We inspected this service in December 2015 and rated the home as ‘Good’ overall. At this inspection, on 20 September 2018, we rated the service as ‘Requires Improvement’ overall. This is the first time Hubbard Close has been rated as Requires Improvement. This inspection was announced the day before we visited. This was to ensure a member of staff would be present to let us into the home.

Hubbard Close is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Hubbard Close provides personal care and accommodation for people who have a range of learning disabilities. Hubbard Close can provide care for up to five adults. At the time of this inspection five people were living at the home. Hubbard Close comprises of accommodation over two floors.

The care service has 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.” Registering the Right Support CQC policy.

There was a registered manager in place when we inspected the home. 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’s risk assessments and the care plans created to guide staff about how to manage and respond to certain risks, had not been updated or were not completed fully. A plan to manage a person’s safety in the community was not robust.

The service was not compliant with the Mental Capacity Act 2005. An activity a person engaged with was being controlled by staff. The persons’ ability to agree to this restrictive plan had not been checked. They had not been involved in this plan. The plan was not being reviewed on a regular basis. There were gaps in the recording of some people’s capacity assessments. It was not always clear that these assessments were robust. Even though, these assessments were considering if people could make certain important decisions about their lives.

The provider and registered manager’s audits were not always effective or thorough. At times, these audits did not always consider if people’s experiences could be improved upon or lead to action to try and make this happen. People were funding elements of their care rather than the provider looking at alternatives to this.

These issues constituted breaches in the legal requirements of the law. There were three breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the full version of the report.

There were various safety checks taking place to ensure people received safe care and support. However, there were some shortfalls in this area. These related to timely action to issues identified about the building, infrequent fire evacuation drills, and gaps in people’s risk and care assessments. Lessons were not always being learnt or considered when incidents took place affecting the people at the home.

Staff recruitment checks were not complete or well evidenced. We made a recommendation that the service improved this aspect of people’s safety.

People received support to access health care services when they needed this input. Staff also followed up concerns and outstanding issues in relation to people’s health needs.

The service was involving people with what foods were available to them and they were promoting healthy options. People

This inspection took place on 20 November 2015 and was unannounced. When we last inspected the home in April 2014 we found that the provider was meeting the legal requirements in the areas that we looked at.

Hubbard Close provides accommodation and support for up to five people who have a learning disability or physical disability. At the time of this inspection there were three people living at the home.

The home has a registered manager. 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 safe and the provider had effective systems in place to safeguard them. Their medicines were administered safely and they were supported to access other healthcare professionals to maintain their health and well-being. People were given a choice of nutritious food and drink throughout the day and were supported to maintain their interests and hobbies. They were supported effectively and encouraged to maintain their independence. They were aware of the provider’s complaints system and information about this and other aspects of the service was available in an easy read format. People were encouraged to contribute to the development of the service.

There was a small but stable staff team who covered for all absences at the home. Staff were well trained and understood and complied with the requirements of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards. They were caring and respected people’s privacy and dignity. Staff were encouraged to contribute to the development of the service and understood the provider’s visions and values.

There was an effective quality assurance system in place.

We considered our inspection findings to answer questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found.

Is the service safe?

Care and treatment was planned and delivered in a way that was intended to ensure people’s safety and welfare. Suitable risk assessments had been carried out and staff were knowledgeable about the content of these. People who used different types of equipment had these regularly checked and properly maintained. Health and safety audits were carried out by the registered manager on a quarterly basis as part of a system for monitoring people's safety.

Members of staff had been through an appropriate recruitment process. This included carrying out background checks, for example, through the Disclosure and Barring Service. This meant the provider could demonstrate that the staff they employed were suitable and had the skills and experience needed to safely support the people living in the home.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. None of the people who used this service had had applications submitted under this system. However, we saw evidence that staff had received training in relation to the operation of the DoLS and there were appropriate policies in place.

Is the service effective?

The service promoted people's independence and ability to make choices as much as possible. Members of staff described a person-centred approach to care and demonstrated a good working knowledge of the contents of people's support plans. We saw that people were engaged in a wide variety of activities. Suitable equipment was provided and maintained in order to promote people's independence. People were also effectively protected from the risks of inadequate nutrition and dehydration. One person told us "I watch what I eat because of my diabetes. The food is lovely and I get a choice. Sometimes I help with the cooking."

Is the service caring?

We observed that people were relaxed and confident in their interactions with staff. For example, we observed that people were often engaged in sharing jokes or lightly teasing members of staff. All of the members of staff responded positively to this type of interaction. We spoke to three of the people using this service. They all told us that they were happy with the care being provided. One person said "This has been my home for ages. The people are great. I like it here."

Is the service responsive?

People's support plans carefully described their preferences, likes and dislikes and included a personal development plan. People met regularly with key workers to discuss any changing needs and had access to the activities that they wanted to engage in.

There were no records of any formal complaints having been made by the people using the service. However, people were encouraged to attend a weekly meeting where they could discuss any concerns that they had. Those who did not wish to attend the meeting were encouraged to contribute in other ways. One person told us "I don’t join in with the meeting, but I can say what I want to say. There is nothing wrong at the moment.”

Is the service well-led?

The provider had an effective system to regularly assess and monitor the quality of service that people received. People using the service met weekly and could discuss potential improvements to the service. Members of staff were invited to attend monthly meetings where they could raise any concerns and the quality of care being provided was addressed. An area manager visited the service each month and carried out a series of checks to ensure that the quality of care was maintained.

When we visited Hubbard Close on 9 October 2013, we spoke with three people who use the service and two staff members. We also used a number of methods including observation to help us understand the experiences of people who used the service. We found that people looked relaxed and comfortable in the company of staff who were supporting them. One person said, “I’m happy here.”

We found that people received treatment from a wide range of professionals. One person told us, “I see the doctor when I need to.” This meant that people’s health and well-being was protected against the risks associated with unsafe or unsuitable care and support.

We found that people received their medicines at the appropriate time. The medication administration record (MAR) sheets were fully completed in line with best practice.

People were supported by staff that were appropriately trained, supervised and appraised. Staff said that the training equipped them with the skills to do their job effectively.

The home had effective systems in place to ensure that both staff and people's records were stored securely and accurately maintained so that confidentiality was protected.

We visited Hubbard Close on 10 January 2013 and found a very friendly, welcoming environment. At the time of our visit four people were living in the home.

We spoke with two people who told us they enjoyed living in the home and that staff were kind and supportive, assisting them to maintain their independence wherever possible. We observed positive engagement and interactions between staff and residents and saw people were treated respectfully at all times. The people who lived at Hubbard Close had lived together for many years.

We also spoke with two members of staff on duty who had worked at the home for a number of years, and also the head of service. Staff were knowledgeable about people’s needs and preferences and we saw these were responded to appropriately.

When we visited the service on 26 March 2012 only two people were at home. One person spent much of the time asleep when coming in from work. Both people communicated to us that they were well looked after and we heard appropriate rapport with the member of staff supporting them during their evening meal. We noted that people were responding appropriately with the staff and were relaxed in their presence.

One of the people who spoke with us said that they liked the staff as they helped him to do things for himself. They said, "I love living here, the staff help me with all sorts of things". Another said that they liked living there and that the staff were kind. One person told us that they looked after their own medicines with a bit of staff support.

We observed staff supporting people in a kind and sensitive way. There was good communication between staff and people living in the home.

During our visit we heard people living in the home telling one of the people to, "Shut up" and to, "Be quiet".