This inspection took place on 7 June 2017 and was unannounced.

Hambleton House provides accommodation for up to 16 people with learning disabilities who require personal care and support. At the time of our inspection there were 16 people using the service.

When we inspected the service in May 2015 it was rated as requires improvement because we found breaches of legal requirements. At the focused inspection in December 2015 we found the service had made the required improvements and was rated as Good.

At this inspection we found the service remained Good.

People told us that staff promoted their safety, wellbeing and independence. Staff understood their responsibility to protect people from the risk of abuse.

Risks were managed so that people were protected from avoidable harm whilst promoting their choices and independence. People lived in a clean and well maintained service.

Safe medicines and infection control practices were followed by staff. People received sufficient to eat and drink.

Staff were recruited through safe recruitment practices. They received appropriate induction, ongoing training and supervision to provide effective care and support. Sufficient numbers of staff were on duty to meet people’s needs both at home and to access the wider community.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. We found the policies and systems in the service supported this practice.

People received personalised care that was responsive to their needs. Care records contained information to support staff to meet people’s individual needs.

People’s diverse, cultural and lifestyle choices were respected. People maintained contact with family and friends and took part in social events, activities that were of interest to them and employment.

People’s privacy and dignity was respected. Staff’s approach was caring. Staff worked closely with people to promote their independence and their individual goals. Continuous review of people’s care meant they were able to respond to any changing needs.

People’s rights were protected and respected. A complaint process was in place and staff knew how to respond to complaints. Advocacy support was made available to people.

At the time of the inspection the manager had begun the process of being registered with CQC. They along with the care manager provided leadership and guidance to staff to ensure people received safe care and support that promoted their wellbeing and independence. Staff were confident that any suggestions made and concerns raised would be listened to and action would be taken.

Following our inspection visit the manager had successfully completed the registration process to become the registered manager.

The provider was meeting their regulatory responsibilities. People had a range of opportunities to be involved in the development of the service. There were effective systems in place to monitor and improve the quality of the service provided.

We carried out an unannounced comprehensive inspection of this service on 11 and 12 May 2015. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation the breaches. Those related to how people’s needs were assessed and the management of risks associated with aspects of their health and wellbeing, improvements to the staffing numbers and deployment of staff, the premises and the use of the provider’s quality assurance system

We undertook this focused inspection of this service on 4 December 2015 which was unannounced. The focus of the inspection was to check that they had followed their plan of action and to confirm that they now met legal requirements. This report only covers our findings in relation to the requirements and information gathered as part of the inspection. You can read the report from our last comprehensive inspection, by selecting ‘all reports’ link for Hambleton House on our website at www.cqc.org.uk

Hambleton House is a care home that provides residential care for up to 16 people with learning disabilities. At the time of our inspection there were 14 people in residence.

A registered manager was 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.

We found that the provider had taken action and made the required improvements to meet the legal requirements in relation to the breaches.

People were supported by knowledgeable staff who understood people’s individual and diverse needs and how to support them to keep them safe. People’s care needs were assessed including risks to their health and safety. The plans of care provided staff with the information they needed to manage those risks, which helped them to keep people safe.

People told us there were enough staff on duty to meet their needs and to enable them to go out with staff support, when needed, and to access local services. Staff were trained, supported and had clear roles and responsibilities in promoting people’s independence and wellbeing.

We found repairs had been carried out to the premises. The premises were clean and regular checks were carried out to ensure the environment was maintained to protect people’s safety.

The provider’s quality governance and assurance systems were used effectively to ensure people’s health, safety and welfare. Regular internal audits were carried out and information gathered from those including views from people who used the service and staff were used to continually develop the service.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

We spoke with four people who used the service. Three of them spoke to us enthusiastically about improvements that had been made by the provider since our last inspection in November 2013. Two said, "It's better now." Another person told us, "I'm very happy. We have better choices."

The provider had taken action that helped people increase their knowledge and develop skills. People who used the service had attended a training session about food hygiene and nutrition. People now took a more active role in making their own meals and took more responsibility for helping keep their room and communal areas tidy. Those were important skills for people who were aiming to eventually move to their own flats in a supported living environment. The provider had also made it easier for people to manage their own money.

Staff we spoke with also told us that the home had improved. Staff had received training that had helped them understand and put into practice person centred care. They had received other training that had equipped them to carry out their roles more effectively.

We found that the provider had responded positively to our last inspection and had brought about necessary improvements.

When we inspected the service in May 2013 we required the provider to make improvements in six key areas. The provider sent us an action plan and we allowed time for that plan to be successfully implemented. At this inspection we found that very little had changed and improvements were still required.

We found that despite people having capacity to make decisions themselves people had become highly dependent on staff. People had not been helped to develop everyday living skills such as making their own drinks or helping with preparation of meals. One person told us, "I would like to help with cooking. I've been on a cookery course, I like cooking” but they had not been supported to develop their skills at the home. Another person had wanted to progress to living in their own flat, but we found no evidence of how the service had supported them towards that aim.

People told us that they enjoyed the food at the home. However, one person told us, "I'd like lamb chops or steak occasionally but I'd be surprised if I could have it." People had a choice of food but choices did not include healthy eating options or more nutritious food.

All of the people who used the service had been assessed as having capacity to make decisions about their finances. However, not all people had direct access to their money. The registered manager told us that this was for people's protection but we saw no evidence that there had been meetings to decide a person's best interests or that the provider had power of attorney over a person's finances.

The provider had a recruitment policy but it had not been followed. In one instance an applicant had been allowed to start work without proper references.

Not all staff had received training in key important subjects such as the Mental Capacity Act 2005.

The provider had not carried out effective monitoring of the quality of service provided.

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We spoke with 11 of the 17 people who used the service. All of the people we spoke with expressed that they enjoyed living at the home and that they felt well supported by the staff. People told us that they could spend their time as they wanted. One person told us, "There has never been a time when I have not been able to do what I wanted to do."

People who used the service had been involved in recent reviews of their care plans. People had been involved in deciding whether they wanted to go on a week long holiday in May 2013 and where to go. One person who initially decided, in January 2013, that they didn't want to go on holiday then decided they wanted to go. They told us, "I wanted to go but they wouldn't take me."

People were complimentary about the meals they had at the home. One person told us, "they cook nice food." Another person told us, "Staff bring me drinks whenever I want." However, people did not always know what they would be having at meal times. One person told us, "Sometimes we are asked what we want, other times not." Another person told us, "We are usually asked what we want for tea." Another person told us, "Tea is what we get put in front of us." When we spoke to five people in a group and asked, at 1.45pm, if they knew what they would be having for tea all responded that they did not know. We found that the home did not have an effective means of offering people food choice.

People told us that they liked living at the home. People told us that staff were kind and that staff listened to them. People liked that they had a variety of meaningful activities to participate in if they wanted to. We found that people had been supported to enjoy their hobbies and interests at the home and in the community. People were positive about their experience of the home. However, people's care plan documentation contained very limited evidence that people's needs had been re-assessed, planned and delivered

People told us that they were happy living at Hambleton House. They told us that they felt safe there and they were able to decide what they wanted to do and where they wanted to spend there time. One person told us that they liked watching the television, whilst another person told us that they enjoyed looking at their books.

Other people spoken with told us, “I’m alright here, I’ve been here a long time, I go to the football, I really like it”. “I’ve got nothing to worry about".

People told us that they were treated well, one person explained, “Its alright here, the staff are nice and I am treated well and I feel safe now”. Another person told us, “They treat you very well; they don’t make you feel at all uncomfortable”.

People told us that they felt safe living at Hambleton House, one person told us, “I feel safe now”, another person added, “I feel safe, if I was worried about anything I would talk to the staff, there’s always someone you can talk too”.

People told us that they felt that there were enough staff around and they were able to enjoy different activities, one person told us, “I’m going down the supermarket today”, whilst another person explained, “they take me out to do some shopping, they look after me”.

People told us that they were asked their thoughts on the service they received, one person explained, “We have meetings, they ask us, how do you feel and ask what we want to do” another person told us, “We have meetings to talk about holidays and talk about work, we’re going on holiday soon!”

This inspection took place on 11 May 2015 and was unannounced. We returned on the 12 May 2015 announced.

Hambleton House is a care home that provides residential care for up to 16 people with learning disabilities who require personal care.  At the time of our inspection there were 15 people in residence.

A registered manager was 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.

We found the premises had not been well maintained, clean or safe. There were also issues with the management of infection prevention and control. Actions and improvements were not made in a timely manner to remedy issues identified through the provider’s internal audits and external inspections carried out by the fire officer and environmental health officer. That meant improvements were needed to ensure people lived in service that was safe and clean to ensure their health and welfare was protected.

People’s care needs were assessed including risks to their health and safety. Where appropriate, referrals were made to the relevant health care professionals in order to manage those risks safely. However, we found that staff were not always aware of the guidance provided by the professionals because the care plans did not include the information or staff were not available at that time. That meant people could not be assured that their care needs and risks to their health and wellbeing were managed consistently or safely.  

The registered manager understood their responsibilities and they acknowledged the need for improvements to the service The provider’s policies and procedures did not give clear guidance as to the actions staff should take in relation to identifying and managing risks to people. The provider’s quality governance and assurance systems were not used effectively and consistently to ensure people’s health, safety and welfare.

People told us they felt safe at Hambleton House and we found that staff had a good understanding of safeguarding (protecting people from abuse).

Medicines were stored safely and people received their medicines at the right time. Further action was needed to ensure staff were aware the safe temperatures for medicines that needed to be refrigerated and follow the procedure for recording of the medicines that needed to be tightly controlled.

People’s told us that their care needs were met although there were times when staff were not available when people needed support to go out or to minimise the risks to people’s health and wellbeing. There was no clear system to determine the numbers of staff that were required to meet the care and support needs of people who used the service.

Staff were recruited in accordance with the provider’s recruitment procedures. People who used the service were encouraged to be involved in staff recruitment process which ensured staff were qualified and suitable to work with people.

Staff received an induction when they commenced work but the completion of their induction training was not always monitored. Although staff were confident in the delivery of care, the staff training matrix showed gaps in the training of staff. The systems for monitoring and planning of staff training was not used effectively to ensure staff’s on-going training, skills and knowledge was kept up to date.

Staff felt supported by the registered manager and provider. Although staff supervisions and appraisals were not up to date, staff felt supported and confident to approach staff to discuss any concerns that they had. The registered manager had started to conduct staff supervisions and planned to ensure staff team received timely support.

People were protected under the Mental Capacity Act and Deprivation of Liberty Safeguards. The registered manager and some staff understood their role in supporting people to maintain control and make decisions which affected their daily lives. Referrals, where appropriate, had been made to supervisory bodies where people did not have capacity to make decisions or restrictions were placed upon them.

People were provided with a choice of meals that met their dietary needs. People had access to appropriate health support and referrals were made to relevant health care professionals where there were concerns about people’s health.

People had opportunities to pursue their interests and hobbies including observing their faith Staff were knowledgeable of people’s interests, preferences and some were supported to access educational training and voluntary work. People had been on holidays and outings. However, they and the staff felt more opportunities could be provided to support and promote people’s independence and in the development of their life skills.

People told us that they were treated with care and that staff were helpful.

We observed staff respected people’s dignity when they needed assistance.

People were involved in making decisions about their care. People’s views were sought through satisfaction surveys and at meetings. People were asked about the development of the service and decisions about how their quality of life and service provided could be improved. However, records did not always accurately reflect the discussions and actions that the registered manager needed to take in order for the improvements to be monitored.

People knew how to raise any issues, concerns or to make complaints, and were confident that they would be listened to and issues would be acted on

appropriately. Records showed complaints received were addressed.

Staff knew they could make comments or raise concerns with the management team about the way the service was run and knew it would be acted on.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.