Honeysuckle Cottage

Honeysuckle Cottage is a residential care home providing accommodation and personal care to up to 4 people. The service provides support to people with learning disabilities and autistic people. At the time of our inspection there were 4 people using the service.

People’s experience of the service and what we found

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 assessment and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support

People were not supported to have maximum choice and control of their lives and staff did not 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. People’s risk management and care plans were not robust and did not always reflect their current needs. Risks to people from the environment had not been assessed. All radiators in the service were found uncovered. The environment was clean and hygienic.

Right Care

People were supported by staff who knew them well. Medicines were not always managed safely. Medicine records were not clear for staff to follow for time specific medication. Activities were not always tailored to suit the needs of the people. Staff had training on how to recognise and report abuse. Staff were knowledgeable on how to protect people from abuse.

Right Culture

The manager at the time of the inspection was overseeing multiple services. This led to lack of oversight in relation to the quality assurance and governance systems in place. However, the provider is putting in measures to improve this going forward. Staff told us that the manager was supportive and approachable. Complaints procedures were in place, relatives and staff knew how to make a formal complaint.

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 10th July 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We undertook a focused inspection to review the key questions of safe, responsive, and well-led only. For those key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Honeysuckle Cottage on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to the management of risks and governance in the service. We have issued warning notices in relation to governance or safe care and treatment.

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.

Honeysuckle Cottage is one of eight small services operated by the provider which provide support and accommodation for people living with a learning disability. The service can accommodate up to four people. At the time of this inspection four people were living in the home.

There was no registered manager in post at the time of this inspection. 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.

At our previous inspection in June 2016 we found that the provider was in breach of one regulation of the Health and Social Care Act 2008 (Regulated Activities) 2014 which related to the safety of care and treatment. At this June 2017 inspection we found that improvements had been made and that robust systems were in place relating to medicines management and environmental risk assessments. Consequently, the provider was no longer in breach of this regulation.

People living in the home were safe. Staff understood what the risks were to each individual and plans were in place to eliminate or reduce any risks as far as possible. There was enough staff to meet people’s needs and provide them with person-centred care. Medicines were safely managed and people received them as prescribed.

Staff received training to ensure that they could provide effective and appropriate care and support to people. Assessments of people’s capacity to make their own decisions about their care had been completed and their rights were protected. People’s healthcare needs were well managed.

Staff were caring and friendly and had developed good relationships with people living in the home. Staff were responsive to people’s needs and helped them maintain as much independence as possible. People were supported to make their own decisions about how they spent their time in and outside of the home. They were encouraged to maintain and develop appropriate social contacts.

The service had been without a registered manager for over 18 months and had seen four changes of manager since the last registered manager had been in post. The provider needed to ensure that post holders applied for registration when they took up their role.

Honeysuckle Cottage provides residential care for up to 4 people who are living with a learning disability. At the time of this inspection there were 4 people living within the home. The accommodation includes three bedrooms with private bathrooms and one self-contained annex situated within the main building. A kitchen, dining room, lounge, laundry room and garden are also available.

At the time of our inspection, there had been no registered manager in post since September 2015. 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.

However, an acting manager had been recruited and had started in post one week prior to this inspection taking place. The service had also recruited a general manager to oversee all of their services and had been in post since September 2015.

The service did not have procedures in place to ensure medicines were managed safely and we could not be sure that people received their medicines as prescribed. Good practice was not being followed in all areas. Although the individual risks to the people who used the service were well managed, the risk assessments associated with the premises and environment were in need of updating. This put people at potential risk.

The service had a quality monitoring system in place that was not effective in all areas. The system had failed to identify issues relating to the safe management of medicines. The need for environmental risk assessments had been identified and actions put in place to address this however, at the time of the inspection, these were still outstanding.

Processes were in place to ensure that only those suitable to work in health and social care were employed. Staff received an induction and on-going training which included the Care Certificate. Staff felt supported and received regular supervision.

The service encouraged a respectful, friendly and welcoming culture that was mutually supportive. Staff demonstrated professionalism, patience and compassion when interacting with those they supported. Staff, and the people living in the home, were aware of professional boundaries. People had privacy and staff demonstrated that they promoted dignity, choice and independence.

The staff we spoke with understood the types of abuse people could experience and knew how to report any concerns they may have. The service had processes in place to manage any safeguarding issues and contact details for the local safeguarding team were on display.

The CQC is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. The service demonstrated that they worked within the principles of the MCA. Staff had received training in this and could give us basic information on how they were applied. No DoLS were in place and the people who used the service had support and encouragement to make their own decisions.

People and, where appropriate, their relatives, had been involved in planning the support they required. Support plans were in place that were detailed and individual to each person. They were not always accurate however staff demonstrated that they knew the support needs, likes, dislikes and preferences of those they supported. People told us their needs were met and the relatives we spoke with agreed.

Although the service had identified, and was addressing, that more support was required around assisting people to access activities, people told us they were happy with the engagement they had in the community. We did note, however, that the service had not acted upon a repeated request from one person to attend a particular activity.

People’s nutritional needs were met and the service monitored people’s food and drink intake to ensure their wellbeing. Additional monitoring had been implemented as required for each person. People had access to healthcare professionals as required and staff supported people to attend appointments. Robust recording was in place regarding this that identified the treatment each person had received, any actions required and any follow up treatment needed.

Although the staff and management team had recently been unstable, it had not impacted on the level of service that people received or the morale of staff. Relatives told us that the service had managed all the changes well and that people had been kept informed. Staff told us morale was good and that the team was supportive of each other with an open and honest approach.

We spoke to all of the people who were using this service and the feedback received was positive. One person told us, 'I would pass it with flying colours [in terms of our inspection]; it is the best place I have been'. Another person told us, 'I get the support I need and the staff are kind to me'. A third person responded 'yes' when asked if they liked living at Honeysuckle Cottage.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

Appropriate checks were undertaken before staff began their employment at this home.

There was an effective complaints system available and comments and complaints people made were responded to appropriately.