Hamilton House is a care home which supports people who have a learning disability. We inspected this service on 13 February 2018. This inspection was unannounced, which means they did not know we were coming.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

People in care homes receive accommodation and nursing or 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. Hamilton House accommodates six people in one adapted building. There were five people who were living at the home on the day of our visit.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. We found the provider followed these values to ensure people lived as ordinary life as possible.

People continued to receive safe care as they were supported by staff who knew how to protect them from harm. Staff were aware of people’s individual risks and plans were in place to minimise these while maintaining the person’s independence. Staffing was arranged based on people’s individual needs and what activities were happening in the home. Staffing remained flexible to suit the people living at the home.

The registered manager supported staff by arranging training so staff developed the skills to provide care and support to people, which was in-line with best practice. People receive care and support that was in line with their consent. People were supported by staff who knew their individual dietary requirements and how to support them in the right way. People had access to healthcare professionals when they required them.

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

People were treated well which had a positive impact on their well-being. People were supported by staff who were kind and caring towards them. Staff helped people to make choices about their care and the views and decisions they had made about their care were listened and acted upon.

People and where appropriate their family members were involved in the planning and review of their care and support. People were supported to continue with their hobbies and interests and further activities were being put into place which reflected people’s individual interests. Information was provided to people should they wish to raise a complaint.

The registered manager had worked at the service for three months prior to this inspection. They were in the process of registering with us at the time of inspection, during the writing of this report that manager is now registered with the CQC.

There were opportunities for people and relatives to feedback their views about their care and this was used to improve the service. Staff were supported to carry out their roles and responsibilities effectively, so that people received care and support in-line with their needs and wishes. The provider had systems were in place to monitor and assess the quality and safety of the care provided. These checks focused on people’s experience of care. Where areas for improvement were identified, systems were in place to ensure lessons were learnt and used to improve the service delivery.

Further information is in the detailed findings below.

This inspection took place on 13 October 2016 and was unannounced. Hamilton House provides accommodation and personal care for up to six people who have a learning disability. There were five people who were living at the home on the day of our visit.

There was no registered manager in place at the time of our inspection. There was a manager in place who was in the process of applying for their registration. 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 lived in a safe environment as staff knew how to protect people from harm. Staff recognised signs of abuse and knew how to report this. Risk assessments were in place and staff took appropriate actions to minimise risks without taking away people’s right to make decisions. There were sufficient staff on duty to meet people’s needs and keep them safe. Regular reviews of people’s care and the deployment of staff meant staffing levels reflected the support needs of people who lived there. People’s medicines were administered and managed in a way that kept people safe.

The provider supported their staff by arranging training and up-skilling staff in areas that were specific to the people who lived in the home. People received care and support that was in-line with their needs and preferences. Staff provided people’s care with their consent and agreement and understood and recognised the importance of this. We found people were supported to eat a healthy balanced diet and with enough fluids to keep them healthy. People had access to healthcare professionals when they required them.

We saw that people were involved in the planning around their care. People’s views and decisions they had made about their care were listened and acted upon. People told us that staff treated them kindly, with dignity and their privacy was respected. People received individual responsive care and support that was in line with their preferences which had a positive outcome for people who used the service.

People and relatives knew how to complain and felt comfortable to do this should they feel they needed to. We looked at the providers complaints over the last 12 months and found that nine complaints had been received. Eight had been responded to with satisfactory outcomes for those who had raised the complaint and one complaint was still being investigated by the provider.

The manager demonstrated clear leadership. Staff were supported to carry out their roles and responsibilities effectively, which meant that people’s received care and support in-line with their needs and wishes.

We found that the checks the provider completed focused upon the experiences people received. Where areas for improvement were identified, systems were in place to ensure that lessons were learnt and used to improve staff practice.

An adult social care inspector carried out this inspection. As part of the inspection we spoke with three people who used the service. We also spoke with the registered manager and three members of staff. We reviewed the records relating to the management of the home. This included four care records, three staff personnel records, policies and procedures, and minutes of meetings.

Hamilton House is registered to provide accommodation for six people who require personal care. On the day of our visit there were five people using the service.

Below is a summary of what we found. The summary describes what people using the service and staff told us, what we observed and the records we looked at. We used the evidence we collected during our inspection to answer five questions.

Is the service safe?

People told us that they felt safe. One person told us, “I always feel safe here”. Individual risk assessments were well completed and actions to minimise the risks identified were reflected in care plans. Service wide risk assessments, together with the actions to reduce those risks, were reviewed regularly.

The provider had effective safeguarding and Mental Capacity Act 2005 policies and procedures. Staff had received training and were clear about their role and responsibilities. The provider was appropriately applying Deprivation of Liberty Safeguards.

The provider had effective recruitment and selection policies and procedures that were applied in practice. All staff had had appropriate pre-employment checks.

Is the service effective?

People's needs were assessed and care plans developed. Care plans reflected both the needs and choices of people. Staff had a good knowledge of people’s care needs.

People were supported to make choices and prepare and cook their own meals. People were supported to improve or maintain their independence.

Policies and procedures were appropriate, up to date, and reflected current research and guidance.

Is the service caring?

People told us that the staff were kind and friendly. One person told us, “The staff are brilliant.” We observed staff treating people in a friendly and caring way. People had individual activity plans. There were sufficient staff on duty in order that people could participate in the activities that were important to them.

Is the service responsive?

People were asked for their views about the service. Monthly surveys were undertaken. Regular resident meetings were held. People were encouraged to make choices about the way the service was provided.

People who used the service and staff were clear about the complaints process. People told us they were confident that any issue raised, or complaint made, would be investigated and acted upon.

Is the service well-led?

People and staff we spoke with told us they felt well supported by the registered manager. Staff said they were able to raise issues with their manager at any time and were confident they would be acted upon. Staff had opportunities to raise and discuss issues at staff meetings and at supervision sessions.

A range of audits were undertaken and the results used to improve the service. Action plans clearly identified who was responsible for implementing any change required. Lessons learnt from incidents were analysed, shared with staff, and actions agreed and monitored.

We were unable to speak with the people that lived there due to the complexity of their health needs. We spoke with one staff, the registered manager and a relative of a person who lived there. We also observed how staff cared for people.

We looked at care plans for three of the people who lived there. They covered a range of needs and had been reviewed regularly to ensure that staff had up to date information. There were also detailed assessments about the person's health so that staff could support people to keep healthy and well. All the staff we spoke with had knowledge of the needs of the people who lived there.

People who lived there were supported to make choices around the care they received. A relative told us: “X is always able to make choices”.

We saw that staff helped and supported people. We saw that people received care that met their individual needs.

We found that medicines had been appropriately stored and administered.

People lived in a clean environment and the provider had reduced the risk of the spread of infection.

We found that there had not been any recent complaints. We found that the provider had a system to follow any complaints until they were resolved.

The person who lived at the home was not able to talk directly with us because of their condition so we used different methods to see whether they received the care and support they needed. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experiences of people who could not talk with us.

Staff treated people with dignity and respect. People were able to make choices relating to their care and how they lived.

Staff knew about the needs of the person they were caring for. We looked at the care plan for the person who lived at the home and found that it contained guidance for staff on how to meet their needs. We saw that the person’s needs were reviewed regularly.

We found that the person who lived at the home was protected from the risk of abuse.

The person who lived at the home was cared for and supported by staff who were suitably trained and supervised. Staff were able to receive training specific to the needs of people they were caring for.

The provider had systems in place to regularly assess and monitor the quality of service that people received.

Hamilton House provides accommodation and personal care for up to six people with learning disability and mental health needs. This inspection took place on 22 and 29 October 2015. The inspection on the 22 October 2015 was unannounced, however, on our arrival there were two sets of external contractors on site. Due to the nature of the people who lived at Hamilton house, it was agreed that having so many unfamiliar people at the home could have a negative impact on people. We made the decision to continue our inspection on the 29 October 2015, where we provided short notice to the provider.

There were five people who were living at Hamilton House on the day of our visit.

At the time of our inspection there was no registered manager in post. The provider was in the process of recruiting a new manager, during this time a manager from the providers organisation had been managing the home for five weeks. 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 did not always live in a safe environment as staff did not always know how to protect people from the risk harm. Staff did not always take actions to minimise risks to people who lived in Hamilton House. We found that people’s medicines were not always managed in a way that protected people from risk of potential harm. The provider had identified medicines management as areas for improvement.

Staff recognised signs of abuse and knew how to report this. Relatives and staff told us there were enough staff to provide care and support to people.

Staff were supported by the deputy manager to use their knowledge and learning from past incidents to carry out their roles effectively so that people received care in the right way. Care and support was provided to people with their consent and agreement. Where it had been deemed that the person did not have the capacity to make decisions on their own behalf the provider had taken steps to ensure the Mental Capacity Act (MCA) had been followed. We found people were supported to eat a healthy balanced diet. We found that people had access to healthcare professionals, such as their doctor or the dentist.

People and their relatives were involved in planning their care. People’s views and decisions they had made about their care were listened and acted upon. We found that staff treated people kindly, with dignity and their privacy was respected.

People were supported to continue their hobbies and interests that was individual to them. The provider actively sought information from people’s family members to gain greater knowledge around people’s personal likes and dislikes.

Information was provided to people in how they could raise a complaint should this be required. Relatives told us that they would know how to make a complaint and felt comfortable to do this should they feel they needed to. Where the provider had received complaints, these had been responded to. While there were no patterns to the complaints, learning had been taken from complaints received and actions were put into place to address these.

People, relatives and staff felt supported by people in management and the provider. They felt that they were listened to. The provider had identified and had begun address shortfalls that they had identified through their checks.