been appropriately recorded and monitored and risk assessments were in place for people who used the service and staff. Staffing levels were appropriate and a consistent staff team was in place, who were trained and supported to manage behaviour that may challenge through approved training. Staff also had access to regular sessions with external community professionals to discuss incidents, behaviour and strategies to support people with their anxieties.
We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people. Appropriate systems were in place for the management of medicines so that people received their medicines safely. Medicines were stored in a safe manner. Appropriate health and safety checks had been carried out on the building.
The service was now effective. Staff were now suitably trained and received ongoing training and support. Staff received regular supervisions and appraisals and told us they felt supported. People’s day to day health needs were met by the staff and the service had good relationships with external healthcare professionals. People were supported to lead a healthy lifestyle and where needed to lose or to gain weight. Care records showed that people’s needs were assessed before they started using the service and they were supported to transition to the service as smoothly as possible.
The provider was working within the principles of the Mental Capacity Act 2005 (MCA). 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 supported this practice.
The service was now caring. Staff supported people who used the service with their social and emotional needs. We observed that all staff were caring in their interactions with people at the service. People told us they got on well with staff members and we saw people were given opportunities on a regular basis to discuss with the management team their views on their staff team and how the service was working for them. We saw people being treated with dignity and respect and people told us that staff were kind and professional.
The service was now responsive. People’s care records were detailed and personalised which enabled staff to support people in line with their personal preferences. Staff used a variety of methods to communicate effectively with people. People were provided with an ‘easy read’ complaints process that supported people who had a learning disability to understand and people also had regular opportunities to meet with management on a one to one basis to discuss any issues they may have. Effective systems were in place to manage any complaints that the provider may receive.
The service was now well-led. The newly registered manager was well liked by all and they carried out their role enthusiastically and professionally. There was a positive ethos and an open culture at the home resulting in an improved working environment for staff, and a calm and person centred atmosphere for people living there. People and staff were encouraged to contribute to the development of the service and effective auditing processes were in place to monitor the quality of the service.
This service is registered to provide care, support and accommodation to a maximum number of 11 people with a learning disability and/or mental health conditions within two separate properties that are next door to each other. When we inspected six people were using the service.
The service did not have a registered manager. The previous registered manager left their employment in March 2017 and last worked at the home in January 2017. A peripatetic manager had supported the registered manager from December 2017 and took over as acting manager when the registered manager left. At the time of the inspection the acting manager was still in place when we inspected the home. The provider had recruited a new manager who was due to start their employment in June 2017. It was then intended the new manager would apply to register with the Care Quality Commission. 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.
During this inspection we found the provider had breached five of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These regulations related to; safeguarding service users from abuse and improper treatment; safe care and treatment; need for consent; person-centred care; and, good governance. In particular, there were multiple failures to mitigate risks. The provider had not ensured risks posed to people and others were managed in a manner that ensured safety. Risk assessments had not been completed around the safety of people and staff when in confrontational situations. Physical intervention records showed staff regularly used restraint techniques that were not part of people’s care plans.
The provider did not routinely carry out debrief sessions to identify any lessons learnt following serious incidents.
Not all staff felt supported by managers and the provider. Staff were regularly subjected to assaults but there was no evidence available to show the provider had considered how these assaults affected staff member’s wellbeing. Records showed they did not have regular supervision sessions and an annual appraisal. We have made a recommendation about this.
We found care records did not always detail how staff should support people when displaying behaviours that challenge. Risk assessments and care plans had not been evaluated or reviewed to reflect people’s changing needs. Risk assessments were general and did not provide details of the measures required to mitigate specific risks.
Staff told us staffing levels were insufficient and impacted on their safety. There was a lack of evidence that staffing levels were reviewed and analysed to provide reassurance that sufficient staff were available to provide a safe service. Due to vacancies there was sometimes only one qualified nurse on duty.
New staff had been recruited with no prior experience of the nature of this work. Induction and training was not always effective in ensuring new staff were prepared for the challenges of working at the service. There were also difficulties with staff retention.
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice. We found restrictions were in place for some people but there were no records to show these had been made following a ‘best interest’ decision. There was also no record of discussions with people or family members when making decisions on behalf of people. We received mixed views about some people’s capacity and whether they understood and were accountable for their actions. We also found no evidence to show the use of CCTV in people’s flats had been discussed with the person.
Staff had completed basic training but not always training relating to the specific needs of people using the service, such as training on the Mental Health Act 1983, autism, acquired brain injury and personality disorder. Records showed not all staff were taking advantage of training and support offered by community nurses. The provider said staff were expected to use positive behavioural support (PBS) techniques and training in relation to this was provided during induction. However, one person’s records indicated Dialectical behaviour therapy (DBT) a specialist therapy should be used. Staff records showed that staff had also not completed training in this area. We have made a recommendation about this.
There was a lack of oversight from managers of the management of risk within the service. During our inspection visits we requested information to show how incidents were reviewed and analysed. However, this was not readily available when we asked for it. Some incidents of aggression leading to staff being injured had been rated as minor with no internal review having been carried out. Clinical and support staff were not part of meetings to review safety within the service. Minutes of clinical governance meetings suggested areas of risk were not fully analysed, such as staffing levels and skills mix.
Care records were out of date and had not been reviewed to keep up with people’s changing needs. Care records did not also support the effective use of positive behaviour support techniques to pro-actively deal with behaviours that challenge.
Staff felt communication was not effective to ensure they had the information they needed to support people appropriately.
We wrote to the provider on 13 April 2017 about the serious concerns we had. In response the provider supplied us with a robust action plan detailing the action they planned to take to improve the management of the use of physical interventions and to review people's care records. The provider then proceeded to consistently supply a weekly progress update to ensure close monitoring of the outstanding actions identified to meet the requirements of the regulations.
Relatives said they felt the service was safe and provided a good standard of care. However, staff gave us mixed views about how safe the service was.
We found effective systems were in place to ensure medicines were managed, stored and administered in a safe way. However, improvements were required to ensure that the appropriate guidance was in place about when to administer medicines to be taken ‘as and when required’.
Health and safety checks and infection control measures were carried out to help keep the premises clean and a suitable and safe place to live.
People had opportunities to take part in their preferred activities. Each person had their own personal activity timetable which staff told us was followed.
Staff were kind, compassionate and caring towards people using the service even though they often had to deal with challenging situations.
We inspected Hope House on 18 May 2015. This was an announced inspection. We informed the provider at short notice (the day before) that we would be visiting to inspect. We did this because the location is a small care home for people who are often out during the day; we needed to be sure that someone would be in.
This service is registered to provide care, support and accommodation to a maximum number of 11 people within two separate properties that are next door to each other. One of the properties has six bespoke, self-contained flats each with en-suite facilities, kitchenette and a separate lounge for adults with a learning disability. The other property was not in use at the time of the inspection. The provider was in the process of discussing with the local authority and determining the service user group the property would be used for. It was then intended that the property would be refurbished.
The service has 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 2008 and associated Regulations about how the service is run.
There were systems and processes in place to protect people from the risk of harm. The care staff understood the procedures they needed to follow to ensure that people were safe. They were able to describe the different ways that people might experience abuse and the right action to take if they were concerned that abuse had taken place.
Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety.
Staff told us that they felt supported. There was a regular programme of staff supervision in place. Records of supervision were detailed and showed that the registered manager had worked with staff to identify their personal and professional development goals.
Staff had been trained and had the skills and knowledge to provide support to the people they cared for. There was enough staff on duty to provide support and ensure that their needs were met. We found that each person who used the service had a designated staff team. This included a named nurse and a team of support workers. This helped to provide consistency to people.
The registered manager and staff that we spoke with had an understanding of the MCA principles and their responsibilities in accordance with the MCA and how to make ‘best interest’ decisions. We saw that appropriate documentation was in place for those people who lacked capacity to make best interest decisions in relation to their care. We saw that a multidisciplinary team and their relatives were involved in making such a decision and that this was clearly recorded within the person’s care plan.
We looked at the arrangements that were in place to ensure that staff were recruited safely and people were protected from unsuitable staff. We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.
Appropriate systems were in place for the management of medicines so that people received their medicines safely. We saw that medicines had been given in accordance with the person’s prescription.
There were positive interactions between people and staff. We saw that people were supported by staff who respected their privacy and dignity. Staff were attentive, showed compassion, encouraging and caring.
People’s nutritional needs were met, with people being involved in shopping and decisions about meals. People who used the service told us that they got enough to eat and drink and that staff asked what people wanted.
People visited their doctor, dentist and optician. Staff told us how they supported and accompanied people on hospital appointments to manager their physical and mental health needs. People who used the service had good links with community nurses who had worked with them for many years and as such knew them very well. This meant that people who used the service were supported to obtain the appropriate health and social care that they needed.
Assessments were undertaken to identify people’s health and support needs as well as any risks to people who used the service and others. Plans were in place to reduce the risks identified.
Person centred plans were developed with people who used the service to identify how they wished to be supported.
People’s independence was encouraged and their hobbies and leisure interests were individually assessed. Staff encouraged and supported people to access activities within the community.
The provider had a system in place for responding to people’s concerns and complaints. The one person we spoke with during the inspection told us they knew how to complain and felt confident that staff would respond and take action to support them.
There were effective systems in place to monitor and improve the quality of the service provided. Staff told us that the service had an open, inclusive and positive culture.