CQC report explained · a residential care home
What the CQC found at 1 & 2 Hedgerows
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found people were protected from abuse and avoidable harm. Risks, medicines, staffing, recruitment, emergencies and infection control were managed safely.
- Effective?
- Good
- People's needs and choices were assessed before each stay. Staff had suitable training and supported nutrition, healthcare, communication and decision-making.
- Caring?
- Outstanding
- Staff built exceptionally positive relationships and treated people with dignity, respect and without discrimination. They supported communication, choice, independence and personal identity exceptionally well.
- Responsive?
- Good
- Care plans were personalised and regularly reviewed. People were supported to communicate, follow their interests, maintain relationships and access activities and community services.
- Well-led?
- Good
- Inspectors found strong leadership, an open culture and effective quality checks. This improved from Requires Improvement at the previous inspection after earlier concerns about auditing.
What inspectors found, December 2019
1 & 2 Hedgerows was rated Good; inspectors found outstandingly caring, person-centred support, with all five areas rated Good or Outstanding.
This was a planned inspection visit on 18 October 2019. One inspector reviewed care plans, staff records, policies, audits and other records. No one was booked to stay, so the inspector spoke with relatives and staff rather than observing care directly.
The home provides planned respite and emergency short stays for up to five adults with learning disabilities and/or autism. Inspectors found people were kept safe, received effective support and had their needs met. Medicines, staffing, recruitment, risk management and infection control were found to be safe.
Caring was rated Outstanding. Inspectors found staff knew people very well, respected their choices and communication needs, and supported their independence. Responsive and well-led were rated Good.
The overall Good rating means the home met the required standards and provided consistently good care at the time of the inspection. Caring improved from Good to Outstanding since the previous inspection, and well-led improved from Requires Improvement to Good.
Respectful and inclusive care
Staff supported people as individuals and promoted equality, dignity and personal identity. The report describes a strong culture of respect and inclusion.
“People were treated exceptionally respectfully and without discrimination.” from the report
Strong understanding of people
Staff knew people's likes, dislikes, communication methods and signs of anxiety, even though stays were short. They adapted support to help people feel comfortable and involved.
“There was a strong and visible person-centred culture, with staff going above and beyond to ensure people were treated equally and fairly and able to advocate for themselves.” from the report
Promoting independence
People were supported to make choices, learn practical skills and take positive risks safely. Staff helped people take part in everyday activities and community life.
“The service was greatly effective at promoting people's independence.” from the report
Safe medicines and staffing
Medicines records, checks and audits were found to be appropriate. Inspectors also found enough staff and safer recruitment checks before staff started work.
“Medicines administration records were completed appropriately by staff and checks and audits were conducted to ensure continued safe administration.” from the report
Improved management checks
The home had introduced regular audits, meetings and action plans to monitor quality. This addressed the previous inspection's concern about incomplete auditing.
“At this inspection we found improvements had been made.” from the report
No direct observation of current stays
minorNo one was booked to use the home during the visit. The findings therefore relied on records and discussions with relatives and staff rather than observing care in practice.
“At the time of our inspection no one was booked to use the service.” from the report
Current survey results were pending
minorThe report says the most recent available annual survey was from 2018 because this year's results had not yet been analysed at the time of inspection.
“this year's results had yet to be analysed.” from the report
- 01How will you make sure staff know about any changes in my relative's needs between short stays?
- 02What communication methods, such as Makaton, pictures or technology, would you use for my relative?
- 03How do you balance positive risk-taking with keeping people safe during activities and community trips?
- 04How do you prepare a bedroom and the wider home to match my relative's preferences for each stay?
- 05How are medicines, care plans and risk assessments checked before an emergency short stay?
This was an announced planned inspection covering all five CQC questions, but no one was staying at the home, so inspectors relied on records and discussions rather than observing care directly. This explanation was written from the published report of 4 December 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, December 2016
Rated Good overall; inspectors found safe, effective, caring and responsive support, but the home needed to improve its management checks.
Inspectors visited on 1 November 2016. This was an announced inspection with 48 hours' notice. They spoke with relatives, people staying at the home, care staff and managers. They observed care and checked care plans, staff records, training records and quality checks.
The home provides respite and emergency short stays for up to five adults with a learning disability. Inspectors found enough staff, safe medicines procedures, suitable training and personalised risk assessments. People were treated with kindness, dignity and respect. They were involved in choices about food, activities and their care.
The overall rating was Good. Safe, Effective, Caring and Responsive were each rated Good. Well-led was rated Requires Improvement because quality checks were not thorough enough, some monthly checks had been missed and updated policies had not always been shared with staff.
Safe medicines
Medicines were locked away and given by trained staff whose competence had been checked. Two staff checked medicine stocks each day, and records matched the medicines supplied.
“People's medicines were being managed and administered safely. Medicines were stored in a locked cabinet in a locked room.” from the report
Trained staff
Staff training covered areas including autism, safeguarding, epilepsy, medicines and moving and handling. Staff also received regular supervision and yearly appraisals.
“Staff received a full training schedule that gave them the skills and knowledge required to support people and this was recorded on the training schedule.” from the report
Kind and respectful care
Inspectors observed staff being kind and supportive. Staff respected privacy and dignity and helped people make choices and remain as independent as possible.
“Staff were seen to be kind and caring towards the people they supported.” from the report
Personal choice
People could choose what to eat, what to do and which activities to join. Care plans recorded personal likes, dislikes and preferred routines.
“People could choose what activities they participated in and these were personalised to their needs.” from the report
Weak quality checks
needs fixingAudits did not fully check whether improvements had been completed. Monthly checks on thermometer calibration, pull cords and food probes had been missed.
“The absence of a robust quality assurance framework meant the provider had failed to identify that monthly tasks had not been completed.” from the report
Updated policies not shared
needs fixingSome updated policies had not been communicated to staff. Inspectors said this created a risk that staff did not know their new safeguarding responsibilities.
“However, we found these updated policies and procedures had not been communicated to staff.” from the report
- 01How do you now make sure monthly checks, including thermometer, pull-cord and food-probe checks, are completed?
- 02How are updated policies shared with staff, and how do you record that staff have read them?
- 03What training and checks make sure staff understand their safeguarding responsibilities?
- 04How will you review a person's care plan before each short stay and record any changes from their family?
- 05How do you make sure there are enough staff for the person's individual needs during daytime and overnight stays?
This was an announced inspection covering all five CQC questions, including observations of care, discussions with people, relatives, staff and managers, and checks of care and management records. This explanation was written from the published report of 10 December 2016 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of 1 & 2 Hedgerows
2 rated inspections over 3 years: the service has held its Good rating throughout.
- December 2019Goodcurrent ratingstayed GoodSafe: GoodEffective: GoodCaring: OutstandingResponsive: GoodWell-led: Good
- December 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- October 2013
Report published without a new overall rating.
- March 2013
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 17 January 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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