Hawthorn Bungalow

Suitable plans were in place to care for people who were symptomatic or COVID-19 positive and protect others living in the care home in the event of an outbreak. Social distancing was promoted and maintained wherever possible. To mitigate the impact of isolation, meaningful activities are provided.

Effective admission assessments were carried out, despite the challenges, the registered manager had considered people's mental capacity.

Staff routinely tested and isolated new admissions to help prevent the spread of infection.

The service was clean and hygienic, and staff were observed using personal protective equipment (PPE) correctly.

Staff had been trained in IPC. People were observed being at ease around people wearing PPE.

Hawthorn Bungalow is a residential care home that was providing accommodation and personal care to 10 people with a learning disability or autistic spectrum disorder, a physical disability and younger adults. At the time of inspection eight people were living there.

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. Eight people were using the service. 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.

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

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 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.

People received safe care and there were enough staff to provide support to people to meet their needs. Staff had been suitably recruited to ensure they could work with people who used the service. People were protected from the risk of harm and received their prescribed medicines safely.

Staff told us they enjoyed working at the service and spoke highly of the support and encouragement provided by the registered manager. People who used the service were supported in a safe way by kind well trained staff who knew people well.

Risk assessments and care plans were reviewed at regular intervals to ensure these were reflective of people's needs.

People were provided with the appropriate care and support at the end of their life. We have made a recommendation about recording people’s preferences and wishes for their end of life care.

The service had good quality assurance arrangements in place and completed internal quality checks and audits. Findings from these were regularly reviewed by the registered manager and provider. The management team continued to drive improvement within the service to ensure people received consistent standards of care and support

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 10 January 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.

Outlook Care - Hedgerows accommodates and cares for up to 22 persons split between two adjacent bungalows, Bluebell and Hawthorn, registered as one service location. There were 15 people in residence when we inspected, with five older people with dementia and nursing needs accommodated in Bluebell. This bungalow was being closed by the provider and the five remaining people were being relocated to other services. Hawthorn bungalow will remain as an active service providing care for adults with learning disabilities.

A registered manager was not 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 in the Health and Social care Act 2008 and associated regulations about how the service is run. An application to register the new manager with the Commission had been submitted.

People were safe. People were safeguarded from harm and poor practice by staff that knew what action they needed to take if they suspected this was happening. There were recruitment procedures in place that protected people from receiving care from staff that were unsuited to the job.

People’s needs were assessed before they were admitted to the home and regularly reviewed to ensure they received appropriate and timely care. People benefited from being cared for by sufficient numbers of experienced staff that had received the training they needed to do their job safely. Staff knew what was expected of them when caring for older people, including those with dementia care needs, and people with learning disabilities. Staff carried out their duties effectively and with compassion.

People’s individual nutritional needs were assessed, monitored and met with appropriate guidance from healthcare professionals that was acted upon when required. People had enough to eat and drink and enjoyed their meals. People that needed support with eating and drinking received the timely practical help they required.

People’s medicines were appropriately and safely managed. Medicines were securely stored and there were suitable arrangements in place for their timely administration. People’s healthcare needs were met and they received treatment from other community based healthcare professionals when this was necessary.

People’s individual preferences for the way they liked to receive their care and support were respected. People’s care needs had been assessed prior to admission and they each had an agreed care plan that reflected their individual needs. Their care plans were regularly reviewed and provided staff with the information and guidance they needed to do their job.

People were enabled to do as much as they were able to do for themselves by staff that were attentive to each person’s individual needs. They understood and acted upon the impact of people's disabilities on their capabilities. People received support from staff that demonstrated that they understood what was required of them to provide people with the care they needed.

People were treated with dignity and their right to make choices was upheld. People and their relatives or significant others, including people’s advocates, were assured that if they were dissatisfied with the quality of the service they would be listened to and that appropriate action would be taken to resolve matters to their satisfaction.

Below is a summary of what we found. The summary is based on our observations during the inspections, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see evidence supporting our summary please read our full report.

Is the service safe?

Risk assessments were completed for each person using the service to identify potential risks such as falls or poor nutrition. There were systems in place to ensure the environment was well maintained and that people knew how to respond to emergency situations such as fire. Accidents and incidents were recorded and appropriate actions taken to minimise the risk of reoccurrence.

Medicines were stored securely and handled safely and appropriately by staff. Staff had completed training and their competency to administer medicines was regularly assessed. There were systems in place and staff had received training to ensure people were protected from abuse and that their human rights were upheld.

Is the service effective?

People's health and care needs were assessed with their involvement. A care plan was then developed that reflected the level and type of support each person required to be safe and have an independent lifestyle. People's mental capacity to make informed choices had been assessed and we saw that their relatives or advocates had been involved to ensure their best interests were considered. People we spoke with told us that they had regular meetings with their key worker who ensured that any changes they requested regarding their day to day care were acted upon.

Is the service caring?

We observed that people using the service had their privacy and dignity respected. We spoke with people and their relatives. A relative said ''The staff are kind and are genuinely caring; I am pleased we chose this place.''

People had been involved in the planning of their care and supported to identify their preferences and what was important to them. Staff demonstrated a good understanding of each person's needs and how to effectively communicate with them. This ensured that people were supported and involved in decisions about their day to day care. We noted that staff took time to answer people's questions and provide suitable explanations in a respectful manner. One person we spoke with said 'I love it here, they (the staff) really spoil me.'

Is the service responsive?

People were invited to be involved and make decisions about their environment and group activities such as holidays. We saw that people had access to information about how to raise a concern. Complaints records we saw showed that people's complaints had been responded to promptly and actions had been taken to address their concerns. We noted that safeguarding concerns had been correctly reported and responded to in a timely manner so that people were protected. There was evidence to show that the service worked well with other health care professionals such as dentists and doctors to ensure people received care they had requested. We observed that peoples wishes about aspects of their care and daily activities were respected and responded to appropriately. We saw that people had access to information about how to raise a concern or make a complaint. People's complaints we reviewed had been responded to appropriately by the service.

Is the service well led?

The manager had completed themed audits to assess the safety and quality of the service and used the information to identify non-compliance with policies and procedures or risks to people using the service. The provider's quality assurance manager and the area manager had also undertaken unannounced spot checks and audits to ensure people using the service received safe and effective care.

You can see our judgements on the front page of this report.

Care records we looked at showed that people's needs and preferences were thoroughly assessed, documented and reviewed. One person told us, 'I wouldn't want to go elsewhere, it's quite homely here.'

We saw evidence that people were provided with a good choice of food and drink in a way that both encouraged and promoted a healthy balanced diet. A Relative we spoke with said, 'The food they provide is great and of good quality.'

The premises were safe, suitable and fit for purpose. Adequate emergency procedures were in place and the safety equipment we saw had been regularly checked and well maintained.

Records showed the provider had put effective recruitment procedures in place to ensure that staff were fit, able and properly trained to meet the needs of people who used the service. This included carrying out appropriate checks before staff began work.