About the service Heathfield House is a care home providing care and support for up to 10 people who have a learning disability and/or mental health needs. At the time of our inspection 10 people were living at the service. People received support from staff for 24 hours a day. The service is owned by an individual who also owns three other adult social care services in North London.
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 a large home, bigger than most domestic style properties. It was registered for the support of up to 10 people. 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
Some of the practices at the service presented a risk to the health and safety of people who lived there. Medicines were stored in a room which became very hot during the day and the temperature exceeded the recommended range for safe storage. Some of the risks people were exposed to had not been clearly recorded and there was a lack of guidance for the staff about these.
We spoke about the above concerns with the registered manager, who took immediate action to rectify these issues.
People using the service and their relatives felt the service was good. They liked the staff, who they described as kind and supportive. They felt their needs were being met. People were supported to learn independent living skills and regularly accessed the community.
The staff were well supported. They enjoyed working at the home. They spoke about training they had undertaken which had been useful. They worked closely as a staff team and shared information, so they could work in a consistent way. There were suitable procedures for recruiting the staff.
Care had been planned with people who used the service and was regularly reviewed to make sure this met their needs and preferences. People were involved in household activities such as planning menus, shopping, cooking and cleaning. They had access to a variety of foods and drinks throughout the day. The staff supported people to access other healthcare services and make sure they understood about healthcare appointments and what they needed to do to stay healthy.
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 registered manager had worked at the service for a number of years and knew people's needs well. People using the service and staff liked them and felt they were easy to speak with, and the service was well managed. There were appropriate systems for investigating when thing went wrong, monitoring the quality of the service and making improvements.
The service applied 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.
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 Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.
As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.
The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.
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 27 April 2016).
Why we inspected
This was a planned inspection based on the previous rating.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Heathfield House on our website at www.cqc.org.uk.
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.