Archived: HF Trust - Milton Heights

HF Trust Milton Heights is a residential care home providing accommodation and personal care to 24 people with learning disabilities/ or autism at the time of the inspection. The care home can accommodate up to 25 people across six homes on one site.

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.

The service was on a campus type setting (meaning people’s homes were on one site). This setting does not meet current best practice guidance. However, this issue was mitigated as the provider was in the process of identifying alternative accommodation for people to address this. In the interim, the provider was aware of the need to ensure people could access their local facilities with staff support.

The service applied the principles and values of Registering the Right Support and other best practice guidance. This ensured that people using the service could live as full a life as possible and achieve the best possible outcomes that included control, choice and independence.

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 experience of using this service and what we found

At the last two inspections we found that people’s accommodation needed improvements. At this inspection, the required improvements had been made and the provider was no longer in breach of regulation 15 (Premises and equipment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. However, the provider’s systems and processes to monitor the safety of the environment had not been used consistently. This included weekly and monthly checks to ensure the safety of each of the premises such as fire and water safety. This meant the provider continued to be in breach of regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People’s up to date records were not always available in a format for non-permanent staff to refer to. Medicine records and checks were not always managed safely. However, people received their medicines as prescribed and the service had safe medicine storage systems in place. People and their relatives expressed no concerns about their safety.

The service had not improved the rating of Well Led from Requires Improvement to Good. This was because quality assurance systems had not been used effectively to ensure the health and safety of the environment was safe. Therefore, the provider had not ensured that continuous learning and improving care had taken place to rectify all previous breaches of the regulations.

People and relatives told us they felt the service had a positive culture with good outcomes and staff said they felt supported. People and their relatives had opportunities to provide feedback through surveys. The information gathered was used to improve the service. The service worked in close partnership with the relevant external services to support safe care provision.

Staff were respectful and caring with the people they supported. A person told us, “I love it here, everything about it, the staff are nice”. Staff ensured people received flexible care to support them in areas such as hospital visits. People’s equality, diversity and human rights were respected, and they were treated with dignity.

People received care and support specific to their needs, preferences and routines. People were encouraged to be involved. Care plans included information about people’s personal preferences and were focused on how staff should support individual people to meet their needs. People had information on how they best communicated. Staff supported people to access activities, employment and contact with the wider community.

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.

Rating at last inspection and update

The last rating for this service was requires improvement (published 21 September 2018) and there were two breaches of regulations. 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 that actions had been met in relation to regulation 15, however we found further additional evidence that the provider continued to be in breach of regulation 17. This service remains rated requires improvement. This service has been rated requires improvement at the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating. We have found evidence that the provider needs to make improvements. Please see the Safe and Well Led sections of this full report.

Enforcement

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

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

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

The service had two registered managers. One registered manager was responsible for house 4 and the other registered manager for houses 6, 6a, 7, 8 and 10. 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. There was an acting manager in the absence of the registered manager for houses 6, 6a, 7, 8 and 10.

When we completed our previous inspection on 6th and 15th June 2017 we found the houses were in need of refurbishment and redecoration to ensure they were appropriate and suitable for the current needs of the individuals living there. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe and Well Led to at least good. At this inspection we found that not all actions had been completed to ensure the necessary improvements were made. The service was still not fully meeting the fundamental standards that premises and equipment should be clean and properly maintained. The condition of the premises and some equipment in areas such as bathrooms and flooring created a challenge for staff to achieve a good level of hygiene and cleanliness.

The provider’s Information Return had stated that the provider’s estates department were in negotiations to provide new accommodation. However, there were no clear timelines for when this accommodation would be sourced to ensure people were living in well maintained and suitable premises. Regulations state that providers must monitor progress against plans to improve the quality and safety of services, and take appropriate action without delay where progress is not achieved as expected. Insufficient action had been taken to address the shortfalls identified at the last inspection.

Although staff working at the service were suitably qualified and skilled, people and staff told us that more permanent staff would provide more stability. However, staffing numbers and shifts were managed to suit people's needs so that people received their care when they needed and wanted it. Staff had access to information, support and training they needed to provide people with satisfactory care. The provider’s training was designed to meet the needs of people using the service. As a result, staff had the knowledge they required to care for people effectively.

People told us they were safe. Staff knew the correct procedures to follow if they considered someone was at risk of harm or abuse. They had received appropriate safeguarding training and there were policies and procedures in place to follow in case of an allegation of abuse. The service had appropriate recruitment procedures and conducted background checks to ensure staff were suitable for their role.

Risks to people's well-being had been identified and were managed safely. Appropriate individual risk assessments were in place to keep people safe. Medicines were managed safely. All staff had received training in the safe management of medicines. The provider had systems in place to store medicines safely. People received their medicine as prescribed.

People were supported to maintain their health and were referred for specialist advice as required. Staff worked with local social and health care professionals and referrals for specialist advice were submitted in a timely manner. Where people had received end of life care, staff ensured their wishes were complied with and comforted people that had lived with the person.

People's nutritional needs were met and people were supported to maintain a balanced diet.

Staff treated people with kindness, compassion and respect and promoted people's right to privacy.

People’s support plans were informative and contained guidance for staff. They included information about people’s routines, likes and dislikes, preferences and any situations which might cause people anxiety or stress.

People were provided with a range of activities which met their individual needs and interests. Staff also supported people to maintain relationships with their relatives and friends.

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.

Staff told us they were well supported by the management team. Staff support was through regular supervisions (one to one meetings with their line manager), appraisals and team meetings to help them meet the needs of the people they cared for.

People and their relatives were provided with information about how to make a complaint and complaints were managed in accordance with the provider's complaints policy. The registered provider had informed the CQC of all notifiable incidents.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This is the second consecutive time the service has been rated Requires Improvement.

Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

HF Trust Milton Heights is registered to provide accommodation and personal care for up to 33 people with learning disabilities. At the time of the inspection 25 people were being supported across six houses on the same site.

There were two registered managers in post. One registered manager was responsible for one of the premises and the other registered manager had responsibility for the five other premises. 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 environment needed improvement. We found the houses were in need of refurbishment and redecorating to ensure they were appropriate and suitable for the current needs of the individuals living there.

In one of the houses, medicines were not always stored at the advised temperatures. We made a recommendation that advice is sought in respect of this. People had received their medicines as prescribed.

The service had systems in place to assess the quality of the support provided in the home. However, where improvements were needed these had not been acted upon by the provider in a timely manner to ensure that people were protected against the risks of unsafe or inappropriate environment. Other risks had been identified and recorded and action had been taken to reduce the risks.

Feedback from two professionals we contacted spoke of communication not always being as effective as it could be.

All staff spoke positively about the support they received from the registered managers. Staff told us they were approachable and supportive. The service worked with other professionals to ensure people in the service received the appropriate support associated with their health and wellbeing.

People told us they felt safe. Staff had received regular training to make sure they maintained their knowledge in relation to recognising and reporting safety concerns. Staff were aware of people’s needs and followed guidance to keep them safe.

People were supported by staff that had the knowledge and skills to effectively care for them. Staff had received the training and support they required to ensure people received good care. The registered manager and staff were aware of their responsibilities under the Mental Capacity Act 2005 (MCA) which governs decision-making on behalf of adults who may not be able to make particular decisions themselves. People’s capacity to make decisions was regularly assessed.

People had a choice about the food and drink they wanted. People were supported to plan meals, shop and cook if they were able. People we spoke with told us they enjoyed the food and had choices about what they ate.

People spoke highly of the care they received. Staff understood the needs of people and provided care with kindness and compassion. Staff spent time with people and treated them with dignity and respect.

People’s care was planned ensuring that people were treated as individuals. People had been involved in developing their support plans and reviewing these. People were encouraged to be involved in activities and to take part in activities, such as hobbies and social events to ensure they did not become bored or socially isolated.

People in the service knew the registered managers and spoke to them openly and with confidence.

Staff demonstrated a clear understanding of involving people in day-to-day decisions about their care. Interactions with people were respectful. Staff were aware of peoples' needs and how they needed to assist them. Staff had knowledge of safeguarding, and knew the different forms of abuse, and indicators and symptoms to be aware of. Staff also told us they were confident in reporting concerns and felt that there was an open culture fostered by the provider.

All staff we spoke with talked positively about working for the provider and felt they benefitted from appropriate training, communication and support. Records we looked at confirmed that staff were supported to do their job.

The provider had conducted a quality survey and feedback from relatives was positive regarding the service provided. The Registered Manager had a system of logging any constructive feedback as complaints. These were responded to in line with the provider's documented complaints policy.

You can see our judgements on the front page of this report.

Both of the people we spoke with were happy with the service. One person said "staff are good". Observations made during the inspection showed us that staff had positive interactions with people. Choice was offered and people's decisions were respected.

Staff we spoke with demonstrated a clear understanding of involving people in day-to-day decisions about their care. Interactions with people were respectful. Staff were aware of peoples' needs and how they needed to assist them.

Staff we spoke with had knowledge of safeguarding. All five staff we spoke with knew the forms of abuse, and indicators and symptoms to be aware of. Staff we spoke with told us they were confident in reporting concerns and felt that there was an open environment fostered by the provider.

All staff we spoke with talked positively about working for the provider and felt they benefitted from appropriate training, communication and support.

The provider had conducted a quality survey and was in the process of inputting feedback on their computer system. Feedback from relatives was positive regarding the service provided.