Archived: Heightlea

Heightlea is a residential care home providing personal care to five people with a learning disability or autistic people. It is part of the Spectrum (Devon and Cornwall Autistic Community Trust) group, a provider with several similar services across Cornwall. Heightlea is close to the city of Truro.

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

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.

Right Support

The model of care did not maximise people’s choice, control and independence. Staff told us they were committed to finding new activities and opportunities that met people’s preferences. However, people received limited support to identify long term goals. This meant activities and how they spent their time were not always part of a clearly laid out plan to ensure they lived a meaningful life. How people spent their time was also sometimes limited by the number of staff or vehicles available.

People were not always supported to develop their independence or to increase the control they had over their own lives. People’s care plans did not focus on people’s strengths or identify areas where people wanted to develop skills.

People who experienced periods of distress had plans in place which ensured physical restraint was only used by staff if there was no alternative. However, there were several restrictions in place in the service that were not the least restrictive options or in people’s best interests.

People had some choice about their living environment and were able to personalise their rooms. People were able to socialise in the living areas and enjoyed the privacy of their own rooms when they chose.

People were supported to use community health and social care services when needed.

Staff supported people safely with their medicines.

Right care

The provider had not given sufficient support to the service. This meant staff did not always recognise poor care or take action to make appropriate changes. People did not always receive support that focused on their quality of life and followed best practice. There was an overly cautious culture in the service that did not enable people to take positive risks.

Information shared by the provider regarding people’s finances showed the provider’s systems were not robust and did not protect people adequately from the risk of financial abuse.

The service was understaffed and did not always provide the number of hours to each person they had been assessed as needing.

People received kind care from staff who valued their relationships with people.

People were able to communicate with staff and understand information given to them by staff who understood their individual communication needs.

Right culture

People did not lead fully inclusive or empowered lives. The ethos and culture of the service were paternalistic which limited the opportunities people were offered.

Staff knew and understood people well, however the provider had not ensured they had a good understanding of best practice models of care. This meant staff did not consistently support people’s aspirations to live a quality life of their choosing.

There was a culture of improvement within the service; however staff did not always have the skills and knowledge to identify all areas for improvement.

People’s views as well as the views of those who were important to them were respected and listened to.

People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support best practice.

Rating at last inspection and update

The last rating for this service was requires improvement (published 19 February 2022) and there were breaches of regulation in staffing, good governance and safe care and treatment.

We specified a date by which the provider needed to meet the requirements of the regulations regarding good governance.

At an inspection in June 2021, due to concerns about staffing, we required the provider to share monthly reports detailing the numbers and training of staff in the service each day, including the number of management hours the registered manager completed. Concerns about staffing were again identified at the February 2022 inspection so the provider was required to continue sending monthly reports.

At this inspection we found the provider remained in breach of regulations.

The last two ratings for this service were requires improvement (published 15 November 2022 and 19 February 2022). The service has now deteriorated to inadequate and has therefore been rated below good for the last three consecutive inspections.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last 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.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well led sections of this full report.

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

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

Enforcement and Recommendations

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 in relation to person centred care, safe care and treatment, ensuring all decisions are in people’s best interests, staffing and governance of the service.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'.

Following this inspection the provider decided to transfer the service to another provider.

Heightlea is a residential care home providing personal care to five people with a learning disability or autism. It is part of the Spectrum (Devon and Cornwall Autistic Community Trust) group, a provider with 15 other similar services across Cornwall. Heightlea is close to the city of Truro.

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

The service was short staffed with staffing levels regularly only meeting contingency numbers. This is the number of staff as defined by the provider, that is the minimum required to provide safe care.

The low staffing levels had negatively impacted on people’s experiences of living at Heightlea. Staff told us it had been difficult to support people to take part in their usual hobbies and pastimes due to low staff numbers.

Tasks in place to ensure the safe running of the service had not been consistently completed. For example, financial audits, vehicle checks and a planned food shop.

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.

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

Right support:

• Staff supported people to have choice and control in their everyday lives. Their ability to do this had been impacted by staffing shortages in the service which meant people were not always able to attend planned events and sometimes had to share support.

• People lived in a safe and well-maintained environment which was set up to maximise their independence.

• Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcome.

Right care:

• The service did not have enough appropriately skilled staff to meet people’s needs and keep them safe. Following the inspection, the registered manager told us an agency worker had been assigned to work at Heightlea. This had improved the situation.

• There were not enough staff to cover the rota to allow staff to complete refresher training and this had fallen behind in some areas. At a previous inspection we had recommended staff complete Makaton training to support effective communication, this had not been done.

• People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs.

Right culture:

• Staff worked together well and demonstrated an approach where people’s best interests and well-being were prioritised.

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.

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 requires improvement (report published 18 August 2021) and there were breaches of the 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 not enough improvement had been made and the provider was still in breach of regulations. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last 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.

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safety, staffing levels and oversight of the service.

Follow up

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.

Heightlea is a residential care home providing personal care to five people with a learning disability or autism. It is part of the Spectrum (Devon and Cornwall Autistic Community Trust) group, a provider with 15 other similar services across Cornwall. Heightlea is close to the city of Truro.

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

There were not enough staff available to ensure there were always sufficient staff to support people in line with their commissioned needs. In order to maintain safe staffing levels, the registered manager was regularly covering support shifts. They told us they sometimes found it difficult to take time away from work because of the need to cover shifts. Following the inspection the registered manager told us senior management had arranged for two additional staff members to support the service on a temporary basis starting the following week. At our next inspection we will check this improvement to staffing levels has been sustained.

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.

Based on our review of safe, responsive and well-led the service was able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support:

• Staff worked to support people in line with their preferences. This was sometimes difficult to achieve when staffing levels dropped below those identified as necessary to meet people’s needs.

Right care:

• Staff demonstrated a person-centred approach to care and support. People were treated as individuals, their communication styles were respected and staff understood what worked well for them. Some language used in records was paternalistic in style. Language is important as it can have an ‘othering’ effect or infantilise people.

Right culture:

• Most of the staff working at Heightlea had been working at the service a long time and knew people well. They were used to supporting people to go out and have a full life. During lockdown they had been pro-active in supporting people to maintain their interests in-house.

People received their medicines as prescribed. Staff had completed the relevant training. Arrangements for the storage of medicines did not support people to become more independent in this area and we have made a recommendation about this in the report.

Risks were clearly identified and staff had guidance on how to mitigate known risks. The guidance provided was not always the least restrictive option and we have made a recommendation about this in the report.

Staff knew how people liked to spend their time and what their interests were. They had identified ways for people to continue doing the things they enjoyed during lockdown restrictions.

One person used some basic sign language to support their communication. Staff had not received training for this and we have made a recommendation in the report.

The registered manager was line managed by an area manager who they told us they found approachable and supportive. However, the registered manager was aware the area manager was busy and they were reluctant to make further demands on their time. They had no other sources of support and sometimes found this difficult.

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 (report published 4 May 2018).

Why we inspected

We received concerns in relation to staffing. As a result, we undertook a focused inspection to review the key questions of safe, responsive 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. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to staffing and governance.

We imposed conditions requiring the provider to submit monthly reports in relation to staffing arrangements at the service.

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 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.

This unannounced comprehensive inspection took place on 10 April 2018. The last comprehensive inspection took place in January 2016 when the service was rated Good overall. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. At this inspection we found the service remained Good.

People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

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.

The service requires a registered manager and there was one 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 were comfortable and at ease with staff. Some people chose to spend time in their rooms and others were in shared areas of the service. People were in and out of the office at various points, asking staff for support or to check what was happening during the day. Staff were considerate and respectful when speaking with people. Relatives told us they were confident their family members were safe and well supported by staff who knew them well and understood their needs.

People were supported to have their medicines as prescribed. Systems for recording when people had received their medicine were not robust and we have made a recommendation about this in the report. Some people had specific health needs and not all staff training was up to date in this area. Following the inspection the registered manager contacted us to confirm this training had now been booked for all staff.

Staff told us they were well supported and confident in their abilities to fulfil their roles and responsibilities. Staff, relatives and external healthcare professionals all commented on how well the team worked together. Staff told us roles and responsibilities were clearly defined and understood by all. Systems for communicating about changes in people’s needs were effective.

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. DoLS applications or authorisations were in place for everyone living at Heightlea. Where relevant, best interest processes had been followed to help ensure any restrictive practices were necessary and proportionate.

People had access to a range of activities on a day to day basis both in and outside of the service. The activities provided were varied and met people’s individual preferences and interests. In addition, people were supported to have holidays and short breaks away from the service. Family contact was valued and encouraged. Relatives told us they were kept informed of any changes and were invited to take part in care plan reviews.

Care plans were detailed and informative. Staff recorded information about how people spent their time and their health and emotional well-being on a computerised system. Some of this information was brief and lacked detail. Information about tasks was completed consistently. When people’s health needs led to additional monitoring records being kept this was done in line with guidance from external healthcare professionals.

There were effective quality assurance systems in place to monitor the standards of the care provided. Audits were carried out regularly by the registered manager and staff. Relatives and people’s views about how the service was operated were sought out.

Further information is in the detailed findings below.

We undertook this unannounced focused inspection on 12 July 2017 to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Heightlea on our website at www.cqc.org.uk.

Heightlea provides care and accommodation for up to five people who have autistic spectrum disorders. At the time of the inspection five people were living at the service. The service is part of the Spectrum group who run several similar services throughout Cornwall, for people living on the autistic spectrum.

There was 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.

All potentially hazardous products were stored safely. Action had been taken to treat decking to ensure it was not slippery underfoot. Weekly temperature checks on hot and cold water taps were carried out to monitor the safety of the hot water.

There were sufficient staff to help ensure people’s needs were met. People were supported to take part in a range of activities which were in line with their interests and preferences.

Staff had received safeguarding training and information on reporting procedures were available in the service. Risk assessments were in place and new ones developed as people tried new activities. People were supported to go out on a daily basis to take part in activities they enjoyed.

Systems in place for the management and administration of medicines were robust.

We found the breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 identified at our comprehensive inspection in January 2017 was now being met.

Heightlea provides care and accommodation for up to five people who have autistic spectrum disorders. At the time of the inspection five people were living at the service. There was 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.

Heightlea is part of the Spectrum group who provide services to people living with autism in Cornwall. The service is a modern property located on the outskirts of Truro. Three people who had lived in another Spectrum home had recently moved into Heightlea, effectively merging the two services. Staff from both services had worked with people to help ensure a smooth transition

The premises were well maintained, pleasant and roomy. People had large bedrooms which had been decorated and furnished in line with their personal preferences. Everyone had access to their own bathroom. We identified several risks associated with the environment. There were a large number of COSHH (Control of Substances Hazardous to Health), items being kept in an unlocked utility room. Hot water temperatures were not effectively regulated and staff had identified that one person had been running their bath independently but not always at an appropriate temperature. Outdoor decking was slippery underfoot but there were no risk assessments in place to help ensure the area was used safely.

The atmosphere at Heightlea was relaxed and welcoming. Interactions between staff and people were friendly and supportive. One person’s accommodation was separated from the main building which gave them a degree of independence and privacy that was important to them. Staff described to us how they worked to support them according to their preferences while protecting them from any risk of becoming socially isolated. They were able to tell us about activities the person enjoyed doing with others and who they liked to spend occasional time with.

People were able to access the local community and amenities easily as the city centre was within walking distance. People took part in a range of activities such as keep fit sessions, attending local social clubs and playing snooker. Relatives told us their family members had full and active lives.

Recruitment practices helped ensure staff working in the home were fit and appropriate to work in the care sector. Staff had received training in how to recognise and report abuse, and all were confident any concerns would be taken seriously by the registered manager.

People were assessed in line with the Deprivation of Liberty Safeguards (DoLS) as set out in the

Mental Capacity Act 2005 (MCA). DoLS provide legal protection for vulnerable people who are, or may become deprived of their liberty. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals when appropriate.

The registered manager and staff spoke of the importance of providing continuity of care for people. This had been identified as a priority for the service following the recent changes. More frequent staff meetings were being arranged to help ensure consistency. Staff told us they communicated well with each other and observed how people were supported by staff who knew them well.

There were effective quality assurance systems in place to monitor the standards of the care provided. Learning from incidents, feedback and complaints had been used to help drive improvement across the service.

We observed staff interacted with people who used the service in a kind and calm manner. We saw staff showed, through their actions, conversations and during discussions with us empathy and understanding towards the people they cared for. We saw that people's privacy and dignity was respected by the way that staff assisted people with their personal care.

We examined people's care records and found the records were up to date and reviewed as the person's needs/wishes changed.

We found that people who used the service were involved in making day to day decisions and participated in tasks at home, such as cleaning and doing their laundry. During the visit we noted that people attended a variety of activities so that they had opportunities to pursue their interests.

People were protected from the risks of inadequate nutrition and dehydration.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

Staff, and people who used the service told us they felt there was sufficient staff on duty.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

We observed staff interacting with people who used the service in a kind and calm manner. We saw that staff showed, through their actions, conversations and during discussions with us empathy and understanding towards the people they cared for.

We saw that people's privacy and dignity was respected by the way that staff assisted people with their personal care.

We examined people's care file and found the records were up to date and reviewed as the person's needs/wishes changed.

We found that people who used the service were involved in making day to day decisions and participated in tasks at home, such as cooking, cleaning and doing their laundry. The records showed that they went out frequently and saw healthcare professionals when they needed to.

Staff said they had received sufficient training and support to enable them to carry out their roles competently. The provider may like to review the staffing levels to ensure there was sufficient staff on duty.

Systems for safeguarding people from abuse were robust. Legal safeguards, which protect people unable to make decisions about their own welfare, were understood by staff and used to protect people's rights