Hawthorn House is a residential care home for up to 29 people with a learning disability. Care is provided from two separate two storey buildings. On the day of our inspection 18 people were living in the home. The care service had not originally 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. However, it was clear that people were given choices and their independence and participation within the local community was being encouraged.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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At this unannounced inspection on 21 November 2018 we found the service remained Good.

People were cared for by a sufficient number of staff who were suitably checked prior to commencing work. Staff understood people’s risks and how to protect them from harm and poor care. People received their prescribed medicines from staff who had been trained and whose competency to deliver medicines safely was observed. Staff followed infection control practices to protect people.

People were 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 supported this practice. Staff received training and support to provide care effectively. People were provided with a variety of foods, presented in a way that met their needs and plentiful drinks to maintain their wellbeing. People were supported by health care professionals to sustain their health.

Staff provided kind, considerate and compassionate care which recognised people’s right to privacy, upheld their dignity and promoted their independence. People were supported to maintain the relationships which were important to them.

Care plans provided an accurate reflection of people’s care which was reviewed, with their relatives if preferred, on a regular basis. There were activities arranged for people to take part in whilst they were at home, day trips for them to enjoy and support for people with specific interests.

There were arrangements in place to communicate with staff and relatives with opportunities for them to feedback their opinions. There was an audit process in place to measure the quality of the service provided. The registered manager was complying with the requirements of their role.

Further information is in the detailed findings below

We inspected this service on 3 February 2016. This was an unannounced inspection. At our previous inspection on 19 August 2014 the provider was meeting all of the legal requirements we inspected.

Hawthorn House provides care and support for up to 29 people with a learning disability.

There was 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 were protected from unnecessary harm because staff knew how to recognise abuse and understood how to report their concerns. People’s risks associated with their care were identified, assessed and managed to keep them safe. People were supported by a sufficient number of suitably recruited staff who received training and support to care for people safely and effectively. People received their medicines in the correct way at the right time to keep them well.

Staff understood the importance of gaining consent from people and supporting people when necessary to make decisions in their best interest. People had access to advocacy services to provide them with additional support.

People were provided with a sociable mealtime experience and received a varied diet and plentiful drinks to maintain their health. People had access to health care professionals when they needed additional support to maintain their physical, mental and psychological wellbeing.

People were supported by kind and caring staff who recognised their individuality. People’s privacy was respected and staff recognised when people needed assistance to maintain their appearance to promote their dignity. Visitors were welcomed at any time which meant people could maintain the relationships which were important to them.

Staff knew people well and provided care which met their preferences. People were encouraged to personalise their bedroom and staff supported them to enjoy outings associated with their hobbies. People were provided with choices and opportunities to socialise together during activities in the home and maintain links with the community.

There was a complaints procedure which ensured that any concerns raised by people or their relatives were investigated and responded to appropriately.

People, their relatives and staff felt the service was well managed by the provider and registered manager. The registered manager and staff listened to people’s opinions and tailored their care to reflect their choices. Audits and checks were in place to monitor the quality of the service and make improvements where needed.

This inspection was carried out by a CQC inspector. We spoke with eight people who used the service, two relatives, six members of staff and the senior care manager. We also reviewed records relating to the management of the service, which included three care records, staffing records, sample menus and quality audits. We used the information to answer five questions we always ask:

Is the service safe?

We saw detailed care records that contained information for staff about people's needs and the support needed to ensure they were safe. Risk assessments identified risks in daily living and the measures in place to reduce those risks. A person at risk of choking had been referred to speech and language specialists for assessment. A person who had frequent falls had been referred to the falls clinic. Information from the assessments had been included in the person's care and treatment plan to ensure their safety.

The provider had a system in place to monitor and review accidents and incidents. Serious incidents were reported in detail and reviewed by managers to see if lessons could be learned to reduce the risks of them happening again.

All care records had been reviewed and updated since our last inspection. This ensured that there was a current profile of risk for each person and staff had the necessary information to keep people safe.

We monitor the operation of the Deprivation of Liberty Safeguards 2009 (DoLS) that apply to hospitals and care homes. No applications had been made to the local authority under this legislation since our last inspection. The service were aware of their responsibility to make applications under this legislation having made previous applications. No DoLS authorisations were in place at the time of our inspection.

Is the service effective?

People's health and care needs had been assessed. Records reflected the correct level of support that people needed. Care records had been reviewed monthly and any changes to individual needs had been reflected in care records and risk assessments.

The GP regularly visited the service. Health checks and medication reviews had been carried out annually. The GP carried out detailed health checks using the Cardiff health check for adults with a learning disability. A copy was in each person's care records. The check is for adults with learning disabilities who may need more health support and who may otherwise have health conditions that go undetected.

Some people were not able to communicate verbally. Staff told us that each person had their own communication style. People communicated with body language, signs, sounds and facial expressions. A communication plan was in place for each person and we observed good communication between staff and people who used the service.

Is the service caring?

We saw that people were well supported by staff. People were cared for in small groups of six people with a minimum of two members of staff. This meant that close and positive relationships were established between people and staff. We saw that everyone was included in the discussions and activities that took place. Staff had a good understanding of what people were feeling and saying and were able to respond to what they needed.

A relative we spoke with told us, "We are delighted with the care that X receives. Staff are sensitive to their needs, they are very, very caring." We saw many similar comments in the questionnaires that had been returned by relatives expressing high levels of satisfaction with the care and support given by staff.

Is the service responsive?

When people's health care needs changed health professionals had been contacted. Their recommendations had been recorded and followed. A relative told us, "They look after X very well who has on-going health care needs. We feel that X has better medical care than most of us in the community."

We saw that suggestions made by staff in team meetings had been acted upon. Staff told us that managers listened to their views and would consider any suggestions they made to change or improve the service.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a coordinated way.

The provider had an effective quality assurance system of checks and audits in place to monitor the quality of the service. We saw that where shortfalls had been identified they had been addressed promptly. As a result the quality of the service was continuously improving.

A relative told us, "Staff keep us informed about any developments relating to X. They listen and respond positively. We know we can speak with the manager at any time."

This was a scheduled unannounced inspection, which meant that the home did not know we were visiting. During this inspection we spoke with people that lived at the home, care staff and the registered manager.

There were 16 people living at the home at the time of our visit all of whom had complex needs and varied levels of communication abilities. We saw that people looked happy and relaxed in the home. One person told us, “I am very happy living here”. Another person said “The carer’s look after me well”.

People were involved in planning their care. They made decisions and choices about how they wanted their care provided. Systems were in place to make sure that people were supported to make decisions about their care and treatment.

We saw that people were supported to have their health and personal care needs met. We observed that staff understood people's individual and personal care needs.

We saw that people had attended health care appointments within the community. Care records we read showed that health and social care professionals outside of the home were involved in ensuring people’s care needs were met.

We saw that the medication audit tool used by the home did not show what medicine practices had been monitored with the outcomes to confirm that safe practices were maintained.

We saw that improvements were needed to ensure that people's care records accurately reflected the care and support care staff provided.

Our inspection was unannounced which meant that no one knew would be visiting. There were 16 people living at Hawthorn House on the day of our visit. We spoke with one of the people who lived there, staff on duty and the registered manager. We found that staff understood people’s individual and personal needs. We saw that staff treated people kindly and respectfully. We saw that people were relaxed and at ease with staff within their home environment.

Information we read from relatives told us, “We are more than happy with the excellent care ‘X’ receives at the home”.

We looked at the care records for two of the people living at the home to see how their care was provided and managed. We talked with two care staff who demonstrated they were aware of people's care and support needs. Staff said they had received training to help them understand how to meet the needs of people in their care.

Information we read showed that people were supported to make choices in their daily lives. These included for example attending a day centre, shopping and eating out. If the person did not want to take part in a planned event or go out their wishes were respected.

We read documents that showed that the provider regularly audited the service people received at Hawthorn House. These included monthly unannounced visits to the premises by a representative from Staffordshire County Council.

We carried out this inspection because we had not visited the service (home) since 2008 and we did not have enough information to assess compliance. We wanted to see what life was like for the people who lived in the home. We also wanted to see whether the service had made any improvements since we last visited.

During this inspection visit we looked at outcomes four and sixteen of the essential standards of quality and safety, under the regulations of the Health and Social Care Act 2008. Outcome four looks at the care and welfare needs of people using the service. Outcome sixteen looks at how the service assesses and monitors the quality of the services that people receive.

The visit was unannounced. This means that the service did not know that we were coming.

The service accommodates up to 29 people with learning disabilities. At the time of our visit there were 16 people living in the home. The providers (Staffordshire County Council) were planning to close the home and find appropriate alternative provision for people as part of their modernisation programme. Families and representatives of people living in the home had been kept fully updated and the manager told us that there had been many meetings held in respect of this. As a result, the manager told us the service was not accepting any new admissions to the home although there was always the possibility of taking an emergency admission. Relatives we spoke with told us that they had been kept informed about progress with this but were never the less worried and said, “Why must an excellent home like this close?”

The manager and staff knew each person well and understood their needs, choices and preferences. Each person had an effective care plan in place which ensured that their specific needs were met.

During our visit we spoke with the manager and two of the support staff. The staff team was consistent, skilled and experienced and delivered a high standard of care and support to people.

After our visit to the service we spoke with two professional people who visited the home regularly. We also spoke with some of the relatives of people who live in the home. Everyone we spoke with was extremely complimentary about the care and services the home was providing.