Hapstead Village

About the service

Hapstead Village is made up of six separate houses and is registered to support up to 48 people with learning disabilities and or autism. People in care homes receive accommodation and 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.

This service provides care and support to people living in two 'supported living' settings, so that they can live in their own home as independently as possible. In supported living settings people's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at the quality of personal care provided in the supported living settings.

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

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The service was not always able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support:

Although we saw some examples of how the model of care at Hapstead Village maximised people’s choice, control and Independence, we also identified instances where staff shortages had impacted on people. The provider was taking action to address this.

We were assured that the majority of people received individualised care and support in a way that was flexible and responsive to their needs from staff who knew them well, and who were skilled at delivering care and support.

Right care:

From our observations and speaking with staff and the provider it was clear that there was a

positive culture at Hapstead Village and staff worked with the values of person-centred care. Staff supported people in a dignified way. However, we found examples of restrictive practices taking place.

Whilst we found no evidence that people had been placed at a disadvantage, the failure to assess people’s capacity and record best interest decisions risked compromising people's rights. The provider has taken action to address this.

Right culture:

The ethos, values, attitudes and behaviours of the leaders and staff at Hapstead Village ensured people lead confident and inclusive lives. However, we found examples of where the provider had not carried out regulatory requirements. The provider was taking action to address this.

There was a positive culture at the service that valued people as individuals and looked for ways to continually improve people's experience.

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 17 January 2019)

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding.

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.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to staffing levels, consent, good governance and a failure to notify The Care Quality Commission (CQC) of important events.

Please see the action we have told the provider to take at the end of this report.

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

Hapstead Village consists of care home made up of six separate houses and is registered to support up to 48 people with learning disabilities. People in care homes receive accommodation and 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.

This service provides care and support to people living in two 'supported living' settings, so that they can live in their own home as independently as possible. In supported living settings people's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at the quality of personal care provided in the supported living settings.

At the time of our inspection 36 people were living in the care home and 10 people were receiving supported living care. One of the six houses had been recently extended to enable the service to meet the needs of people as they aged.

The service is based on a campus style mode and had been set up over 30 years previously to provide a home for life for people with learning disabilities. The care service was established before the introduction of Registering the Right Support which is current best practice guidance on how services for people with learning disabilities should been designed. One of the key principles of this guidance is that people with learning disabilities should be supported to live as ordinary a life as any citizen. In Hapstead Village we found that people received personalised care, were supported to be as independent as possible and lived varied and interesting lives.

The service was within one hundred acres of land, including a farm and people were supported to participate in a wide variety of activities both within the service and in the local community. The registered manager told us the service operated, “a college style timetable of activities” and people had the choice of which activities they engaged with (if any). On the day of our inspection people engaged with rural tasks and various craft activities including, metal work, jewellery making, woodwork, pottery and weaving. People took pride in their creations which were exhibited at local craft fairs. People told us they enjoyed the variety of activities available within the service and commented, “I go out at about 8.30 in the morning, collect eggs, and check the hens are alright, “[I am] very happy indeed with my workshops, metal working in morning, and pottery in afternoon” and “I was doing the [donkeys] this morning.”

In addition, each of the six houses had it’s own dedicated transport and people were able to go out in the evening and participate in events within the wider community when they wished. People told us, “I get out a lot, staff can drive. Last week I went to Cornwall” and “I’m Going to [Plymouth] Argyle [football match] at the weekend.” While relative said, “They involve [my relative] in a variety of activities” and “[My relative] is really busy, Workshops during the day and going bowling and to the theatre. They took her on holiday to Majorca last year.”

People told us they felt safe and well cared for. Their comments included, “I feel safe, I am happy living here” and “We all feel safe here.” Staff had received safeguarding training and were confident any safety concern they reported to managers would be addressed. People’s relatives were complimentary of the support the service provided and told us, "I think [My relative] is quite happy and is in as good a care home as you can get” and “We are very very impressed with the whole place.”

The service was staffed by a combination of employed carers and volunteers from overseas. Staff told us, “We always have enough staff for every shift” and the service’s rotas showed there were sufficient staff available to meet people’s needs. Each of the six houses and the supported living service had it’s own staff team and was led by a manager.

Volunteers normally stayed at the service for up to two years and told us they enjoyed their roles. Their comments included, “I am happy. I am really glad I had the opportunity to work here”, “I gain a lot and learn a lot here” and “I have come back for a second year.” Volunteers where included on the service’s staffing rotas and were allocated time off each week. The registered manager told us, “Volunteers are treated exactly the same as staff.”

All staff and volunteers completed formal induction training in line with the requirements of the care certificate. Regular training updates were provided in topics considered mandatory by the service. Staff told us “We had loads of training” while relatives commented, “Everyone has had the training they need to look after my relative.” There were systems in place to ensure all staff and volunteers received regular support and supervision form their managers. Staff told us, “[The manager] is really nice she is very supportive” and “[The service manager] is really nice. Very hands on. She is very supportive.” The service was led by a registered manager and the roles and responsibilities of all of the service’s managers were well defined and understood by staff. Professionals told us, “[They] are very good and well organised. Easily contactable and are able to provide any information I require.”

The service had robust recruitment procedures. Necessary checks had been completed to ensure prospective staff and volunteers were suitable for employment in the care sector.

Risk assessments had been completed and staff were provided with guidance on the actions they must take to ensure people’s safety. This included information on how to safely support people to stand up. Where risks had been identified in relation to people becoming anxious or upset, staff were provided with guidance on how to support people to manage these situations using appropriate distraction techniques. Staff told us restraint was not used at this service and records showed staff were able to support people to manage their anxiety without the use of restraint.

Care plans provided staff with sufficient guidance to enable them to meet people’s support needs. Staff told us these documents were accurate and up to date and commented, “If you look through [the care plan] it tells you every single thing you need to know about [that person].” People and their relatives had been involved the care plan review process and relatives told us, “They keep us up to date. There is a yearly review [of the care plan].”

Accident and incidents that occurred were documented and reported to service managers for further investigation. However, it was unclear how learning from specific incident was shared between houses. In addition, the language used in some incident records gave the impression that staff may have responded punitively to some incidents. We discussed these concerns with people who had been involved in recent incidents and it was clear they had been supported to understand the impact of their action to help them manage similar situation in future. We raised these issues with the registered manger and following our inspection new procedures were introduced to ensure details of all incident and accident that occurred were shared with the registered manager.

Staff and managers understood the requirements of the Mental Capacity Act 2005 (MCA). Where people lacked capacity in relation to specific decisions these had been consistently made in the person’s best interest with appropriate involvement from relative, advocates and health professionals. Some people living in the care home lacked capacity were unable to access the community without support from staff. The service had appropriately applied to the local authority for authorisation of these potentially restrictive care plans.

There were appropriate quality assurance systems in place designed to drive improvements in the service’s performance. Regular audits had been completed by the care manager in each house in line with the commission’s ‘Key lines of enquiry’. Where any issues were identified, action plans were developed and reviewed to ensure the service complied with the requirements of the regulations.

People and their relatives understood how to raise complaints and there were systems in place to ensure any complaints received were investigated and resolved. People’s feedback was valued and an external advocate had been commissioned to host meetings in which people were able to raise and discuss any concerns or issues they had. The advocate fed any concerns or suggestion raised during these meetings back directly to the provider’s trustees. People were thus able to raise issues anonymously if they wished. Minutes of trustee meetings showed action had been taken in response to people’s suggestions.

The home had 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

This inspection took place on 19, 25 and 26 April 2016 and the first day of inspection was unannounced. At the time of our inspection there were 36 people living in Hapstead Village and 10 people, who lived in supported living, receiving personal care from the service. People had a range of needs with some people being more independent and others requiring more support with their care needs.

People, staff and healthcare professionals expressed confidence in the care provided at the service and with the service’s management. People told us they were happy with the support they received and felt they could live their lives the way they wanted. People were encouraged to have as much freedom as they wanted. Risks to people were identified and plans were put in place to manage these risks without restricting people’s freedoms and rights to take risks.

Staff had received training in safeguarding people and knew how to raise concerns if they were worried about anybody being harmed or neglected. The service had a very open culture which encouraged people and staff to raise any concerns they had. People and staff told us they felt very comfortable raising concerns and felt confident these would be acted on. Staff had received information about whistleblowing and felt confident about doing this if they needed to. There was information available in a way people understood relating to safeguarding and how people could keep safe. This information was easily available to all people who received support, either on the site or in their own homes, and contained contact details for external bodies.

People’s medicines were managed safely and where people wanted to, they were encouraged and supported to manage their own medicines independently. People were also encouraged and supported to manage their monies safely.

People and healthcare professionals spoke highly of the staff and the care and support people received. People’s care was person centred and focused on their health needs, their social needs and their wellbeing. People were fully involved in every aspect of their care and support. Staff used a number of different methods to communicate with people in order to ensure they fully understood their options and their choices. The support staff provided to people reflected people’s wishes and their preferences. Staff told us they had enough time to meet people’s needs and throughout our inspection we saw staff supporting people in personalised ways and being flexible to people’s wishes. Staff had time to take people to activities, involve people in activities and spend one on one time with people.

A large variety of activities were organised and provided to people. Hapstead Village organised their own activities on the site which included a number of workshops such as pottery, working on the farm, woodwork, art and weaving. People could choose to take part in these organised activities or could choose to attend a number of other activities in the wider community, such as swimming, dance classes, rock climbing and attending sporting events. People were encouraged to engage in activities and lead an active social life. The setting for the service encouraged socialising and friendships were promoted. There was transport available to ensure people could attend events they wanted and go out in the evenings. People went out for meals, went to the cinema and enjoyed going to pubs and evening social events.

Staff received sufficient training to meet people’s needs well and further training was available to those who wanted it. Staff were encouraged to progress and gain further qualifications. Staff received regular supervisions and yearly appraisals during which they were encouraged to share their views and ideas. Staff views and feedback were also sought during team meetings and in the form of a yearly questionnaire, currently in draft.

There were robust recruitment processes in place to ensure that suitable staff were employed. The service used value based recruitment in order to ensure they recruited staff who were kind, caring and shared the values of the service. Staff performance was monitored and poor practice was picked up and acted on.

Staff were knowledgeable and confident when they spoke about people’s support needs. Staff had received training in, and understood the principles of the Mental Capacity Act 2005 and the presumption that people could make their own decisions about their care and treatment. The registered manager had a good understanding of the laws regarding the Deprivation of Liberty Safeguards and had made appropriate applications to the local authority.

Staff knew the people they support well, including their interests, personalities and likes and dislikes. People felt staff knew them well and enjoyed their company. Even though staff knew people well, they never assumed they knew what people wanted and always asked them for their wishes and their opinions.

Each person had a care plan which was written in a person centred way. People had been involved in writing their care plan and were involved in every care plan review. Their care plan detailed their support needs and also how to maximise their independence. People were encouraged to set themselves goals to achieve during the year, such as learning to cook a meal on their own or do their own laundry.

Where people were at risk relating to their health, their wellbeing or their safety, these risks had been identified and recorded. Staff had sought advice from external healthcare professionals and had created plans, with people’s involvement, to minimise these risks for people. People’s care plans and risk assessments were fully reviewed yearly and were updated more regularly with any changes. Staff had effective systems in place to communicate changes in people’s needs or wishes in order to ensure staff had up to date information.

Mealtimes were sociable and enjoyable. People were encouraged to be as independent as possible with their meals and were given options that reflected their preferences. Where people were independent with their meals, people were supported to go shopping and were given advice about healthy eating. Where people required support with their meals, they were involved in planning the menus and were always offered options and alternatives.

The environment at Hapstead Village was welcoming, open and friendly. People moved around the service independently and came and went into town on their own or accompanied. Each house reflected the personalities of the people who lived there and people’s bedrooms were individual. Staff told us they cared about the people they supported. Staff spoke highly of people and displayed caring attitudes towards them. During our inspection we saw positive interactions between staff and people. We saw people laughing with staff and taking part in jokes and light banter. Staff showed affection for people and communicated with them in ways that met their needs.

People and healthcare professionals spoke highly of the registered manager and the rest of the management team. Staff told us they felt very supported and encouraged by the management and would not hesitate to approach them with their ideas and suggestions. The leadership structure at the home was clear and staff were confident in their responsibilities.

There was an effective quality monitoring system in place which was used to continually review and improve the service. People’s views, opinions and feedback were sought in a number of different ways which met people’s communication needs. People were asked to give their feedback in yearly and quarterly questionnaires which they could answer on paper, in easy read format, in groups, on their own, directly to staff, or with the help of an independent advocate. People were also encouraged to share their views during weekly meetings, individual house meetings, regular meetings held by independent advocates and in person. People were also supported to attend board meetings which were attended by directors in order to ensure people’s views and feedback was heard at the highest level. People’s views were acted on to improve the service provided.

There were systems in place to ensure the environment was safe for people and there were regular quality and safety monitoring checks undertaken.

We saw evidence that arrangements were in place to obtain consent of people who use the service. People we spoke with said 'staff ask 'would you like me to do something for you' and 'staff give information and we decide'. Staff explained that they 'give people a few choices' to enable them to choose their preferred option.

We saw that a variety of meaningful activities were available including weavery, pottery, woodwork, metalwork and others. People we spoke with told us that they could 'choose for myself what I do' including taking part in individual activities such as playing the piano. People were able to engage in community activities such as going to college and taking part in voluntary work.

People we spoke with said that staff were 'absolutely brilliant', that they were 'very well cared for' and that they 'felt very safe living here'. Other comments included 'they try to encourage me', 'they keep me safe' and 'staff help me manage and look after my money'. Everyone we spoke with said that they were treated with dignity and respect and that they felt safe at Hapstead Village.

We found that people's privacy was protected and staff spoke to people respectfully. Information was provided to people in suitable formats. Records showed that people had regular opportunities to be involved in and discuss their care.

People made choices about everyday living, such as their preferred layout of things in their room. Where people did not have the capacity to make significant decisions their rights were protected.

People's needs were assessed and care was planned and delivered in line with their individual care plan. People had access to community and specialist health services.

Records showed and people told us that they had made progress at Hapstead Village, such as learning new skills. Some people had recently moved into supported living units. People took part in activities in the community.

There were effective recruitment procedures and sufficient trained staff were employed. Effective systems were in place to protect people from the risk of abuse.

The provider had an effective quality assurance system in place, which took account of people's views.