Archived: Hillgreen Care Ltd - 185 Herbert Road

We saw the provider had met the recommendations made by the London Fire Brigade at their inspection of the service in August 2015. Improvements were made to the garden and the provider carried out a range of feedback surveys, checks and audits to monitor the quality of the service that were effective in identifying areas for improvement.

We have improved the rating for the key question ‘Is the service well-led?’ from ‘requires improvement’ to ‘good’.

185 Herbert Road provides care and accommodation for up to three men with learning disabilities and autism. On the day of the inspection three people lived at the home.

At the time of the inspection, there was 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.

Relatives told us they felt people were well cared for and safe living at the service. This view was confirmed by the health and social care professionals we spoke with. Staff knew how to help protect people if they suspected they were at risk of abuse or harm. Risks to people’s health, safety and wellbeing had been assessed. Staff knew how to minimise risks and manage identified hazards in order to help keep people safe from harm or injury.

There were sufficient numbers levels of staff to meet people’s needs. This was endorsed by the relatives of people we spoke with and by staff.

People received their medicines appropriately and staff knew how to manage medicines safely.

Staff had a good understanding of their responsibilities in relation to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). DoLS provides a process to make sure people are only deprived of their liberty in a safe and correct way. There were policies in place in relation to this and appropriate applications were made by the provider to the local authorities for those people who needed them. Staff supported people to make choices and decisions about their care wherever they had the capacity to do so.

People had varied and nutritious diets and choice of meals. They were supported to stay healthy by staff who were aware of people’s healthcare needs and through regular monitoring by healthcare professionals.

Relatives and professionals told us staff were consistently kind and caring and established positive relationships with people and their families. Staff valued people, treated them with respect and promoted their rights, choice and independence.

Comprehensive care plans were in place detailing how people wished to be supported. They had been produced jointly with relatives and where possible people using the service. Relatives told us they agreed the care plans and were fully involved in making decisions about their family member’s support.

People participated in a wide range of activities within the home and in the community and received the support they needed to help them to do this.

There was a complaints procedure in place and relatives felt confident to raise any concerns either with the staff or the registered manager if they needed to. The complaints procedure was available in different formats so that it was accessible to everyone.

We found there was an open and transparent culture in the home where staff were encouraged to share in the development of the home for the people living in it.

We saw staff were motivated in their work and were keen to improve their learning. They told us and we saw they had access to good and relevant training. Staff received regular and effective supervision. The registered manager had completed qualifications in management in care and supported a culture where staff training, support and development was emphasised.

We found the provider was meeting the breach of regulation 17 because they had implemented a new system that sought feedback about the quality of the service from different people involved with the service. There were systems in place to use the feedback received to improve the service where necessary.

This inspection took place on 27 and 28 January 2016 and was unannounced. 185 Herbert Road care home was registered with the Care Quality Commission in 2010. At the last inspection the home met the required standards that were in place at the time.

185 Herbert Road is a large detached house in Greenwich over two levels with four bedrooms with

communal bathroom, kitchen, dining and living room areas. There is an outdoor area with grassed lawns.

There was a registered manager in post at the time of our inspection. 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.

At the inspection we found a breach in regulations because the provider did not seek feedback from health care professionals and others involved in the service to make improvements at the home. You can see the action we have asked the provider to take at the back of the full version of this report.

People using the service could not express their views so we observed the support offered and spoke with relatives and staff. Relatives told us that their family members were safe and well treated. During the inspection we saw that people appeared happy and content and not at risk of harm. Each resident had an independently appointed advocate who could express their views and help them to ensure their voice was heard.

Safeguarding adult’s procedures were robust and staff understood how to safeguard the people they supported from abuse. There was a whistle-blowing procedure available and staff said they would use it if they needed to. Appropriate recruitment checks took place before staff started work. People were being supported to have a healthy balanced diet. People’s medicines were managed safely and they received their medicines as prescribed by health care professionals.

Staff had received training specific to the needs of people using the service, for example, mental health awareness and safeguarding adults. They received regular supervision and an annual appraisal of their work performance. The manager and staff demonstrated a clear understanding of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People’s relatives and health care professionals had been involved in planning for their care needs. Care plans and risk assessments provided clear information and guidance for staff on how to support people to meet their needs. Staff encouraged people to be as individual as possible and to do things they wanted to do. People’s relatives were aware of the complaints procedure and were confident their complaints would be fully investigated and action taken if necessary.

The manager recognised the importance of regularly monitoring the quality of the service provided to people. Staff said they enjoyed working at the home and they received good support from the manager.

We followed up concerns we identified at our inspection on 01 May 2013 and found the provider had made the required improvements. We found the provider had acted in accordance with the Mental Capacity Act (2005) in relation assessing people's capacity and making decisions on their behalf where relevant. We found people's care plans had been reviewed so they reflected their current needs, and people's care was delivered in line with these. The provider had updated their safeguarding vulnerable adults procedure and had made these available to staff. The majority of relevant training had been updated to ensure people were supported by appropriately trained staff.

We found that staff sought consent from people before supporting them, but the provider did not have records to evidence that people's mental capacity had been assessed or that decisions had been appropriately made in their best interests. People's care needs had been reviewed but care plans did not always reflect changes in their needs. The provider did not have safeguarding procedures available, although staff were trained to recognise the signs of abuse. We found the premises were adequate. Staff were appropriately supported through induction, supervision and appraisal but some training had not been completed. We found the provider had some adequate systems to monitor the quality of the service.

People who used the service were treated with dignity and respect and their independence was promoted by staff, for example a psychiatrist had been consulted to improve staff communications with people. People received care and treatment appropriate to their needs and staff involved relevant external professionals where this was required. For example, one person attended a group exercise session following advice from a physiotherapist. People were appropriately supported with their nutritional needs and the service had acted on the advice of a dietician to change the menus. People were supported by staff who were adequately trained in areas relevant to their needs such as challenging behaviour and autism, and staff were adequately supported to do their jobs. The service had effective quality assurance systems in place including regular internal inspections, and its record keeping was appropriate.