Hambleton House

About the service

Hambleton House is a residential care home providing personal care to up to 18 people. The service provides support to people with Learning Disabilities and Mental Health support needs. At the time of our inspection there were 17 people using the service. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

Right Support: We identified some potential environmental risks. However, the provider told us what action was going to be taken to remove these risks. Some people’s care plans were missing information about risks related to their care needs. The provider immediately updated these care plans during our inspection.

We were mostly assured infection prevention and control was well managed at the service. Safe recruitment checks were in place and the provider obtained employment references to ensure staff were suitable. People were protected by an effective safeguarding system and people told us they felt safe. Staff were trained in safeguarding and understood how and when to raise concerns.

There was an effective system in place to monitor incidents. This was reviewed to identify themes and make service improvements. 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.

Right Care: People’s medicines records were well managed supporting safe medicines practices. People received their medicines as prescribed. Medicines were safely stored, and regular stock checks and audits took place.

There was consistent evidence that people’s health and wellbeing improved after they moved to the service. Key workers gained regular feedback from the people they supported regarding their likes and dislikes. People were supported to access treatment from health care professionals.

Right Culture: Some quality assurance systems were not always effective. The provider described what they would do to improve their quality oversight systems. There was a good rage of skills across the management team and directors, creating an effective and dynamic team. Feedback about the directors and management team was positive and staff were clear about their roles and responsibilities.

We observed positive and friendly interactions between staff and residents. The provider sought involvement from the local authority to support people to achieve good outcomes.

The provider understood their legal responsibilities in relation to duty of candour. The provider was open and forthcoming during the inspection and demonstrated commitment to the staff and residents at the service.

There was an effective on call system in place to provide staff with managerial support out of hours. Regular staff and resident meetings took place to encourage people to provide feedback. There was an effective system in place that supported staff development and continuous learning.

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 3 March 2020)

Why we inspected

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.

We received concerns in relation to the management of people’s finances, the management of medicines, and staff conduct. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only. We found no evidence during this inspection that people were at risk of harm from these concerns.

The overall rating for the service has remained good. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

Please see the Safe and Well-led sections of this full report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Hambleton House is a residential care home providing personal to 17 adults with a learning disability, autism and mental health difficulties at the time of the inspection. The service can support up to 18 people.

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.

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

People’s safety continued to be promoted through effective systems to protect people from abuse. Potential risks to people had been assessed and care was planned to keep them safe. Staff knew how to report concerns when people’s safety and wellbeing was at risk. People's care and support needs were met by staff who knew them well and enjoyed working with them.

People’s dietary needs were met, and healthy eating was promoted. People received their medicines at the right times. Staff ensured people's healthcare needs were met. Staff were alert and responsive to any changes in people's needs and liaised with health care professionals.

People were supported by kind and caring staff who they trusted. Staff had undergone a robust recruitment process. There were enough staff to support people and they worked flexibly to promote their independence and social engagement. The staff team was established, experienced, and trained.

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 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 maintained relationships with family and friends, and had develop new friendships. People’s independence and social engagement was promoted. People felt valued members of the community as they pursued hobbies, social and sporting activities and voluntary work.

People received person centred care that met their needs. Care plans reflected individual preferences, diverse cultural needs and how they wished to be supported. Staff ensured people’s dignity and respect was always promoted and protected. People had developed positive relations with staff who were committed to non-discriminatory practices. People were confident complaints would be listened to and acted on.

The provider had effective systems in place to monitor the quality of care provided. Policies, procedures and other information was made available to people in formats that met their communication needs, such as easy read and picture styles. Staff were happy working for the service and felt supported by the registered manager. Partnership with health and social care professionals and various community services ensured people received joined up care.

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 26 July 2017).

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hambleton House on our website at www.cqc.org.uk.

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.

Hambleton House provides accommodation for up to 16 people with learning disabilities who require personal care and support. At the time of our inspection there were 16 people using the service.

When we inspected the service in May 2015 it was rated as requires improvement because we found breaches of legal requirements. At the focused inspection in December 2015 we found the service had made the required improvements and was rated as Good.

At this inspection we found the service remained Good.

People told us that staff promoted their safety, wellbeing and independence. Staff understood their responsibility to protect people from the risk of abuse.

Risks were managed so that people were protected from avoidable harm whilst promoting their choices and independence. People lived in a clean and well maintained service.

Safe medicines and infection control practices were followed by staff. People received sufficient to eat and drink.

Staff were recruited through safe recruitment practices. They received appropriate induction, ongoing training and supervision to provide effective care and support. Sufficient numbers of staff were on duty to meet people’s needs both at home and to access the wider community.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. We found the policies and systems in the service supported this practice.

People received personalised care that was responsive to their needs. Care records contained information to support staff to meet people’s individual needs.

People’s diverse, cultural and lifestyle choices were respected. People maintained contact with family and friends and took part in social events, activities that were of interest to them and employment.

People’s privacy and dignity was respected. Staff’s approach was caring. Staff worked closely with people to promote their independence and their individual goals. Continuous review of people’s care meant they were able to respond to any changing needs.

People’s rights were protected and respected. A complaint process was in place and staff knew how to respond to complaints. Advocacy support was made available to people.

At the time of the inspection the manager had begun the process of being registered with CQC. They along with the care manager provided leadership and guidance to staff to ensure people received safe care and support that promoted their wellbeing and independence. Staff were confident that any suggestions made and concerns raised would be listened to and action would be taken.

Following our inspection visit the manager had successfully completed the registration process to become the registered manager.

The provider was meeting their regulatory responsibilities. People had a range of opportunities to be involved in the development of the service. There were effective systems in place to monitor and improve the quality of the service provided.

We spoke with four people who used the service. Three of them spoke to us enthusiastically about improvements that had been made by the provider since our last inspection in November 2013. Two said, "It's better now." Another person told us, "I'm very happy. We have better choices."

The provider had taken action that helped people increase their knowledge and develop skills. People who used the service had attended a training session about food hygiene and nutrition. People now took a more active role in making their own meals and took more responsibility for helping keep their room and communal areas tidy. Those were important skills for people who were aiming to eventually move to their own flats in a supported living environment. The provider had also made it easier for people to manage their own money.

Staff we spoke with also told us that the home had improved. Staff had received training that had helped them understand and put into practice person centred care. They had received other training that had equipped them to carry out their roles more effectively.

We found that the provider had responded positively to our last inspection and had brought about necessary improvements.

We found that despite people having capacity to make decisions themselves people had become highly dependent on staff. People had not been helped to develop everyday living skills such as making their own drinks or helping with preparation of meals. One person told us, "I would like to help with cooking. I've been on a cookery course, I like cooking' but they had not been supported to develop their skills at the home. Another person had wanted to progress to living in their own flat, but we found no evidence of how the service had supported them towards that aim.

People told us that they enjoyed the food at the home. However, one person told us, "I'd like lamb chops or steak occasionally but I'd be surprised if I could have it." People had a choice of food but choices did not include healthy eating options or more nutritious food.

All of the people who used the service had been assessed as having capacity to make decisions about their finances. However, not all people had direct access to their money. The registered manager told us that this was for people's protection but we saw no evidence that there had been meetings to decide a person's best interests or that the provider had power of attorney over a person's finances.

The provider had a recruitment policy but it had not been followed. In one instance an applicant had been allowed to start work without proper references.

Not all staff had received training in key important subjects such as the Mental Capacity Act 2005.

The provider had not carried out effective monitoring of the quality of service provided.

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People who used the service had been involved in recent reviews of their care plans. People had been involved in deciding whether they wanted to go on a week long holiday in May 2013 and where to go. One person who initially decided, in January 2013, that they didn't want to go on holiday then decided they wanted to go. They told us, "I wanted to go but they wouldn't take me."

People were complimentary about the meals they had at the home. One person told us, "they cook nice food." Another person told us, "Staff bring me drinks whenever I want." However, people did not always know what they would be having at meal times. One person told us, "Sometimes we are asked what we want, other times not." Another person told us, "We are usually asked what we want for tea." Another person told us, "Tea is what we get put in front of us." When we spoke to five people in a group and asked, at 1.45pm, if they knew what they would be having for tea all responded that they did not know. We found that the home did not have an effective means of offering people food choice.