Hemlington Hall is a large detached house set in its own grounds and provides support for up to eight people who have a learning disability. It has en-suite accommodation for six people in the main building. There is further accommodation for two people within a separate annexe. It is located within walking distance to local amenities and local bus routes. There were eight people using the service at the time of inspection.

At the last inspection in February 2015, the service was rated 'Good'. At this inspection we found the service remained 'Good'.

Staff understood the procedure they needed to follow if they suspected abuse might be taking place. Risks to people were identified and plans were put in place to help manage the risk and minimise them occurring. Medicines were managed safely with an effective system in place. Staff competencies, around administering medication, were regularly checked.

There was sufficient staff of duty. On the day of inspection there was one senior and two carers in the main house and three carers supporting people who lived in the annex buildings. Staff were available to provide one to one support and with visits out in the community.

People were supported by a regular team of staff who were knowledgeable about people’s likes, dislikes and preferences. A comprehensive training plan was in place and all staff had completed up to date training. 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. People were able to choose meals of their choice and staff supported people to maintain their health and attend routine health care appointments.

Care plans detailed people’s needs, wishes and preferences and were person-centred. Care plans were reviewed on a regular basis to ensure they contained up to date information that was meeting people’s care needs. People were actively involved in care planning and decision making and this was evident in signed care plans and consent forms. People who used the service had access to a wide range of activities and leisure opportunities. The service had a clear process for handling complaints which the registered manager had followed.

Staff told us they enjoyed working at the service and felt supported by the registered manager. Quality assurance processes were in place and regularly carried out by the registered manager and registered provider, to monitor and improve the quality of the service. The service worked with various health and social care agencies and sought professional advice to ensure individual needs were being met. Feedback was sought from people who used the service through regular ‘resident meetings’. This information was analysed and action plans produced when needed.

Further information is in the detailed findings below:

We inspected Hemlington Hall on 27 February 2015. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.

Hemlington Hall is a large detached house set in it's own grounds. It has en suite accommodation for six people in the main building. There is further accommodation for two people within a separate annexe. Hemlington Hall provides support for up to eight people who have a learning disability.

The home had a registered manager in place who commenced working at the home in February 2014. 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 living at the home required staff to provide support to manage their day-to-day care needs; to develop impulse control; as well as to manage their behaviour and reactions to their emotional experiences. We found that the registered manager had taken appropriate steps to ensure staff reviewed their behaviour; analysed what worked or what didn’t; and provided consistent responses when people’s needs changed to ensure that staff could continue to meet the individual’s needs.

We observed that staff had developed very positive relationships with the people who used the service. We saw that the staff effectively assisted people to manage their anxiety. Interactions between people and staff were warm and supportive. Staff were kind and respectful. People told us that they made decisions about what they did throughout the day.

Staff had received Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards training and understood the requirements of the Act. Where people had difficulty making decisions we saw that staff gently worked with them to work out what they felt was best. We saw that when people lacked the capacity to make decisions staff routinely used the ‘Best Interests’ framework to ensure the support they provided was appropriate. This meant staff worked within the law to support people who may lack capacity to make their own decisions.

People told us they were offered plenty to eat and assisted to select healthy food and drinks which helped to ensure that their nutritional needs were met. We saw that each individual’s preference was catered for and people were supported to manage their weight and nutritional needs.

People’s needs were assessed and care and support was planned and delivered in line with their individual care needs. The care plans contained comprehensive and detailed information about how each person should be supported. We found that risk assessments were very detailed. They contained person specific actions to reduce or prevent the highlighted risk.

We reviewed the systems for the management of medicines and found that people received their medicines safely.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff or relatives to hospital appointments. We found that staff worked well with people’s healthcare professionals such as consultants and community nurses.

People and the staff we spoke with told us that there were enough staff on duty to meet people’s needs. People told us they found the staff worked very hard and were always busy supporting people. The registered manager, a deputy manager, a senior care staff and five care staff were on duty during the day and a senior care staff member on sleep over and two staff were on duty overnight. We found information about people’s needs had been used to determine that this number of staff could meet people’s needs.

Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work. The checks included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

Staff had received a wide range of training, which covered mandatory courses such as basic food hygiene as well as condition specific training such as working with people who lived with Autistic Spectrum Disorders. We found that the provider not only ensured staff received refresher training on all training on an annual basis but offered staff regular access to a wide range of course and educational material.

We found that the building was very clean and well-maintained. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. All relevant infection control procedures were followed by the staff at the home. We saw that audits of infection control practices were completed.

We saw that the provider had a system in place for dealing with people’s concerns and complaints. People we spoke with told us that they knew how to complain and but did not have any concerns about the service.

The provider had developed a range of systems to monitor and improve the quality of the service provided. We saw that the registered manager had implemented these across the service. This had enabled the manager to identify areas for improvement and make the necessary changes. We found that the registered manager constantly critically reviewed the service and looked at what more could be done to make sure people lived fulfilling lives and assist them to reach their full potential. The systems being used were extremely effective and the service was well-led.

One inspector carried out this inspection. During the inspection, we spoke with four people, three staff, the manager and operations manager. No relatives were available at the home during our visit. We looked at three sets of care records and ten staff files. We also observed care practices within the home.

The service had a registered manager in post. The management of the home was good and we saw strong leadership and a positive environment for people and staff. Staff spoke highly of their manager and the support which they received.

Records showed that CQC had been notified, as required by law, of all the incidents in the home that could affect the health safety and welfare of people.

During the inspection, the inspector worked to answer five key questions which are outlined below.

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

Is the service safe?

People told us they felt safe and secure. Good protocols were in place to maintain people’s safety at the home and out in the community. All staff we spoke with were confident about the action they needed to take to keep people safe and were able to describe the procedures which they needed to follow if they became concerned.

The home was clean and well-maintained. We saw that some work needed to be carried out and plans were in place for this.

We found gaps in some of records during our inspection. The manager said they will take action to address this.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand where an application should be made, and how to submit one.

Is the service effective?

Care plans were specific to people and clearly detailed people’s daily routines, how and when to support people and the action needed to be taken to manage people’s risk. Regular reviews of people’s records were in place and detailed the people involved in those reviews.

People had access to a range of health care professionals, some of which visited the home. Staff and / or relatives escorted people to health care appointments. People had information packs available about their health and care needs and took these to appointments with them. This gave professionals unknown to people guidance on how to offer support.

Staff knew the people who they cared for well and were quick to respond to changes. People we spoke with were happy with the care which they received.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People were given the time they needed to make decisions.

Care plans were very detailed and provided the information needed to meet people’s specific care needs.

Staff training was up to date. This meant staff had the necessary skills to provide care and support for people’s specific health and care needs.

Is the service responsive?

Since the new manager took over they had worked hard to respond to the needs of people and staff at the home. They had introduced changes which meant that people and staff were happier living and working at the home.

People had good links with the community and participated in activities specific to their individual care needs. People also participated in activities with each other, both at the home and out in the community. People were supported by staff to participate and attend activities and events which increased their social contact.

Regular care plan reviews were in place, were planned in advance and detailed the people involved in their reviews.

People, relatives and staff knew how to make a complaint if they were unhappy. Staff were knowledgeable about the action which they needed to take if they received a complaint.

Is the service well-led?

The home maintained good links with health and social care professionals. This meant that people received the care and support which they needed.

The new manager had ensured that staff appraisals, supervision and staff meetings were up to date. This meant that staff felt supported and felt able to approach their manager when needed.

People and staff told us that they had confidence in their new manager. Staff felt that they were now working well as a team and morale had increased. Staff were happy with the changes which had been made.

What people said

People who were able to express their views told us they were satisfied with the care and support they received. One person told us, “I am happy here. I like my room.” Two people we spoke with told us about their day and where they had been. People spoke positively about the activities which they had been involved in that day.

Staff spoke positively about the home and the people who they cared for. One staff member told us, “It’s a friendly happy home. We all have a laugh. Staff are very happy.”

During the inspection we spoke with four people who used the service. We also spoke with the manager, a senior carer, three carers and the organisation’s quality assurance manager. People we spoke with told us they liked living at the home and that they were like a family. One person we spoke with told us, “I am very happy here.” Another person told us, "I am going home for Christmas.” Some of the people had limited verbal skills and found it difficult to make direct comments about many aspects of the service therefore we spent time observing the practice.

All the people we spoke with were satisfied with the service they received. We found that people had their needs assessed and that care plans were in place. Staff responded quickly when people needed support and people were provided with the care they needed.

We saw that staff worked in collaboration with other health and social care professionals.

People who used the service were protected from the risk of abuse and told us they felt comfortable and safe with staff.

We found there was a recruitment procedure in place and appropriate checks were carried out on staff before they started work.

The quality of the service was monitored and reviewed on a regular basis.

We found that records within the service were accurate, reviewed regularly and easily accessible to staff, thus ensuring that people received appropriate care and support.

During our last inspection we identified a number of concerns about four of the outcomes we inspected. We carried out this inspection to make sure improvements had been made.

People who used the service had their physical and mental health needs met by staff who had the relevant skills and experience to do so. They were able to engage in activities within the community and within Hemlington Hall. People were protected from inappropriate use of restraint because the advice and guidance of health professionals had been sought and staff were all trained in when restraint should be used.

People who used the service were protected from the risk of abuse because there were systems in place to identify the risks of abuse and manage them correctly.

Staff were up to date with mandatory training and received regular supervision and support from the service managers. This made sure that any concerns about people’s performance were addressed quickly. Staff were supported in their role and encouraged to develop their skills and knowledge.

The service had systems in place to monitor the quality of services provided and where incidents occurred, to learn from them and change practice to ensure the risk of them happening again was minimised. This meant that people were supported by a service that checked the quality of support it delivered and made improvements when these were identified as needed.

People we spoke with told us that they staff were always helpful and supportive. They said that the food was good. One person told us that there was plenty for them to do and they liked going out on day trips. Another person however told us that they didn’t like living at Hemlington Hall because other people who lived there were always causing trouble. They said staff tried to stop the trouble but sometimes it was quite frightening. People said they found it easier to stay in their rooms than use communal areas when this happened.