Heathfield House

Heathfield House is a care home for people who may have a learning disability or autism. The service was registered for up to 6 people; 6 people lived there at the time of our inspection.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. 'Right support, right care, right culture' is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support:

Care records did not always contain the accurate and up to date information required to keep people safe. Despite this, staff knew people’s care needs well and people and their relatives told us they felt safe and supported.

Records did not show that appropriate action was taken in response to incidents where people had fallen. Therefore, we could not be assured that action had been taken to reduce the risk of harm from falling.

The systems in place to monitor safety and quality at the service were not fully embedded or effective. The registered manager and provider did not always report notifiable incidents to us and the local authority.

Right Care:

There were sufficient numbers of suitable staff at the service. However, improvements were needed to ensure safe recruitment processes were consistently operated.

Staff supported people in line with their individual preferences and agreed care plans. People were supported to receive their medicines when they needed them and were protected from the risk of infection as staff followed safe infection prevention and control practices.

Right Culture:

People told us they were supported to have maximum choice and control of their lives. However, the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards were not consistently applied. People were not always supported in the least restrictive way possible.

People were able to receive visitors without restrictions in line with best practice guidance.

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

Rating at last inspection and update

The last rating for this service was good (published 10 August 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service. We planned to complete a focused inspection to review safe and well-led only. However, due to concerns identified during the inspection with regards to the application of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards, we also reviewed the effective key question.

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 has changed to requires improvement. This is based on the findings at this inspection

You can read the report from our last comprehensive inspection, by selecting the ‘All inspection reports and timeline’ link for Heathfield House on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified regulatory breaches in relation to; the provision of safe care, the application of safeguarding processes, the processes in place for assessing and obtaining consent to care and the systems in place to assess, monitor and improve the quality of care at the service.

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

We have made a recommendation about the processes in place to obtain feedback about the quality of care from relatives and staff.

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 found the following examples of good practice.

There was a system in place so visitors could enter the home safely, in line with government guidance.

Infection prevention and control policy was in place and infection prevention and control audits had been completed.

The registered manager was aware of the principles of isolation and zoning, should they need to implement this.

Cleaning schedules were in place for high touch point areas, such as light switches and door handles.

Heathfield house 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. Heathfield House accommodates up to six people in one adapted building. At the time of the inspection there were six people living in the care home.

There was not a registered manager in post. The provider had a manager in post and it was their intention to register with us in the near future. 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 our last inspection on 2 December 2015 we found the service was rated good overall. At this inspection we found the service continued to be rated good overall, but some improvements were needed in Well Led.

We found systems in place to check on the quality of the service people received were not always effective and improvements were needed. Whilst the manager had systems in place to monitor the delivery of people’s care, changes to risk assessments were not always documented and medicines stock checks were not always effective in identifying concerns.

People were protected from abuse and risks were assessed and planned for to keep people safe. Premises and equipment were maintained to minimise the risk of infection. People were supported by sufficient safely recruited staff. Medicines were administered safely. The manager had systems in place to learn when things went wrong.

People’s needs were assessed and they had effective care plans in place. Staff were trained and people received consistent support. People were supported to make choices and their needs and preferences for food and drinks were met. The environment was adapted to meet the needs of people. People were supported to maintain their health and wellbeing. 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.

People received support from staff that were kind and caring and staff had good relationships with people and their relatives. People had their communication needs assessed and care plans were in place which supported people to make choices and retain their independence. People were treated with dignity and respect

We were concerned that people's safety was compromised by the lack of maintenance to the building and grounds.

During this inspection we found that the issues had been addressed, people were able to enter and leave the buildings and move about the grounds in safety. The registered manager said, "It's much better now the work has been done".

People were treated with respect by staff and there was a very friendly atmosphere in the home. A person who used the service told us, 'It's nice here. This is where I live'.

We saw that people were supported in a way which met their individual needs. Records were person centred and enabled staff to understand the support people needed and how this should be delivered.

At the time of our inspection the provider did not have a registered manager in post.

We saw that inside the home was clean and tidy. Staff used aprons and gloves when they served food or assisted people with their meals.

We found that maintenance of the exterior of the house and the grounds had been neglected. People who used the service or visited the home were put at risk. The deputy manager said, 'We are supposed to be having the drive done in December'.

There were sufficient experienced staff available to meet the needs of people who used the service.

The provider had a complaints policy and procedure in place. We found that complaints and issues of concern were not recorded and dealt with appropriately.

We saw staff knocking on people's doors and waiting for an answer before entering. People told us they could spend time in any area of the home or alone in their bedroom when they wished to. This meant people's privacy and dignity were respected.

We were able to see that people received care and support that met their individual needs. The care records included pictures and photographs to support understanding.

We checked to ensure medication was stored and administered in a safe way and found suitable systems and procedures were in place.

We looked at the recruitment procedures for staff and found that systems were in place to protect people using the service.

We looked at ways in which the home assessed its own quality and safety. We saw systems were in place but there was little evidence to demonstrate how outcomes were improved for the people who lived there.