Haydock House

¿ People were protected by strong and inclusive safety systems, with a focus on openness, transparency and learning. There were systems in place to make sure the service was safe, with very good staffing levels and highly skilled staff to deliver good quality care. Risks to people were fully assessed and exceptionally well managed. People were supported to take positive risks, to make sure they had greater choice and control of their lives. The positive risk-taking approach showed that staff respected people's right for independence and their right to take risks.

¿ People were fully involved and supported to safely recruit staff to work at the service. This ensured that successful applicants had the right values and skills to match the values that were at the heart of the service.

¿ The staff and the management team were passionate about providing people with support that was based on their individual needs, goals and aspirations. We saw that people were at the centre of their care and each person was treated as an individual. As a result, their care was tailored to meet their exact needs. The staff at Haydock House were committed to making sure people lived fulfilling lives and were protected from social isolation. People were well supported to make their own choices and staff were highly motivated with a 'can do' approach which meant they were able to achieve positive outcomes for people. People received care and treatment that was delivered in line with up to date best- practice guidelines in relation to Prada Willi Syndrome.

¿ Without exception, people spoke positively about their experience of the service and the successes they had been supported to achieve. It was clear the culture within the service valued the uniqueness of all individuals who lived there.

¿ There were excellent systems in place to monitor the quality of the care provided and to ensure the values; aims and objectives of the service were met. There was a high level of satisfaction with the service and people were well supported to express their views so improvements could be made. There was strong leadership that put people first and set high expectations for staff. We found an open ethos with a clear vision and values, which were put into practice by staff, who were proud to work for the service and felt valued for their work. A positive culture was demonstrated by the attitudes of staff and management when we talked with them about how they supported people.

¿ Staff were trained in infection control, and had the appropriate personal protective equipment to perform their roles safely. There were robust arrangements in place for the service to make sure that action was taken and lessons learned when things went wrong, to improve safety across the service

¿ People’s needs and choices were assessed and their care provided in line with their preferences. Staff received an induction process when they first commenced work at the service and received on-going training to ensure they could provide care based on current practice when supporting people. Each person's food intake was closely monitored to ensure they maintained a healthy weight in line with best practice guidance in relation to Prader-Willi syndrome. Staff supported people to access health appointments when required, including opticians and doctors, to make sure they received continuing healthcare to meet their needs.

¿ 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. The principles of the Mental Capacity Act (MCA) were followed.

¿ Staff were caring and had built open and honest relationships with people. They were knowledgeable about how best to communicate with people and to advocate for them and ensure their views were heard. People spoke of the family atmosphere at the service and the genuine interest staff took in their wellbeing. There was a strong culture within the service of treating people with dignity and respect and staff spent time getting to know people and their specific needs before they provided them with care and support.

More information is in Detailed Findings below.

Rating at last inspection: Good (report published 20 August 2016).

About the service: Haydock House provides accommodation with personal care for up to eight people. There were six people using the service at the time of our inspection. This is a service that specialises in supporting adults with a range of complex needs and behaviours associated with Prader-Willi Syndrome (PWS). This is a genetic condition that means people with the condition will have an abnormal, insistent desire for food which can make the person eat excessively. This has the potential to result in life threatening obesity.

Why we inspected: This was a planned inspection based on the rating at the last inspection. At our last inspection we rated the service Good. At this inspection we found the service had improved to outstanding under safe and well-led domains. The overall rating for this service is Outstanding.

Follow up: We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Haydock House provides accommodation with personal care for up to eight people. There were seven people in residence when we inspected. This is a service that specialises in supporting adults with a range of complex needs and behaviours associated with Prader-Willi Syndrome (PWS). This is a genetic condition that predominantly manifests with early years onset of hyperphagia which is an abnormal unrelenting great desire for food driving the person towards excessive eating and, left unchecked, life threatening obesity. Other characteristics of PWS include, for example, learning disabilities that may range in severity, and challenging behaviours are a feature of PWS whether or not the person has a measured learning disability.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 cared for by sufficient numbers of care staff that were experienced and had received the specialised training they needed to do their job safely when supporting people with PWS. The care staff team as a whole were very capable and understood and acted upon the complex care support needs of each person. They were able to maintain a safe environment for people to sustain excellent practice that enabled people to meet the challenge of managing their PWS and live rewarding, healthy lives.

People's care needs had been comprehensively assessed prior to admission. They each had an agreed care plan with goals they saw through to fruition with the support of their ‘keyworker’, the care staff team, and in no small measure the positive drive of the organisation to empower the individual to achieve life enhancing results through their own efforts.

People were enabled to do things for themselves by friendly, highly motivated care staff that were attentive to each person's individual needs and understood their capabilities and the day-to-day and long term challenges people had to contend with because of PWS.

People's individual preferences for the way they liked to receive their support were respected. There were formal systems in place to assess people's capacity for decision making under the Mental Capacity Act 2005. Care staff were mindful that people with PWS experienced heightened anxieties that had a negative impact on their quality of life if day-to-day living lacked boundaries that people understood had a positive impact on their wellbeing. Care staff consistently ensured that people experienced a well-structured day that enabled individuals to thrive.

People's healthcare needs were met and they received timely treatment from other community based healthcare professionals when this was necessary. People's medicines were appropriately and safely managed. Medicines were securely stored and there were suitable arrangements in place for their timely administration.

People's individual nutritional needs were assessed, monitored and met with appropriate guidance from healthcare professionals with expertise in PWS. People had enough to eat and drink, enjoyed their food, and were pleased with the results of their controlled diet and the health and well-being benefits rising to the challenge conferred.

People, their families or significant others, were assured that if they were dissatisfied with the quality of the service they would be listened to and that appropriate action would be taken to try to resolve matters to their satisfaction.

People received care from care staff that were supported and motivated by the provider and management team to do more than just keep people safe. The goal of the provider was to enable people with PWS to make positive life changes and the success of the care staff team was to support each individual to achieve this through the person’s own efforts.

We spoke with the relatives of two people. They all told us that they had been fully satisfied with the care their relatives received.

One relative said; 'I am delighted with my sons progress in the home. Staff are very pleasant'.

We observed the relationship between staff and people who lived in the home. This was friendly and helpful.

This was a positive inspection. People we spoke with told us they were satisfied with the care provided. All the relatives we spoke with also said that they had no concerns. The essential standards we inspected were found to have been met.

There was one suggestion made; for head office to reinstate people's holiday entitlement. The previous arrangement was that people were able to afford to go on long holidays without the new requirement for them to pay for staff input.

A person told us that her key worker always had time for her. 'All the staff are good. They would help you with anything'.

We spoke with six relatives. They all told us that the care staff provided was of a high standard and they had no concerns about the quality of care that staff had provided.

One relative said; 'The care there is excellent 'Another relative said; 'My son is very happy there. He always looks forward to going back '.

We received a comment that there was too much paperwork for staff to complete. This took them away from their main job of providing quality one-to-one care to people. The manager stated that action had been taken to try and lessen the burden of paperwork. Management may wish to note that the company should look at reviewing this issue to ensure that staff can spend as much time as possible with people.

This was a positive inspection. People living in the home stated that they were satisfied with the care they were given. Their next of kin were also satisfied with the service. All essential standards inspected were met.