Hardwick View

Hardwick View is a residential care home providing personal care to younger and older people living with a learning disability, physical disability or a sensory impairment. The home can support up to 20 people; 19 people were living there at the time of the inspection. The home consists of a large family home and an adjacent bungalow where two people live independently.

The service has been developed and designed prior to the implementation of Registering the Right Support. However, we found the home adhered to the principles and values to ensure people 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.

The service was a large home, bigger than most domestic style properties. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

People received a high level of person-centred care based around their abilities, preferences and interests. The manager and staff took time to get to know people and refused to see disability as a barrier to a full and inclusive life. A relative told us, “We chose Hardwick for its outstanding qualities of care, compassion and an open friendliness. These qualities have never changed and if anything, have grown, helping to give it the homely, warm atmosphere that the clients live in.” Another told us their loved one had a lifestyle that “exceeded their expectations.”

People told us they were happy and safe at Hardwick View. They were proud to show us around their home and tell us about their life. They told us of the friendships and relationships they had made and the various leisure activities they enjoyed.

Relatives and professionals told us of the support people were provided with to remain as healthy as possible to enable them to live comfortable and fulfilling lives. They gave us examples of where people’s health had improved as a result of the determination and dedication of staff to ensure everything possible had been done to support people to live their best life. One relative told us that without the support of the home, their loved one would not be alive to celebrate their birthday. People had the support of professionals to help them understand their health care needs and to work alongside staff to provide the best possible outcomes for people. The manager challenged healthcare professionals if people had not been given fair access to services and the same opportunities for support as people without disabilities. One person told us staff had helped them understand a newly diagnosed health condition and that they had the support of a specialist nurse. A professional told us, “Every individual is given the very best chance in life” and another described the home as “always excellent”.

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. People were fully involved in making decisions about their care and treatment. Staff understood the importance and principles of supporting people to make their own decisions about their care. They always approached decision making from the view that with the right information, including advice and guidance from healthcare professionals, people could make their own decisions. A relative told us of the “amazing” support their loved one had received when deciding whether to have surgery. Staff were highly motivated and held a strong belief that people should be as independent as possible and live fulfilling lives.

What was important to people was very much respected and valued by staff, and staff did their utmost to support people’s preferences and interests. A relative told us about how positive the move to Hardwick View had been for their loved one; they said, “The day [name] moved in here her life started again, she’s hit the jackpot. She hasn’t stopped smiling since she has been here. It’s stunning here, she got a life.”

Social engagement was seen by the home as being important to people’s well-being and sense of self-worth. People enjoyed a wide range of social activities including clubs, sports and engaging with other organisations such as colleges, the Royal British Legion Club, churches and the local theatre. Staff recognised the importance of relationships with family and other people.

People received truly kind, caring and compassion support during their end of life care. The provider and manager saw Hardwick View as a home for life for people, should that be their wish. Staff had received training in end of life care and saw it as a privilege to care for people at this sensitive time. We were provided with examples where the home had gone ‘above and beyond’ what would have been expected of them to ensure people approaching the end of their lives were able to be with family and friends and enjoy special events. Feedback received from family members praised the home for their loving care. One considered themselves “blessed” to have found Hardwick View for their relation.

The home applied 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.

The provider, manager and staff, through their actions and how they spoke about the people living at Hardwick View, demonstrated they put their values of individuality, independence, inclusiveness, dignity and rights into practice. We received very positive feedback from people, relatives and professionals about how well the home was managed. One relative said, “[Manager] has done an outstanding job as manager. She has a wonderful kind and caring manner which she encourages the staff to follow. Hardwick stands out as a flagship to all other homes.”

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 29 June 2017).

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.

Hardwick View is a residential care home providing care and accommodation for up to 20 people. On the day of the inspection 19 people were using the service.

Hardwick View provides care for people with a learning disability.

Hardwick View is a large house. There were shared bathrooms, a shared kitchen and a shared lounge and conservatory. There was a large outside garden area. Access to the house was step free. In addition there was a further smaller bungalow within the grounds for people ready for more independent living.

The service had 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.

People’s quality of life continued to improve under the leadership of the management team. Staff and relatives all described the management in exceptional terms. Staff talked positively about their jobs and their shared commitment to people achieving their best. Care was compassionate and based on best practice. The staff team were highly motivated to achieve excellent care so people had the best quality of life possible. The registered manager and deputies were caring and proactive, they ensured effective and close monitoring of all aspects of the service to ensure ongoing improvement across all areas.

On the day of the inspection staff within the service were relaxed, there was a welcoming, calm and friendly atmosphere. Relatives repeatedly told us, “It’s like a large family”. Everybody had a clear role within the service. Information we requested was supplied promptly, records were organised, clear, easy to follow and comprehensive.

Staff put people at the heart of their work; they exhibited a kind and compassionate attitude towards people and their loved ones. Strong relationships had been developed and practice was person focused and not task led. Staff had appreciation of how to respect people’s individual needs around their privacy and dignity.

People led very busy, full lives at Hardwick View. People told us they enjoyed football matches, shopping and coffee outings, pamper evenings, arts and crafts and we saw everyone enjoying a pet therapy afternoon during the inspection. Special events had been held such as a music festival and dog show which people had thoroughly enjoyed.

Some people had limited verbal communication but we observed they felt comfortable with staff, were warm, tactile and engaged in their interactions with staff. Staff knew people’s individual communication styles. Other people we met were keen to share what they had been doing since the previous inspection, and showed us around their home. We heard of people’s exciting trips to watch football in London, balls attended and people being chosen to represent England at the Special Olympics.

Care records were personalised and gave people control over all aspects of their lives. Staff responded quickly to people’s change in needs. People or where appropriate those who mattered to them, were involved in regularly reviewing their needs and how they would like to be supported. People’s unique preferences were identified, known by all staff and respected. People’s rooms were decorated with their favourite things, for example, football and Dr Who memorabilia. People were supported with their personal choices for example one woman who was 78 had just had her ears pierced and was enjoying buying new jewellery to match her outfits.

People had their medicines managed safely. People received their medicines as prescribed, received them on time and understood what they were for. People were supported to maintain good health through regular access to health and social care professionals, such as GPs, social workers, and physiotherapists.

People we observed were safe. The environment was uncluttered and clear for people to move freely around the home, equipment was well maintained and outings to external venues risk assessed. Staff discreetly monitored people’s behaviour and interactions to ensure the safety of all the people and staff at the service. All staff had undertaken training on safeguarding vulnerable adults from abuse, they displayed good knowledge on how to report any concerns and described what action they would take to protect people against harm. Staff told us they felt confident any incidents or allegations would be fully investigated.

People’s risks were managed well, known by all staff and monitored. Staff were highly motivated and creative in finding ways to overcome obstacles that restricted people’s independence and would help to improve their self-esteem and confidence.

People were supported by staff that confidently made use of their knowledge of the Mental Capacity Act (2005), to make sure people were involved in decisions about their care and their human and legal rights were respected. Families were involved in decision making and advocacy services were used when required. The service followed the laws and processes in place which protect people’s human rights and liberty.

People were supported by staff teams that had received a comprehensive induction programme, tailored training and ongoing support that reflected individual’s needs.

People were protected by the service’s safe recruitment practices. Staff underwent the necessary checks which determined they were suitable to work with vulnerable adults, before they started their employment. Staffing levels were flexible dependent upon people’s needs and activities.

The service had a policy and procedure in place for dealing with any concerns or complaints.

No written complaints had been made to the service in the past twelve months.

There were robust quality assurance systems in place. Feedback from relatives and professionals was excellent. Any concerns however would be noted, listened to and action taken.

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. The summary is based on our observations during the inspection, speaking with sixteen people using the service, three staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. People told us "I feel safe here". During our inspection we spent time observing people as they enjoyed a musical entertainer. We noted the interactions were good and showed staff respected people at the home.

Safeguarding procedures were robust and staff understood how to safeguard the people they supported. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager told us they had not needed to submit any applications. Proper policies and procedures were in place and the manager knew to liaise with the local DoLS team if required. The manager and senior staff had been trained to understand when an application should be made, and how to submit one.

Recruitment practice was safe and thorough. Staff files showed us that the staff had undertaken appropriate inductions, training and had regular one to one meetings and appraisals with their manager.

Is the service effective?

People who lived in the home told us they were happy with the care they received. We spoke with staff who were able to tell us how they met people's care needs. We observed the care provided and spoke with the people who lived in the home. This gave us evidence that staff knew people well. People's health and care needs were assessed to ensure they received high quality care that met their individual needs. Where people were not able to make certain choices and decisions we found evidence that relatives and representatives had been involved in the care planning process. Regular support plan reviews were carried out to ensure they reflected people's current needs.

Is the service caring?

People were supported by kind and attentive staff. They said "The staff are patient, nice and kind." Staff told us "We try to give our clients the best possible life we can and that they deserve." We observed this during our inspection and saw that staff were patient and went at the person's pace when assisting them with their mobility, food, and personal care needs. During the musical entertainment we saw staff and people who lived at the home sharing a song and dance together. We saw that people were having fun and were very happy.

During our inspection it was a very hot day and ice lollies were handed out to help people stay cool. People were encouraged to wear their sunhats in the heat and sit in the shaded areas to reduce the risk of sunburn.

Staff knew people's personal communication styles and responded promptly to meet their needs. We observed a mutually caring environment between staff and people during our inspection. The staff we observed acted as role models for people to help them manage all aspects of daily living.

Is the service responsive?

People's needs had been assessed before they moved into the home where possible and a gradual, individual transition to Hardwick View had been made. The manager visited people and carried out an assessment to ensure the service was able to meet their needs. People were able to visit the home and meet the current residents and decide whether they liked Hardwick View.

The home were observant to people's changing needs, moods and behaviours and promptly intervened to reduce people's anxiety or distress. The provider liaised closely with health and social care professionals and followed their advice when needed. We spoke to staff about how they supported people's individual behavioural needs and all staff were clear and consistent in the support provided.

People had access to activities that were important to them such as college, access to the local discos and the library. We saw the home provided a relaxed environment where people enjoyed the garden, chickens and rabbits. There was a complaints policy and several people told us they felt able to speak to the staff if they were unhappy about something. They felt confident that the service would deal with any matters to their satisfaction.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. Regular meetings were held on a Monday morning and afternoon to encourage people to share their thoughts and views about their lives at the home. Staff told us they were clear about their roles and responsibilities. Staff told us they had regular meetings with the manager and there was an "open door" philosophy at the home. Staff told us they felt supported by their colleagues, the manager and the owners. This helped to ensure that people received a good quality service at all times.

There were audits and monitoring in place which ensured the home maintained a high quality of care and a shared philosophy of respect and choice for people.

We found people were involved in the running of Hardwick View. People had their views listened to through regular resident's meetings, annual questionnaires about their experiences and people were involved in choosing the staff they wanted to employ at the home.

People had their individual needs assessed and were involved in their care and treatment where possible. Staff liaised closely with relevant health and social care professionals to meet people's care and welfare needs.

People's nutritional needs were met. People living at Hardwick View choose their menu's, did the shopping for the food and were supported to manage their diet where this was required.

Staff were aware of their roles and responsibilities to protect people from harm at Hardwick View. There was regular training in place for staff and an open, transparent culture was evident at the home.

There was a complaints process if someone wished to make a complaint. There had not been any recent complaints at Hardwick view.

We talked with ten people who lived at the home. They all told us that they were happy with the service provided by Hardwick View and that they felt safe. Other people who were not able to communicate verbally with us appeared to be calm, comfortable and relaxed. People told us that staff helped them to make choices about their lives and supported their decisions.

We looked at the care provided and records relating to three people. We saw detailed records relating to each person's care. These included risk assessments and care plans and these records enabled staff to meet people's individual needs.

People were involved in the daily life of the home and took part in ordinary domestic activity. The home respected people's food likes and dislikes, and food choices.

We spoke with four staff who told us that that they felt supported in their role and enjoyed working at the service. People told us staff were approachable and always available. Staff training was updated and relevant to the care needs of people using the service.

We saw that all areas of the home were warm, clean and safe for the people living there.

The registered manager monitored the quality of the service provided. He had responded to information received and changed areas of care being provided in order to improve the service.