Archived: Houghtons

Updated 12 October 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This comprehensive inspection was unannounced and was carried out on 6 September 2018, by one inspector.

Before the inspection we checked the information, we held about the service and the provider, such as notifications. A notification is information about important events which the provider is required to send us by law.

The provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We also asked for feedback from the local authority who have a quality monitoring and commissioning role with the service.

During the inspection we used different methods to help us understand the experiences of people living at the service, because some people had complex needs which meant they were not able to communicate with us using words. We observed the care and support being provided to four people during different points of the day, including breakfast and an activity session. We also spoke with the team leader, area manager, the provider’s head of operations for the south, a relative and four members of care staff. The registered manager was on leave on the day of the inspection, so we spoke with them on their return.

We looked at various records, including records for three people, as well as other records relating to the running of the service. These included staff records, medicine records, audits and meeting minutes; so that we could corroborate our findings and ensure the care and support being provided to people was appropriate for them.

Updated 12 October 2018

Houghtons is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Houghtons can accommodate up to six people living with a learning disability or autistic spectrum disorder. The accommodation is single storey and is accessible for people who may also have a physical disability. At the time of this inspection there were six people living at the service.

At the last inspection in January 2016, the service was rated Good. During this inspection, which took place on 6 September 2018, we identified some areas requiring improvement. Consequently, we have changed the rating from Good to Requires Improvement. This is the first time the service has been rated Requires Improvement.

Why we rated the service Requires Improvement:

We found some anomalies with medicines and how medicine records were being maintained. Although there was no evidence that people were not receiving their medicines as prescribed, there was also no clear audit trail to explain some of the concerns we found, such as gaps in Medicine Administration Records (MAR) and tablets taken from the wrong day in medicine packaging.

Systems were in place to make sure people's consent was sought in line with legislation and guidance, but these needed strengthening. This included the processes for gaining people’s consent to care and support, and for managing people’s finances where they lacked capacity to manage their own money.

The provider had systems in place to monitor the quality of service provision, to drive continuous improvement. Quality audits had identified several areas where improvements were needed, and a new management team was working to make the required changes. As stated above we also identified some areas requiring action, for the service to become fully compliant with legal requirements (regulations). The registered manager took swift action to address our inspection findings and provided evidence soon afterwards that improvements had already begun to take place. There was still more work to be done, but some good progress was being made to improve the service for the people living there.

We did find that the service continued to provide a good service in other areas that we checked. For example, people were protected from abuse and avoidable harm. Staff had been trained to recognise signs of potential abuse and knew how to keep people safe. Processes were also in place to ensure risks to people were managed safely and they were protected by the prevention and control of infection.

Arrangements were in place to make sure there were enough staff, with the right training and support, to meet people’s needs and help them to stay safe. The provider carried out checks on new staff to make sure they were suitable and safe to work at the service.

The service responded in an open and transparent way when things went wrong, so that lessons could be learnt and improvements made.

People received care and support that promoted a good quality of life and was delivered in line with current legislation and standards.

People were supported to eat and drink enough. Risks to people with complex eating needs were being managed appropriately.

Staff worked with other external teams and services to ensure people received effective care and treatment. People had access to healthcare services, and received appropriate support with their on-going healthcare needs.

The building provided people with sufficient accessible space, including a garden, to meet their needs. The service operated in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion.

Staff provided care and support in a kind and compassionate way. People were enabled 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.

People’s privacy, dignity, and independence was respected and promoted. They received personalised care and were given opportunities to take part in activities, both in and out of the service.

Systems were in place for people to raise any concerns or complaints they might have about the service. Feedback was responded to in a positive way, to improve the quality of service provided.

Arrangements were in place to support people at the end of their life to have a comfortable, dignified and pain free death, if the need arose.

There was strong leadership at the service which promoted a positive culture that was person centred and open. Arrangements were in place to involve people in developing the service and seek their feedback.

Opportunities for the service to learn and improve were welcomed and acted upon, and the service worked in partnership with other agencies for the benefit of the people living there.

Further information can be found in the detailed findings below.