Hammonds

Updated 5 January 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

Three Inspectors, and an Expert by Experience carried out the inspection. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Hammonds 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.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke/ communicated with eight people who used the service and five relatives about their experience of the care provided. Some people who used the service who were unable to talk with us using speech so we used different ways of communicating including using Makaton, pictures, photos, symbols, objects and their body language. We spoke with two visiting health professionals.

We spoke with eight members of staff including the registered manager, senior support workers, support workers and the cook.

We used the Short Observational Framework for Inspection (SOFI)/ spent time observing people. SOFI is a way of observing care to help us understand the experience of people who could not talk with us

We reviewed a range of records. This included four people’s care records and multiple medication records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We received feedback from four additional professionals who regularly visit the service.

Updated 5 January 2023

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

About the service

Hammonds is a West Sussex County Council in-house residential care home supporting people who have learning disabilities, physical disabilities and autistic people. Hammonds can support up to 20 people and 16 people were living there at the time of the inspection. Hammonds accommodates people across three separate buildings, each of which has separate adapted facilities. One of the buildings had four rooms for people who stay at the home for short breaks. There is also an administration building which houses offices, a catering kitchen and shared area for group activities.

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

Right Support

Staff did not always support some people to have the maximum possible choice, control and be independent and they had limited control over some areas of their own lives. Some people had limited opportunities to build skills and participate in individual activities. Staff were trying to be more focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life, some work had begun with some people but we were told there were not enough staff to provide this support consistently for everyone. Each person had their own rooms, which were generally personalised to meet their needs and preferences. People had shared bathrooms in two of the houses and only one person held keys for their own room, one other person requested staff to lock and unlock their door. People did not have alternative and accessible door locking systems. The home had outside shared space for group activities but this was not always accessible to everyone and was in places, unkept. For example, the courtyard area was cluttered and some parts of the garden were not accessible to people. The registered manager told us of plans to make the rear garden accessible. At the time of inspection the indoor shared space in the administration building was being used as a staff changing area and storage while a new floor was being laid.

The layout of the service did not promote person centred support, for example main meals were cooked in an area that people did not have access to. People went in and out of other’s homes uninvited, limiting people’s ability to enjoy their home without interruption.

The service worked with people to plan for when they experienced periods of distress so that their freedoms were restricted only if there was no alternative. Staff did everything they could to avoid restraining people. Staff learned from those incidents and how they might be avoided or reduced.

Staff enabled people to access specialist health and social care support in the community. Staff supported people to make decisions following best practice in decision-making.

Right care

People experienced mixed quality of care, some staff spoke over people and talked to each other about people in the presence of others. Not all staff respected people’s dignity, this was something raised in the last inspection and was still happening at this inspection. In contrast most staff were delivering kind and compassionate care. Staff understood how to protect people from poor care and abuse. The service worked with other agencies to do so. People’s care, treatment and support plans reflected their range of needs and this promoted their wellbeing. Staff and people cooperated to assess risks people might face. Staff had begun to encourage people to take positive risks.

Right culture

People did not always lead inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the provider, management and staff. There was mixed understanding or opportunities to apply active support approaches. The provider had not fully considered people’s needs and wishes in the planning and deployment of staff. Some improvements had been made towards person centred support, with more choices being offered and developed understanding of people’s communication needs. Managers and staff were trying to further develop these areas locally within the limitations of the layout and staffing structure of the service.

People received good quality health care, support and treatment because trained staff and specialists could meet their needs. Most staff knew and understood people well but there was a reliance on agency staff who did not always know people.

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 August 2019) and there were two breaches of regulation. Regulation 9 (Person centred care.) The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, enough improvement had been made and the provider is no longer in breach of that regulation. At the last inspection the provider was in breach of regulation 10 (Dignity and Respect). At this inspection the provider remained in breach of this regulation. At this inspection the provider was in breach of Regulation 17 (Good governance) the provider had failed to assess and monitor the service to include the quality of the experience of people receiving the service. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support right care right culture.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.