HF Trust - Gaston House & Dolphin House

Updated 8 February 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

One inspector carried out this inspection.

Service and service type

HF Trust – Gaston House & Dolphin House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. HF Trust – Gaston House & Dolphin House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post. An interim agency manager had been employed to provide short-term managerial oversight and the provider was actively recruiting a new registered manager at the time of our inspection.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We sought feedback from Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make.

We used all this information to plan our inspection.

During the inspection

We met with all of the people who lived at HF Trust – Gaston House & Dolphin House. We spoke with 1 person and 3 relatives about their experience of the care provided. We spent time observing how staff interacted with people. We spoke with 8 members of staff including 3 support workers, 1 senior support worker, the interim agency manager, the regional area manager, the residential operations manager and the head of service delivery. We also spoke with the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of records. This included information contained in 2 people's care records and samples of medicine and daily records. We also looked at 1 staff recruitment file and records related to the management and quality assurance of the service.

Updated 8 February 2023

About the service

HF Trust – Gaston House & Dolphin House is a residential care home providing accommodation for up to 9 people who require personal care and have a diagnosis of a learning disability and/or autism. The location consists of 2 separate houses, Gaston House which can accommodate 5 people and Dolphin House which can accommodate 4 people. At the time of our inspection, Dolphin House was closed, and 5 people lived in Gaston House.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. 'Right Support, Right Care, Right Culture' is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

People did not always receive person centred care in line with Right Care, Right Support, Right Culture.

Right Support: Although staff knew people well and made attempts to engage people in their hobbies and interests, there was little direction for staff on what they should do each day to promote people’s emotional and social well-being. Meaningful activities were completed on an ad-hoc basis rather than being planned as a regular part of people’s lives. Where people had been allocated one to one staff support to complete meaningful activities, people had not always received this support. When people were supported to pursue social interests within the community, they often had to rely on other people wanting to do the same thing and went out in pairs or as a group. People's goals and aspirations were not always identified with people or those involved in their care.

People were not always supported to have maximum choice and control of their lives, but staff supported them in the least restrictive way possible and in their best interests; the providers policies and systems supported best practice, but these were not always followed by staff.

Right Care: Overall, people received care from a consistent staff team which had the best interests of people at heart. However, there was limited consideration given to the varying ways people could be empowered to make everyday choices using different communication methods. Where people required additional aids to promote their ability to communicate, these were not always used or known by staff.

Right Culture: There had been significant changes in both the internal managers and senior managers within the provider group. Systems were not always operated effectively to identify if people were receiving person centred care in line with Right Care, Right Support, Right Culture.

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 2 October 2018).

Why we inspected

We received concerns in relation to health and safety procedures and good governance. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. Please see the safe, responsive and well-led sections of this full report.

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

Enforcement

We have identified a breach in relation to good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.