Henrietta House

Henrietta House provides residential care for up to 25 older people with physical disabilities and those who may be living with dementia. At the time of our inspection there were 22 people using the service.

Accommodation is provided over the ground and two upper floors with various lounges, a dining room, and an accessible garden.

People’s experience of using this service and what we found

People felt safe. Staff had been provided with training to enable them to recognise signs and symptoms of abuse and they knew how to report any concerns. People had risk assessments in place to enable them to maintain their independence and keep them safe.

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

Sufficient numbers of staff with the appropriate skill mix were available to support people with their needs. Staff knew people well and were able to support them appropriately when they became distressed or anxious. Effective recruitment procedures were in place to ensure suitable staff were employed to work with people using the service.

People were protected from the spread of infection; the service was clean, and staff wore personal protective equipment when needed.

There were positive relationships with health professionals which supported people’s overall wellbeing. Medicine was administered safely and there were clear protocols in place for medicine which was taken when required.

There was a culture of openness, transparency and inclusion amongst staff and people using the service. We observed positive interactions throughout the day. A variety of quality audits were carried out, which were used to drive continuous improvement which was used to good effect in supporting people and staff to express their views about the delivery of care.

Staff received appropriate training, supervision, and support to enable them to carry out their roles and responsibilities effectively. Staff felt well supported and said the registered managers door was always open. The service worked in partnership with outside agencies.

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 14 December 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 and Well-led.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained Good based on the findings of this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

¿ The provider had introduced additional quality assurance processes to ensure robust infection prevention control practises were applied in the home.

¿ We observed staff wearing and disposing of personal protective equipment (PPE) correctly.

¿ The provider used findings from audits to make improvements within the environment and plan refurbishments.

¿ Assurance had been sought that bank staff did not work elsewhere and were included in the weekly COVID-19 testing of staff.

At the last inspection in August 2015 the service was rated good. At this inspection we found the service remained good.

People and their relatives told us that people were safe living in the service. Risks to people were assessed, and any risks identified were mitigated and reduced where possible. There were sufficient numbers of staff with the right skills and abilities to support people when they needed it.

Staff were inducted to the service when they commenced their employment and received appropriate training and support to enable them to carry out their roles effectively.

Staff were aware of the mental Capacity Act 2005 (MCA) principles and were meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). People were encouraged and supported to make choices and retain as much control of their lives as possible. People were supported to eat and drink sufficient amounts to maintain their health and were supported to access health care professionals to meet their individual health needs.

People who used the service were treated in a kind and caring way by staff who respected their privacy and maintained their dignity. People, their relatives and professionals were given the opportunity to give feedback on the service and their views and opinions were taken into account.

People received individualised care that was personal to them. People were given appropriate support and encouragement to access meaningful activities that were of interest to them.

People and their relatives told us that they knew how to raise concerns if they needed to and were confident these would be listened and any concerns would be addressed.

The registered manager had robust quality assurance systems in place and where shortfalls were identified they were promptly acted upon to improve the service. The registered manager had developed an open, transparent and inclusive culture within the service. People and their relatives gave consistently positive feedback about all aspects of the service.

Further information is in the detailed findings below.

Below is a summary of what we found.

The summary is based on our observations during the inspection, speaking with people who used the service and their relatives, the staff supporting them and from looking at records.

The detailed evidence supporting our summary can be read in our full report.

Is it safe?

People were protected from the risk of abuse because there were clear procedures in place to recognise and respond to abuse and staff were trained in how to follow the procedures. The people we spoke with told us they felt safe in the home. One person said, 'Yes I feel safe, I like it here. The staff are all so nice and they really care for me.'

Where people lacked capacity to make a decision, we saw that the service was adhering to the Mental Capacity Act 2005 and appropriate assessments of capacity and best interests' documentation were in place. We saw that people were supported to take informed risks. We found the location to be meeting the requirements of the Deprivation of Liberty Safeguards.

Is it effective?

We found there were arrangements in place to involve people in the assessment of their needs through discussions. We saw where people had signed their care plans after discussing their care and support. This meant steps were taken to involve people in making decisions about their care and support.

Care plans gave details of people's preferences in relation to the way they liked to be cared for and supported. Staff we spoke with had a good understanding of people's likes and dislikes and how they would prefer to be supported.

Records showed that people's health was regularly monitored and when people's needs changed, staff made the appropriate referrals and made changes to care plans to reflect the needs of the person. This meant staff recognised when the needs of people changed and sought advice from the appropriate health professionals.

Is it caring?

We observed interactions between staff and people using the service on the day of our visit. We saw staff engage positively with people, showing them kindness and respect and treating them with dignity.

Staff had a good understanding and knowledge of people's needs and preferences and we saw that diversity monitoring took place on admission to explore individual needs and preferences such as culture and sexuality.

We spoke with a member of staff who had a clear understanding of the role they played in ensuring people were treated with dignity and respect. Policies and procedures were in place to support this.

People had regular discussions with staff to discuss activities and raise concerns and any issues that they may have. An annual questionnaire was also sent to people using the service, relatives and health and social care professionals with regular contact with the service. This meant people were supported to make their views known about the service.

Is it responsive?

We saw that where people lacked capacity, appropriate assessments of capacity and best interests' documentation were completed. Advocacy details were available for people who used the service. This meant that the service considered people's capacity and the support they may need if they lacked the capacity to make a decision.

Staff were observed responding to people who had expressed something that was important to them. Staff knew that details of what was important to individuals were documented in their care plan. People were supported to be involved in a wide range of activities.

People knew how to make a concern if they had one. None of the people we spoke with had any concerns they wished to raise. There was a clear procedure on what action would be taken if people made a complaint. The manager told us there had not been any recent complaints made by people living in the home or by their significant others. Staff were able to explain how they would respond to a complaint.

Is it well- led?

We looked at the processes in place for monitoring incidents, accidents and safeguarding. These were well managed with clear accountability throughout the organisation on how to learn from these.

There were effective procedures in place to monitor and improve the quality of the service provided. People's views on the service were sought and were responded to. The service carried out a number of checks to ensure that people's needs were being met.

Staff were organised in their day to day work and they had a clear direction of how they were to meet the needs of people. Staff we spoke with recognised the visions and values of the home and their role in that. They were provided with the right training and support to ensure they had the skills and knowledge they needed.

Systems were in place to ensure there were sufficient numbers of staff to meet people's needs. We saw that when people needed support or assistance from staff there was always a member of staff available to give this support. The people living in the home and staff we spoke with all told us they felt there were enough staff to support people safely. The registered manager told us that any staff absence was covered by staff directly employed by the service. No agency staff were needed.

We saw there were plans in place for emergency situations such as an outbreak of fire. Staff understood their role in relation to these plans and had been trained to deal with them.

We observed positive interactions between staff and people living in the home, and saw that staff understood the needs of the people they were supporting. Those we spoke with who lived at the home, told us they were happy living there. One person said, "I have been here for a while now. I really like it and have no complaints." Another person told us, "It's nice living here, I am happy with the care. I think the staff are all very good."

We observed staff were polite and respectful of people and involved them in making decisions about their support, and how they spent their time. One person told us, "I always have a lot of choice, about the food I eat and the care that I have from staff. It is nice to be included."

We looked at people's care records and found these to be regularly reviewed and relevant for people's assessed needs. We looked at the staffing systems in place, including staffing numbers, and the training and support provided for staff. We saw evidence that the number of staff on duty was sufficient to meet the needs of people living at Henrietta House.

We found that records were updated on a regular basis and stored appropriately, ensuring that both staff and people's confidentiality was respected.

We observed a friendly, welcoming atmosphere with the home, conveyed by all staff members. We found evidence of respectful, dignified care throughout our visit, and that people were encouraged to be as independent as possible, in line with their needs.

We saw evidence that people and their family members were involved with care decisions and all relatives we spoke with told us they felt supported by the manager and staff within the home. Several of the relatives we spoke with told us they were treated 'as part of the family' and felt very reassured by the approach of the manager and staff towards them and their family member.

We found evidence of robust quality monitoring processes in place to ensure peoples' needs were assessed and met and risks to people were minimised.