Arnold

About the service

Heathcotes (Arnold) is a residential care home registered to provide personal and nursing care to up to ten people. The service provides support to people who have mental health support needs, learning disabilities and/or autistic people. At the time of our inspection there were five people using the service.

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

Right Support

People lived in a property in which some fire doors were defective. This created a potentially increased risk of harm in the event of a fire. The provider told us they would rectify those issues. Waste management was not safe. External waste bins were overflowing and had attracted rodents. Parts of a person’s individual living area required repair and refurbishment and floor coverings in some communal parts of the building required replacement. Staff did not always wear protective face masks and, when they did wear them, did not always wear them appropriately. Some relatives told us they felt the service could involve families more than they currently did. The service worked with people to plan for when they experienced periods of distress so that their freedoms were restricted only if there was no alternative. Staff did everything they could to avoid restraining people. The service recorded when staff restrained people, and staff learned from those incidents and how they might be avoided or reduced. People had a choice about their living environment and were able to personalise their rooms.

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.

Right Care

People had appropriate care plans and risk assessments in place and staff understood how to support people. The inside of the care home was generally hygienic and homely. People were supported by enough staff to meet their care needs. People’s prescribed medicines were managed appropriately. Staff understood how to protect people from the risk of abuse and how to report any concerns. People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs. People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs. Staff and people cooperated to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks.

Right Culture

People were supported to maintain contact with their relatives and were encouraged to engage in community-based activities. People told us they knew how to complain if they were unhappy about anything at the care home. Staff told us they felt supported by the registered manager and told us they believed improvements in the service were being made. Staff placed people’s wishes, needs and rights at the heart of everything they did. Staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing.

We have made a recommendation about the management of premises checks and maintenance works at the premises.

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 18 December 2019) and there was a breach of regulation. At this inspection we found improvements had been made and the provider was no longer in breach of regulation 9 (Person-centred care). However, the provider was found to be in breach of regulation 15 (Premises).

Why we inspected

The inspection was prompted in part due to concerns received about the support provided for people who were expressing distress or agitation; and to check the staffing levels at the care home. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of Safe, Responsive, and Well-led only.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains Requires Improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe section of this full report.

The provider has subsequently told us they intend to take action to mitigate the risks we identified during the inspection, by carrying out identified maintenance and refurbishment works to the property.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Heathcotes (Arnold) on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches of regulation in relation to the fire safety arrangements, maintenance processes, and the management of household waste 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.

We conducted an unannounced inspection at Heathcotes (Arnold) on 11 November 2019. Heathcotes (Arnold) is a care home and accommodates up to 10 people with a learning disability and or autism and complex mental health needs. The service consisted of one house with a self-contained flat within the house. At the time of our inspection five people were using the service.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service:

Whilst improvements were found in all areas, there was further action required to ensure people received personalised care and support that was responsive to their individual needs. Staff responsible for managing the service, needed to escalate and follow up actions with external health and social professionals in a timely manner.

Improvements in how people’s safety needs were assessed and managed had been made. Risks associated with people’s needs had been reassessed and staff had up to date guidance of the support required to manage and mitigate risks. Staff were knowledgeable about people’s support needs.

Lessons learnt at provider and service level had been made, new systems and processes had been implemented to reduce the level of risk experienced at the service from reoccurring. This included increased oversight by senior managers.

Where safeguarding incidents had occurred, these had been reported and acted upon in line with the local multi agency safeguarding procedures. The use of physical intervention since the last inspection had significantly reduced. Least restrictive practice in the care and support people received had improved. Some people had moved to alternative placements more suitable to their needs, this had a positive impact on people remaining living at the service.

Staffing levels had recently increased to ensure people received the support they required to live active, and inclusive fulfilling lives. National best practice guidance in the prevention and control measures to protect people from the risk of cross contamination were followed.

People received enough to eat and drink. People were involved in menu planning and independence was promoted.

People are 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. People were supported with any health conditions and accessed health services to maintain their health needs.

People were positive about the staff who supported them. Positive engagement was seen between staff and people who used the service, where independence and choice were promoted, encouraged and respected.

People received opportunities to pursue interests and hobbies, including social activities and inclusion. People were involved in discussions and decisions about their care as fully as possible.

Since the last inspection, changes had occurred with the management of the service. At the time of the inspection, a new manager had recently taken responsibility for the service. They were being supported by an experienced regional manager who had very recently been assigned to support the service, but historically was familiar with it. Further time was therefore required for improvements to continue to be made; and those developed, to fully be embedded and sustained. The provider had an ongoing action plan that confirmed what action had been completed to make improvements with targets for future work.

Rating at last inspection:

At the last inspection the service was rated Inadequate (published 15 May 2019) and there were three breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, we found improvements had been made with two regulations. However, there remained a continued breach of Regulation 9 Person Centred Care of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Why we inspected:

This was a planned inspection based on the rating of the last inspection. This service has been in Special Measures since May 2019. During this inspection, the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Follow up:

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

The service consisted of one house with a self-contained flat within the house.

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 no registered manager in post at the time of the inspection and an interim manager was managing the service with oversight by senior managers. 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 experience of using this service:

Risks associated with people's needs were not consistently and effectively managed. Assessments of people’s needs were not always undertaken using nationally recognised tools to ensure consistent care.

Safeguarding issues were not always managed effectively to protect people and staff from harm. Incidents were not sufficiently reviewed and robustly analysed, to consider themes and patterns and how lessons could be learnt, and improvements made.

People did not always have consistent support to access their medicines should they need them. They were not always supported by enough staff sufficiently trained to manage their needs.

People's nutritional and health needs were not consistently met, their health needs, such as long-term health issues were not monitored.

Recent changes to the way the environment could be safely used meant people who lived at the service could not safely access some areas of the service.

People did not always receive support that met their needs. There was a lack of consistent up to date information in care plans to provide staff with the guidance to safely meet people’s needs. Where there was guidance staff were not always following the information in people’s care plans to provide safe consistent care.

Complaints were not always recognised and as a result not responded to in a consistent way, in line with the provider’s complaints policy.

There was a failure by the management team to prioritise high risk work, and a lack of response to quality monitoring processes in place at the service. This impacted on several areas of people’s care and resulted in a lack of oversight that was required to improve the quality of care provided for people at the service.

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. They were supported to express their views and opinions about their care. People had formed positive relationships with staff. There were safe recruitment processes in place.

Rating at last inspection: the rating at our last inspection was Good. We last inspected the service on the 10 March 2016.

Why we inspected: This inspection was because of concerns raised prior to our inspection.

Enforcement: We found the provider was in breach of three of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up: The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will act in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will act to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Heathcotes (Arnold) provides accommodation and personal care for up to 10 people living with mental health needs and or a learning disability. Nine people were living at the service at the time of the inspection.

Heathcotes (Arnold) is required to have a registered manager in post. 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. At the time of the inspection there were two registered managers in post and a house manager.

People received a safe service. Staff were aware of the safeguarding adult procedures to protect people from abuse and avoidable harm and had received appropriate training. Risks were known by staff and managed appropriately. Accidents and incidents were recorded and appropriate action had been taken to reduce further risks. People received their medicines as prescribed and these were managed correctly.

Risks to people’s needs had been assessed and plans were place to inform staff of the action required to reduce and manage known risks. These were reviewed on regular basis. The internal and external environment was monitored and improvements had been identified and planned for.

Safe recruitment practices meant as far as possible only people suitable to work for the service were employed. Staff received an induction, training and appropriate support. There were sufficient experienced, skilled and trained staff available to meet people’s needs.

People received sufficient to eat and drink and their nutritional needs had been assessed and planned for. People received a choice of meals and independence was promoted. People’s healthcare needs had been assessed and were regularly monitored. The service worked well with visiting healthcare professionals to ensure they provided effective care and support.

The manager applied the principles of the Mental Capacity Act 2005 (MCA) and Deprivations of Liberty Safeguards (DoLS), so that people’s rights were protected.

Staff were kind, caring and respectful towards the people they supported. They had a person centred approach and a clear understanding of people’s individual needs, preferences and routines. The provider asked relatives and visiting professionals to share their experience about the service provided. Communication between relatives, external professionals and the service was good.

People were involved as fully as possible in their care and support. There was a complaint policy and procedure available. People had information to inform them of independent advocacy services. There were no restrictions on people visiting the service.

People were supported to participate in activities, interests and hobbies of their choice. Staff supported people with their goals and aspirations and promoted independence.

The provider had checks in place that monitored the quality and safety of the service. These included daily, weekly and monthly audits.

One person showed us their bedroom and they had personalised their room and were happy with it. One person said, 'There are enough staff on duty.' Another person told us they got on well with the staff.

We found that people received care that met their needs. We found that people using the service, visitors and staff were in safe surroundings that promoted their wellbeing. We also found that there were effective recruitment procedures in place.

We found that there were enough qualified, skilled and experienced staff to meet people's needs at all times. We also found that people were cared for by staff who were fully supported to deliver care and treatment safely and to an appropriate standard.