Oadby

Heathcotes (Oadby) is an adapted residential care home. The service specialises in supporting people who have learning disabilities, autism, Asperger's syndrome and challenging behaviour.

The service was registered to provide support for up to eight people and there were eight people using the service at the time of our inspection. The service is larger than recommended by best practice guidance. However, we have rated this service good because the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people. People were encouraged to access the community and undertake person centred activities.

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

People were supported to stay safe. Risks were identified and responded to. There was a system in place to report any incidents, including safeguarding concerns, which were analysed for any themes or trends.

Peoples' staffing requirements were assessed individually and met. People were supported by enough staff who knew them well. The environment was clean and good infection control procedures were followed.

People were supported by staff who understood the importance of utilising positive behavioural support and this was used in line with best practice guidance. Staff also worked with health and social care professionals to ensure the support provided met people's needs.

People had access to the foods they liked, and staff encouraged them to choose healthy options. Staff provided support and monitoring to protect people from the risk of poor nutrition and hydration. Staff were supported to provide good support through effective training and induction to the service, and on-going supervision. The environment had been adapted to meet the needs of the people including a sensory room and sensory garden area.

The provider had a clear vision which emphasised that people with a learning disability could, and should, be in control of their own lives. Staff demonstrated these values in their interactions with people. People were presented positively, and staff focused on people's strengths and abilities. People were supported in a manner which recognised their right to privacy and space.

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.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

The registered manager provided good support for staff to be able to do their job effectively. The provider's quality assurance processes were effective and resulted in improvements to the service.

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 requires improvement (published 2 August 2019) and there were four breaches of regulation. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

Heathcotes (Oadby) is a residential care home providing personal care to eight people at the time of the inspection. The service specialises in supporting people who have learning disabilities, autism, Asperger’s syndrome and challenging behaviour.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to eight people. Seven people lived in the main building and one person lived in a self-contained flat joined to the main building. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

There were not always enough care staff to safely meet people’s assessed support needs. People did not always receive the 1:1 support that they required. This also limited the opportunities for people to go out and engage in activities in the local community.

People on specialised diets were not always supported to eat and drink safely or maintain a balanced diet. This placed them at increased risk of harm.

People were not receiving person centred support that was appropriate, and which met their needs and preferences. Some people required a clear structure to their day activities and this was not always provided by the care staff. Independent living skill activities were not effectively planned and co-ordinated.

People were not always supported to have maximum choice and control of their lives.

Care staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. However, not all conditions relating to authorised deprivation of liberty had been met for one of the people who lived at the care home.

The registered manager had a quality assurance system in place to monitor the safety and quality of the service. However, this was not being fully, or effectively, used to assess, monitor and improve the quality and safety of the service provided to people.

People, and their relatives, told us the registered manager was approachable but that complaints and concerns were not always dealt with formally and in line with the provider’s complaints procedure.

Care staff had not all received the training necessary to meet people’s individual needs.

The service didn’t always apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

People were supported to maintain links with their families. However, it was not always clear whether the arrangements in place for transport were in people's best interests. Following the inspection, the provider confirmed that people could choose to pay for access to the care home vehicle or could be supported to use public transport instead.

People told us that they felt safe living in the care home and that the care staff were kind. However there were occasions when one person’s dignity was not always maintained by the way they were supported to dress.

People were supported to access community healthcare support, and had health action plans in place, although urgent healthcare advice had not always been sought by care staff when needed.

People’s communication needs were understood, and accessible information was available in the care home.

People had personalised their bedrooms and the communal areas had a homely feel. The care home had a sensory room and an enclosed garden available for people to use. A self-contained flat was provided so the occupant could learn independent living skills.

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 17 November 2017).

Why we inspected

The inspection was prompted in part due to concerns received about support for people who have special dietary needs. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the five key question sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Since the inspection took place the provider has taken action to increase the monitoring of people’s diets and also the monitoring of staffing levels at the care home.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service is registered to provide accommodation and personal care for up to eight people living with learning disabilities. Accommodation is provided in an adapted detached house in a residential area of Oadby in Leicestershire. Facilities at the service include eight ensuite bedrooms, a communal lounge, a sensory room and a garden with recreational facilities. At the time of our inspection seven people were living in the service.

The previous Care Quality Commission (CQC) inspection was in January 2017. This was a focused inspection to check whether improvements we required the provider to make following an inspection in May 2016 had been made. We found then that people’s nutritional needs were not met and that CQC were not always notified of incidents that had occurred at the service. We found in January 2017 that improvements had been made; and at this inspection we found that the improvements had been sustained. At this inspection we rated the service as Good.

The service had a registered manager until they left their employment two weeks before our inspection. The provider was in the process of recruiting a manager who would apply to be 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 continued to be safe. People were protected against the risk of harm. People felt safe in the service. Staff recognised the signs of abuse or neglect and knew how to raise safeguarding concerns using the provider’s procedures.

Staff followed appropriate guidance to minimise identified risks to people's health, safety and welfare. There were enough staff who were suitably experienced and knowledgeable to keep people safe. The provider had effective recruitment arrangements in place to check the suitability and fitness of new staff to work at the service.

Medicines were managed safely and people received them as prescribed.

Staff received regular training and supervision to help them to meet people's needs effectively.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The provider's policies and systems in the service supported this practice.

People were supported to have a healthy balanced diet and were supported to access health services when they needed them.

Staff were caring and treated people with dignity and respect and ensured people's privacy was maintained.

Each person had an up to date, personalised support plan. These plans were detailed and included information that staff needed in order to know how to support people.

Staff encouraged people to actively participate in activities, pursue their interests and to maintain relationships with people that mattered to them.

Staff ensured the complaints procedure was made available to people to enable them to make a complaint if they needed to.

Regular checks and reviews of the service continued to be made to ensure people experienced good quality safe care and support. The provider’s quality assurance procedures identified and addressed areas requiring improvement.

People and staff were encouraged to provide feedback about how the service could be improved. This was used to make changes and improvements that people wanted.

Further information is in the detailed findings below.

.

Heathcotes (Oadby) provides accommodation for up to eight adults who require personal care and support. There were seven people using the service at the time of our visit. People who use the service live with autistic spectrum disorder and/or a learning disability.

People were safe at Heathcotes (Oadby). They were safe from harm and avoidable harm. People told us that staff looked after them and that their possessions were safe in their home. Staff were supported to recognise and report abuse or any concerns they may have about people’s welfare.

There was sufficient numbers of staff to meet people’s assessed needs. The registered manager increased the staffing levels when people’s needs changed.

The provider had safe recruitment practices. They completed relevant pre-employment checks which assured them that staff were safe to work with people that used care services.

People received their medicines as prescribed by their doctor because staff followed safe practices when they stored and administered medicines to people.

People were not unlawfully deprived of their liberty. The support people received was provided in accordance with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff were supported to access training. People felt that staff were skilled to deliver support to them.

People’s dietary needs were met. They had access to a choice of meals. Staff supported people to maintain their health and well-being. They liaised with other professionals to meet people’s health needs.

The service had 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 positive about the leadership of the home. They told us that the registered manager had improved the home and created a culture of open communication. People has easy access to the registered manager.

Staff felt that they were clearer about the standards expected of them. There was a clear management structure at the service. Staff had access to guidance and support from a manager including during out-of-hours.

The provider had systems in place to monitor the quality of the service. We saw that they worked with the local authority and used their own systems to make the required improvements required at the service.

Heathcotes (Oadby) provides accommodation for up to eight adults who require personal care and support. People who use the service live with autistic spectrum disorder and/or a learning disability.

The manager had applied to the Care Quality Commission to become the 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 at Heathcotes (Oadby). Staff had a good understanding of the provider’s procedure to keep people safe from harm and abuse.

People had the appropriate level of staff support to meet their assessed needs. The provider completed relevant pre-employment checks which assured them that staff were safe to work with people.

People received their medicines as prescribed by their doctor. However staff had not followed guidelines to assure them that people’s medicines remained safe when they administered them.

Staff received the training they required to provide support that met people’s individual needs. They had a good awareness of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) and how they would apply them in their role.

People did not always receive the support they required to have meals that met their needs. The needs of people who required special diets were not always met. Staff did not creatively support people to be involved in planning their own meal. People were not always offered suitable choices of meals that they preferred.

People had prompt access to healthcare services when they needed them.

Staff treated people with kindness and compassion. They respected their dignity and privacy and promoted their independence where possible.

People had access to a variety of activities. They were supported to maintain regular contact with people that mattered to them.

People and their relatives had various opportunities to raise any concerns they had about the service they received.

Management was not open and transparent. They did not share information with staff in a timely manner.

The provider had systems in place to monitor the quality of service. However they did not consistently use the system or other feedback they received to effectively improve the service.

We identified that the provider was in breach of Regulations 9 of the Health and Social Care Act 2008 (regulated activities) Regulations 2014 and Regulations 18 of the Care Quality Commissions (Registration) Regulations 2009. You can see at the end of this report the action we have asked them to take.

The provider had arrangements in place to assess whether people had the ability to make specific decisions. They used a checklist to assess people's mental capacity and put plans in place if a person lacked the ability to make a specific decision.

People had choices about the food they ate. One of the relatives we spoke with told us, 'If they don't like the meal on the menu the staff will offer alternatives. They always have a choice.'

There was a choice of communal areas so people could choose where they spent their time and whether they wanted to join in with others or sit quietly. The home was clean, tidy and well maintained.

Care staff participated in regular training and those we spoke with told us that they received the support they needed to help them fulfil their roles.

People using the service met with their keyworker every four weeks to discuss their views on the service and to establish if any changes were needed. Easy read notes were made of these meetings to record the important aspects of the meeting and the decisions that had been made.

We reviewed care plan documents and these showed that people's individual needs had been assessed and support plans put in place to explain, in detail, how people's care and support needs were to be met. Risk assessments had been used to identify any possible risks to people's safety and welfare with plans in place to explain how these risks were to be managed.

People's personal records were up to date, well organised and stored securely to help ensure that infomation remained confidential.