Hatfield House

Hatfield House is a residential care home that provides accommodation and personal care to four people who are living with a learning disability or autistic spectrum disorder.

The service has been developed and designed in line with the principles of CQC’s policy ‘Registering the Right Support’ and other best practice guidance. This aims to ensure 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:

People told us they felt safe. Staff understood how to keep people safe and how to report any concerns they may have.

Risks associated with people’s care had been assessed and were identified in risk assessments, but they lacked detail. It was not always clear how decisions within risk assessments had been reached to keep people safe.

Staff were recruited safely, and processes checked the background of potential new staff.

People received their medication as prescribed. However, improvements were required to some medication processes.

People’s needs, and wishes were assessed before they started to use the service. These needs and wishes were recorded in people's care plans. Care plans were regularly reviewed to ensure staff had up to date and relevant information about people's care needs.

Staff knew people well and understood their individual needs and preferences. People were offered choices. For example, in the meals and drinks they were offered.

Referrals were made to healthcare professionals where required to ensure people’s health needs were met.

People had identified goals they wished to achieve but there was no information in care records about what staff could do to support people to achieve these goals.

People and relatives told us staff were caring, kind and respected their privacy and dignity.

Staff received the training and guidance they needed to complete their role. Staff understood how to prevent the spread of infection.

People received information about the service in a way that was appropriate to their needs.

People made their own decisions about their care and were supported by staff who understood the

principles of the Mental Capacity Act 2005. However, improvements were required to the recording of decisions relating to mental capacity.

A complaints process was in place and people and relatives felt confident to complain if they needed to.

Systems and processes had not always been effective in driving continuous improvement at the service

Knowledge of meeting the regulations was limited. For example, notifications the provider is required by law to send us about events that happen within the service had not always been sent to us in a timely way.

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 requires improvement (published 16 June 2018). Improvements had been made and the service is now rated good overall. However, the service was not consistently well-led and this key question remains requires improvement.

Why we inspected

This was a planned inspection based on the previous rating. We have found evidence that the provider still needs to make some improvements. Please see the well led section of this full report.

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.

P.A.K.S Trust is a non-profit and independent provider of support for people with learning disabilities, autism, mental health conditions, complex needs and behaviours that challenge.

Hatfield House is one of six services provided by P.A.K.S Trust, who also provide a day centre for people that use their services. Hatfield House provides accommodation with personal care for up to four people with a learning disability. At the time of our visit, there were four people living in the home.

At our last inspection in January 2016 we rated the service as Good. At this inspection, we found three of the five key questions we ask, continued to be Good. However, two key questions about whether the service was safe and well led, we rated Requires Improvement. This meant the overall rating given to the service was Requires Improvement.

There was a registered manager in post. 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.

The registered manager and provider had systems in place to monitor the quality of the service people received. However, audits were not always effective because actions were not always taken or taken in a timely way to make improvements where these were identified as needed.

Staff knew people well and how to keep them safe because risks were verbally identified and shared with staff. However, assessments of identified risks were not completed and actions to minimise risks of harm had not been undertaken.

People had their prescribed medicines available to them. However, the medicines management system was not consistently safe.

Staff had received training in the Mental Capacity Act 2005 and worked in line with this to promote people’s best interests. Staff offered choices to people and gained consent before, for example, supporting them with personal care.

Staff understood their responsibilities to protect people from the risks of abuse. Staff had been trained in what constituted abuse and would raise concerns under the provider’s safeguarding policies. The provider checked staff’s suitability to deliver care and support during the recruitment process.

There were enough staff on shift to support people and meet their individual needs. Staff received training and used their skills, knowledge and experience to provide effective and responsive care.

People’s needs were assessed before they moved to live at the home.

Accidents and incidents were recorded by staff. There was no overall system in place for accident analysis and actions were not always taken to minimise the risks of reoccurrence.

People were supported to eat and drink enough and staff promoted healthy choices around food.

People were very relaxed in the presence of care staff and the registered manager. Staff were friendly towards people, showing respect to them in their approach.

People were able to take part in individual leisure activities according to their preferences. There were also opportunities for people to attend a day centre operated by the provider.

Staff were happy in their job role and felt well supported by the team and the registered manager.

People and their relatives had no complaints about the service. They felt the registered manager would deal with any concern if they needed to raise something.

Further information is in the detailed findings below.

Hatfield House provides accommodation for people in a residential setting for people with learning difficulties. There were 4 people living at the home when we inspected the service.

A requirement of the service’s registration is that they have 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 and associated Regulations about how the service is run. There was a registered manager in post at the time of our inspection. We refer to the registered manager as the manager in the body of this report.

Staff had received training in safeguarding adults and were able to explain the correct procedure to follow if they had concerns. All necessary checks had been completed before new staff started work at the home to make sure, as far as possible, they were safe to work with the people who lived there. Risk assessments around the provision of care and support had been carried out and action was taken to reduce any identified risks. There were systems in place to ensure that medicines were stored and administered safely.

There were enough staff employed at the service to care for people safely and effectively. New staff completed an induction programme when they started work to ensure they had the skills they needed to support people effectively. Staff received training and had regular supervision and appraisal meetings in which their performance and development was discussed.

The provider understood their responsibilities under the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure people were looked after in a way that did not inappropriately restrict their freedom. The provider had made applications to the local authority in accordance with DoLS and the MCA, and at the time of our visit was awaiting the outcome of those applications.

People were encouraged to eat a varied diet that took account of their preferences and where necessary, their nutritional needs were monitored. People were supported effectively with their health needs and had access to a range of healthcare professionals.

Care staff treated people with respect and dignity, and supported people to maintain their privacy and independence. People made choices about who visited them at the home. This helped people maintain personal relationships with people that were important to them.

People were supported in a range of activities, both inside and outside the home. Activities outside the home enabled people to be part of their local community and to take regular holidays. Staff were caring and encouraged people to be involved in decisions about their life and their support needs. People were supported to make decisions about their environment and choose how their room was decorated.

Each person had a care and support plan with detailed information and guidance personal to them. Care plans included information on maintaining the person's health, their daily routines and preferences.

People knew how to make a complaint if they needed to. Complaints received were fully investigated and analysed so that the provider could learn from them. People who used the service and their relatives were given the opportunity to share their views about how the service was run. Quality assurance procedures identified where the service needed to make improvements, and where issues had been identified the manager took action to continuously improve the service.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service and staff told us.

If you want to see the evidence that supports our summary, please read the full report.

Is the service safe?

We saw there were good systems in place to keep people safe. We saw people's needs had been assessed and actions taken to reduce potential risks.

We were told nobody living at Hatfield House was under a Deprivation of Liberty Safeguard.

We saw the home was clean and tidy and there were systems in place to ensure people were protected from the risk of, or spread of infection.

We saw there were sufficient staff on duty to keep people safe at all times.

Is the service effective?

We saw people living at Hatfield House were fully involved in their care assessments.

People had access to health care professionals which supported their health care needs.

We found staff had received the necessary training that enabled them to provide suitable and appropriate care for people when needed.

Is the service caring?

We observed staff being supportive and caring to people at the home.

We spoke at length with two of the four people living at Hatfield House. One person told us staff were, 'Absolutely gorgeous.' The other person told us staff were, 'Alright, very good.'

Is the service responsive?

People received help and support from other health professionals when required, such as doctors, dentists and community health support.

People were supported to participate in activities inside and outside of the home.

People told us they were able to raise any concerns they had. People we spoke with were satisfied with the service they received.

Is the service well-led?

We saw that people's needs were met in a timely way.

We saw there were systems in place to gain feedback from people who lived at Hatfield House, their relatives, and the professionals that supported them.

We were informed the nominated individual (NI) routinely visited the service to provide support to the registered manager and staff working at the home.

We observed effective communication and good relationships between the staff on duty and the three people living in the home. Care plans were up to date, considered all aspects of the person's circumstances and were centred on them as an individual. Risks to people's health and well-being were identified and managed. People had regular opportunities to do things they enjoyed.

People were provided with a choice of suitable and nutritious food and drink. People's independence was encouraged through involvement in shopping, food preparation and cooking.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. People told us they felt safe and said they could talk to a member of staff if they had any concerns.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.

We spoke with the provider and a senior support worker about their roles in providing care and support to people. We looked at records which stated how people liked and needed to be cared for. People told us they were included in planning their care and were happy with the support they received. One person commented, "All of the staff know me well and know what I need help with. I do a lot of things for myself and the staff let me do them."

We observed support staff assisting people with their daily routines and saw that people were treated with dignity and respect.

We looked at records which stated how people liked and needed to be cared for. The senior support worker we spoke with demonstrated an understanding of people's needs and clearly knew them all well. We saw that care plans were in the process of being reviewed so that they remained reflective of people's individual needs.

People told us they were aware of their right to raise concerns and complaints. We looked at records which showed that people were encouraged to raise concerns should they arise.