Hubbard Close

Hubbard Close is a residential care home providing personal care to people with learning disabilities, and autism. During the inspection five people were living at the service. The service can support up to five people. People had their own bedrooms and shared facilities such as the kitchen, the bathrooms and the garden.

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 were positive about their care. One person told us, ''I love it here. The staff are all great.''

People were supported with kindness, respect and compassion by a staff team who had gotten to know people as individuals. There was a focus on people making choices about their support and the staff team promoted people to be as independent as possible. People received personalised care and were communicated to in their preferred communication methods.

People were protected from harm and abuse by systems put in place at the service. People had assessments in place which enabled them to take positive risks. There were enough trained and knowledgeable staff to support people safely and to allow people to do what they wanted throughout the day.

However, people did not always have as required medicine guidelines in their medicine files as they were accessed online. The provider reassured us these would be put into place following the inspection so that staff could easily follow them.

People were supported to take part in a wide array of community-based activities and to take part in daily living skills in the home. Staff members encouraged people to try new things and to be involved in choosing how they spent their time. The manager and staff team had a passion for promoting people's involvement in the local community.

People were positive about the way they were supported with food and drink, people were involved in cooking and preparing meals. People were supported to see health care professionals where this support was needed. People had access to a detailed complaints procedure which was available in accessible formats if people needed to make a complaint.

The manager completed audits to monitor the quality of the service. These included medication audits, health and safety and care delivery.

People and their relatives were encouraged to feed back about their care and support and were involved in service delivery at all levels. The manager and the staff team worked with other organisations to ensure good outcomes for people using the service. People were positive about the management of the service. The manager was passionate about putting plans in place to continue to improve the way people were supported.

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. However, capacity assessments did not always clearly document how people were involved in the assessment process. We discussed this with the provider who assured us they would review these assessments to ensure consultation with people was clearly documented.

The service applied the 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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 20 November 2018) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

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.

We inspected this service in December 2015 and rated the home as ‘Good’ overall. At this inspection, on 20 September 2018, we rated the service as ‘Requires Improvement’ overall. This is the first time Hubbard Close has been rated as Requires Improvement. This inspection was announced the day before we visited. This was to ensure a member of staff would be present to let us into the home.

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

Hubbard Close provides personal care and accommodation for people who have a range of learning disabilities. Hubbard Close can provide care for up to five adults. At the time of this inspection five people were living at the home. Hubbard Close comprises of accommodation over two floors.

The care service has been developed and designed 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. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.” Registering the Right Support CQC policy.

There was a registered manager in place when we inspected the home. 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.

People’s risk assessments and the care plans created to guide staff about how to manage and respond to certain risks, had not been updated or were not completed fully. A plan to manage a person’s safety in the community was not robust.

The service was not compliant with the Mental Capacity Act 2005. An activity a person engaged with was being controlled by staff. The persons’ ability to agree to this restrictive plan had not been checked. They had not been involved in this plan. The plan was not being reviewed on a regular basis. There were gaps in the recording of some people’s capacity assessments. It was not always clear that these assessments were robust. Even though, these assessments were considering if people could make certain important decisions about their lives.

The provider and registered manager’s audits were not always effective or thorough. At times, these audits did not always consider if people’s experiences could be improved upon or lead to action to try and make this happen. People were funding elements of their care rather than the provider looking at alternatives to this.

These issues constituted breaches in the legal requirements of the law. There were three breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the full version of the report.

There were various safety checks taking place to ensure people received safe care and support. However, there were some shortfalls in this area. These related to timely action to issues identified about the building, infrequent fire evacuation drills, and gaps in people’s risk and care assessments. Lessons were not always being learnt or considered when incidents took place affecting the people at the home.

Staff recruitment checks were not complete or well evidenced. We made a recommendation that the service improved this aspect of people’s safety.

People received support to access health care services when they needed this input. Staff also followed up concerns and outstanding issues in relation to people’s health needs.

The service was involving people with what foods were available to them and they were promoting healthy options. People told us that they really enjoyed the food at the home.

The registered manager and staff were kind and thoughtful to the people at the home. They treated people as adults and they had clearly developed kind and respectful relationships with the people living at Hubbard Close.

We did find that there was an issue with how the service stored people’s confidential information. However, this issue was resolved shortly after we inspected the service.

People appeared to be involved in the planning and reviewing of the care and support they received. People’s assessments explored people’s interests, likes and dislikes. We were told about how staff promoted one person’s potential, however staff were unable to give us other examples of this in relation to other people at the home. This aspect of people’s care was not being routinely explored by the provider or the registered manager.

Some people had end of life plans in place. However, we found these were not always person centred. We made a recommendation for the service to review these plans. People’s rooms were not always promoted as personal spaces. The décor in people’s rooms was tired.

There were regular activities taking place at the home and people often attended the provider’s learning centre.

The registered manager was available and present around the home. There was a positive culture at the home, but the service was not always considering how or if they could do better for the people who lived at Hubbard Close.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found.

Is the service safe?

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Suitable risk assessments had been carried out and staff were knowledgeable about the content of these. People who used different types of equipment had these regularly checked and properly maintained. Health and safety audits were carried out by the registered manager on a quarterly basis as part of a system for monitoring people's safety.

Members of staff had been through an appropriate recruitment process. This included carrying out background checks, for example, through the Disclosure and Barring Service. This meant the provider could demonstrate that the staff they employed were suitable and had the skills and experience needed to safely support the people living in the home.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. None of the people who used this service had had applications submitted under this system. However, we saw evidence that staff had received training in relation to the operation of the DoLS and there were appropriate policies in place.

Is the service effective?

The service promoted people's independence and ability to make choices as much as possible. Members of staff described a person-centred approach to care and demonstrated a good working knowledge of the contents of people's support plans. We saw that people were engaged in a wide variety of activities. Suitable equipment was provided and maintained in order to promote people's independence. People were also effectively protected from the risks of inadequate nutrition and dehydration. One person told us "I watch what I eat because of my diabetes. The food is lovely and I get a choice. Sometimes I help with the cooking."

Is the service caring?

We observed that people were relaxed and confident in their interactions with staff. For example, we observed that people were often engaged in sharing jokes or lightly teasing members of staff. All of the members of staff responded positively to this type of interaction. We spoke to three of the people using this service. They all told us that they were happy with the care being provided. One person said "This has been my home for ages. The people are great. I like it here."

Is the service responsive?

People's support plans carefully described their preferences, likes and dislikes and included a personal development plan. People met regularly with key workers to discuss any changing needs and had access to the activities that they wanted to engage in.

There were no records of any formal complaints having been made by the people using the service. However, people were encouraged to attend a weekly meeting where they could discuss any concerns that they had. Those who did not wish to attend the meeting were encouraged to contribute in other ways. One person told us "I don't join in with the meeting, but I can say what I want to say. There is nothing wrong at the moment.'

Is the service well-led?

The provider had an effective system to regularly assess and monitor the quality of service that people received. People using the service met weekly and could discuss potential improvements to the service. Members of staff were invited to attend monthly meetings where they could raise any concerns and the quality of care being provided was addressed. An area manager visited the service each month and carried out a series of checks to ensure that the quality of care was maintained.

We found that people received treatment from a wide range of professionals. One person told us, 'I see the doctor when I need to.' This meant that people's health and well-being was protected against the risks associated with unsafe or unsuitable care and support.

We found that people received their medicines at the appropriate time. The medication administration record (MAR) sheets were fully completed in line with best practice.

People were supported by staff that were appropriately trained, supervised and appraised. Staff said that the training equipped them with the skills to do their job effectively.

The home had effective systems in place to ensure that both staff and people's records were stored securely and accurately maintained so that confidentiality was protected.

We spoke with two people who told us they enjoyed living in the home and that staff were kind and supportive, assisting them to maintain their independence wherever possible. We observed positive engagement and interactions between staff and residents and saw people were treated respectfully at all times. The people who lived at Hubbard Close had lived together for many years.

We also spoke with two members of staff on duty who had worked at the home for a number of years, and also the head of service. Staff were knowledgeable about people's needs and preferences and we saw these were responded to appropriately.