Honeybrook House

Honeybrook House is a residential care home providing accommodation and personal care to up to 10 people. The service provides support to people with a learning disability, and or autistic people. At the time of our inspection there were 9 people living at the service.

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

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.

Right Support

Some care records did not contain important information about people’s health care needs and were not always reviewed regularly.

People's care and support was not always provided in a safe, clean and well-maintained environment.

Staff training was not up to date in some areas, this meant staff may not have the up to date knowledge to provide safe care to people.

People’s rooms were personalised in line with their preferences and choices.

Staff communicated with people in ways that met their needs.

Right Care

People were encouraged to have choice and control and staff encouraged independence in daily activities.

Staff knew people well and communicated in ways that met their individual needs. There were positive interactions between staff and people.

Staff worked in partnership with other agencies to promote people’s wellbeing.

Right Culture

There had been changes to the management team at the service. An interim manager and new deputy had recently started in February 2023 and were still developing working relationships with the wider team.

Governance systems in place to monitor the service were not robust or fully implemented. There was a lack of evidence of internal auditing. Checks were not consistently completed to ensure quality or safety concerns were promptly identified and acted upon. Necessary improvements were not always identified or addressed in a timely manner.

We received mixed feedback from relatives, some felt that communication and engagement from the service had reduced recently.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The rating for this service was required improvement (published 8 January 2020). The service remains rated requires improvement.

Why we inspected

We received concerns in relation to the cleanliness of the home environment, staffing and training. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. 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 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 remained requires improvement based on the findings of 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.

Enforcement

We have identified breaches in relation to safe care and treatment and 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.

Honeybrook House is a residential care home providing accommodation and personal care to 10 people at the time of the inspection. The service is registered to support up to 10 people with learning disabilities or autistic spectrum disorder.

Honeybrook House is large Georgian property with extensive grounds with three large communal rooms and bedrooms which are all en-suite.

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.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 10 people. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were no signs outside to indicate it was a care home, and staff were discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

Peoples risks were assessed, and the management team were reviewing these to ensure staff had effective guidance. People received their medicines regularly, however, systems to provide guidance to staff about topical creams and as and when medicines were not always in place. There were communal areas that needed updating to improve infection control, and regular checks were needed to ensure people were not at risk from infection. People were supported by staff who knew how to keep them safe from abuse. The registered manager ensured there were sufficient staff available to meet people's needs through use of regular agency. Incidents and accidents were investigated, and actions were taken to prevent recurrence.

The management team had identified areas of improvement however the provider had not ensured there were sufficient staff resources available to complete the improvements in a timely way. The culture promoted at the home was open and approachable. The staff at the home had achieved accreditation in relation to a national autism standard.

People's needs were assessed and delivered by staff who were well trained and knowledgeable about people's needs and wishes. People enjoyed their meal time experience. 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.

People were cared for by staff who were caring. The atmosphere within the home was friendly and welcoming and staff were considerate towards people they cared for. People and their relatives felt involved and supported in decision making. Staff championed people’s rights and respected their dignity and independence. Staff supported people to complete their wishes through considered support and desensitisation.

People had their individual needs met by staff who knew their needs. The management team were working on a plan to improve how guidance was recorded and updated to ensure people’s needs were met. People had interesting things to do and had access to the community. Complaints were investigated, and outcomes agreed, and improvements made when needed.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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 25 May 2017).

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.

There was a registered manager in post at the time of our inspection. This person became registered with the Care Quality Commission in September 2016. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered provider, 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 previously inspected Honeybrook House on 30 March and 1 April 2016. At the time of that inspection we rated the location as requires improvement overall. We found three of the five questions to require improvement. These were in the safe, effective and well led questions. The registered manager and his team had worked to address the areas for improvement identified at our last inspection. Further improvement was identified to be made in the safe question.

We found there were some shortfalls in how risks to people’s welfare. These did not always consistently match what staff told us to provide assurance identified risks were always managed safely. The registered manager was aware improvement was needed.

Staff told us how they would recognise concerns to people’s safety. There were occasions when management had not been informed as necessary about incidents involving people who lived at the home.

People medicines were administered and stored safely. Healthcare professionals were involved in people’s care and advice was sought from professionals when required.

Staff had undertaken training relevant to their role and in order to meet the needs of people. Staff were confident they had the skills need and felt supported by the management of the home. The registered manager was recruiting staff to fill staff vacancies. Regular agency staff were used to provide consistency in the level of care provided.

People were supported by staff in a kind and caring way. People were involved in planning their care and how they spent their day. Staff were aware of people’s interests and sought to engage people in these to stimulate them. Staff sought permission from people before care and support was provided. The registered manager and staff were aware of the importance of gaining consent and were aware of the need to involve other relevant people if looking at people’s best interests.

People were supported to remain as independent as possible. Staff were mindful to support people in a way which maintained their dignity and upheld their right to privacy.

Members of staff and the registered manager worked together to provide quality care. Staff and relatives were complimentary of the registered manager and improvements made. Quality checks were in place to continually drive improvements in the service people were provided.

The inspection took place on the 30 March and 1 April 2016 and was unannounced.

At the time of our inspection a manager was in post. They were present during the afternoon of the 30 March and for most of the time we were at the home on 1 April 2016. The previous registered manager had left Honeybrook House a few weeks prior to our inspection. The new manager had been in post for a couple of weeks and was preparing to apply to the Care Quality Commission (CQC) to become the 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.

We carried out an unannounced comprehensive inspection on 10 November 2014. A breach of a legal requirement was found. After the inspection the provider wrote to us to say what they would do to meet the legal requirement in relation to the breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponded to a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breach was due to short falls in how people were lawfully restricted.

Improvements had been made although an application to restrict one person’s liberty had not been made once a previous decision had expired. Staff were not aware of who’s liberty they were lawful able to restrict.

We looked at people’s medicines and found one person had regularly received incorrect pain relief since the start of 2016. Staff were not aware they had made these continual errors. These findings were taken seriously and immediate action was taken.

People who lived at the home responded positively to staff. Staff supported people in a kind and caring way and communicated with people in a way they preferred. People were supported by staff who had received training and support in order they were able to meet people’s care needs. Staff were aware of their responsibility to report any safeguarding matters to the management team and had an awareness of other organisations.

People received care and support from staff who were supported by senior staff and were able to seek guidance on aspects of people’s care and support. Staff enjoyed working for the provider. Staff were able to attend staff meetings during which people’s care needs as well as practices within the home were discussed. The suitability of new staff members was checked before they started working for the provider.

People’s consent was obtained by staff before care and support was provided and people were encouraged to make choices about how they spent their time and in the food they eat. People were involved in their own care and were supported by family members. Best interest decisions were in place and had involved relatives and healthcare professions as needed. There were however occasions when decisions had taken place without referring to the people or their representative.

People were seen to be supported to do things they enjoyed doing in the home and in the wider community. Staff understood what people liked doing and how best to meet these needs. People’s health needs were had accessed regularly by professionals to support them and to maintain their health and well-being.

The quality of the care provided was checked and reviewed by provider and staff at the home. Management systems were not always in place to identify trends within the home. Staff were unable to inform us why notifications following incidents or event which effected people’s welfare were not always sent to the CQC.

We observed how care was provided for the people who lived at Honeybrook House. People who used the service were involved in decisions about their care. Consent from people had been obtained before care and treatment was provided or arrangements were made to support people who were unable to consent to their treatment or support.

People's needs had been assessed and care and treatment was planned and delivered in line with their individual care plan. Staff were aware of each person's needs. Staff demonstrated that they knew how to give care and support to meet those needs to ensure people's health and welfare was maintained.

People who used the service were protected from the risk of abuse. We saw that staff had a kind and caring approach towards people they supported. People appeared happy, comfortable and relaxed in their home. Staff told us they would: 'Not hesitate to tell a senior or the manager' if they had any concerns about the care people received.

The service had been reviewed during 2012 and showed that people's views of the service had been obtained and taken into account in the way the service was provided.