Heath Rise

Heath Rise is a care home providing personal care to 4 people with a diagnosis of learning disabilities and/or autism at the time of the inspection.

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

Risks to people had not been consistently assessed or mitigated. Risk assessments were not always kept up to date. Equipment used to reduce risks had not been kept in good working order.

Infection control procedures required improvement. Not all procedures were followed regarding taking staff and visitors temperature. Cleaning schedules had gaps in the records.

Records of care tasks contained gaps in the recording. These issues had not been identified prior to the inspection.

Systems and processes to ensure oversight of the service required improvement. We found limited audits completed and most audits had not been completed since November 2020.

People were supported by staff who knew them well and had been safely recruited. Not all staff had received up to date training. However, the registered manager was in the process of ensuring training was updated.

People received their medicines as prescribed and staff were competent to administer medicines.

Care plans were person centred and detailed for each person. Information was given to people in a format that suited their needs.

The service had not received any complaints within the past 12 months. Complaints, when received, were dealt with appropriately and within the providers timeframe.

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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• Model of care and setting maximises people’s choice, control and independence

Right care:

• Care is person-centred and promotes people’s dignity, privacy and human rights

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives

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 15 January 2019).

Why we inspected

We received concerns in relation infection control and a COVID-19 outbreak. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection

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.

The overall rating for the service has changed from good 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 reports’ link for Heath Rise 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.

We have identified breaches in relation to risk assessments, infection control and oversight of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

We will request an action plan for 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.

People continued to receive safe care. Staff had been provided with safeguarding training to enable them to recognise signs and symptoms of abuse and how to report them. There were risk management plans in place to protect and promote people’s safety. Staffing numbers were sufficient to keep people safe and the registered provider followed thorough recruitment procedures to ensure staff employed were suitable for their role.

People’s medicines were managed safely and in line with best practice guidelines. Systems were in place to ensure that people were protected by the prevention and control of infection. Accidents and incidents were analysed for lessons learnt and these were shared with the staff team to reduce further reoccurrence.

People’s needs and choices were assessed and their care provided in line with their preferences. Staff received an induction process when they first commenced work at the service and received on-going training to ensure they could provide care based on current practice when supporting people. People received enough to eat and drink and were supported to use and access a variety of other services and social care professionals. People were supported to access health appointments when required, including opticians and doctors, to make sure they received continuing healthcare to meet their needs.

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. The principles of the Mental Capacity Act (MCA) were followed.

People continued to receive care from staff who were kind and caring. People were supported to make decisions about how their care and their privacy and dignity were protected and promoted. Staff had developed positive relationships with people and had a good understanding of their needs and preferences.

People’s needs were assessed and planned for with the involvement of the person and or their relative where required. Staff promoted and respected people's cultural diversity and lifestyle choices. Care plans were personalised and provided staff with guidance about how to support people and respect their wishes. Information was made available in accessible formats to help people understand the care and support agreed.

The service continued to be well managed. People and staff were encouraged to provide feedback about the service and it was used to drive improvement. Staff felt well-supported and received supervision that gave them an opportunity to share ideas, and exchange information. Effective systems were in place to monitor and improve the quality of the service provided through a range of internal checks and audits. The registered manager was aware of their responsibility to report events that occurred within the service to the CQC and external agencies.

Further information is in the detailed findings below.

Rating at last comprehensive inspection: Good (report published 20 July 2016)

About the service: Heath Rise provides accommodation and personal care for up to four adults. People living at the service have complex needs that include Autism spectrum disorder and learning disabilities. At the time of our visit there were four people using the service.

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service remained rated Good overall.

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

At the last inspection of the service on 7 July 2015 we asked the provider to take action to make improvements to, staffing levels, complaints management and the management governance and oversight of the service. The provider sent us an action plan telling us how they planned to improve. We found at this inspection the actions had been completed.

Staffing levels were sufficient to meet people’s current needs. The staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service. Staff training and on-going training was provided to ensure staff had the skills, knowledge and support they needed to perform their duties. Staff supervision systems ensured that all staff received support through one to one and team meetings to discuss their learning and development needs and the needs of the service.

Suitable systems were in place to receive and handle complaints. Management governance systems were in place to regularly monitor the quality and safety of the service.

The service had 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.

People using the service had complex communication needs and were unable to directly tell us if they felt safe from abuse. General observations made on the day of the inspection and feedback from relatives indicated that people were protected from the risk of abuse. Staff were aware of what constituted abuse and of their responsibilities to report abuse.

Risks to people using the service and others were assessed, and appropriate measures were in place to manage identified risks. People received their medication safely and the systems to receive, store and administer medicines were appropriately maintained.

Staff knew how to protect people who lacked the capacity to make decisions. There were policies and procedures in place in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

People’s nutritional needs had been assessed and they were supported to make choices about their food and drink. Their physical and mental health was closely monitored and appropriate referrals to health professionals were made.

Staff showed care and compassion when supporting people and ensured that privacy and dignity was respected at all times.

People using the service and their representatives were involved in making choices about their care, which was based upon their individual needs and wishes. The care plans reflected people’s current needs and they were regularly reviewed and updated. Staff supported people to follow their choice of leisure, educational and recreational activities and people had regular access to the local and wider community to reduce the risk of social isolation.

One person used body language to indicate they were happy and that they liked living at Heath Rise. Another person indicated that they liked the staff and the activities that were planned for them.

The people we met were complimentary about the premises, indicating by the used of body language that they felt safe living there.

We found that National Autistic Society (NAS) - Heath Rise was a safe and caring service, the provider may wish to note that the care plans had no been updated for over a year therefore the information contained may be outdated as regards the person who used the service and their current needs.