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Inspection carried out on 9 July 2019

During a routine inspection

About the service

Heathcotes, Sheffield is a residential care home providing personal care and support to people with a learning disability and/or autism. The care home accommodates up to 16 people in two separate buildings (Norton and Woodseats). There were 15 people living at Heathcotes, Sheffield at the time of this inspection.

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.

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

There were systems in place to help keep people safe. Staff understood how to protect people from abuse. There were enough staff available to ensure people’s needs were met. The provider had effective recruitment procedures in place to make sure staff had the required skills and were of suitable character and background. Medicines were stored safely and securely, and procedures were in place to ensure people received their medicines as prescribed. The premises were clean and well maintained.

Staff understood the requirements of the Mental Capacity Act 2005. 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 interest; the policies and systems in the service supported this practice.

People were supported to access relevant health and social care professionals to ensure they were getting the care and support they needed to best meet their needs. Staff were provided with relevant training and ongoing support to make sure they had the right skills and knowledge for their role.

Positive and supportive relationships had been developed between people and staff. People told us they were treated with dignity and respect and we saw this throughout the day of the inspection. People were supported to engage in meaningful and social activities that were important to them. There was an up to date complaints policy and procedure readily available to people in a variety of formats. People and staff told us all the managers were approachable and responsive to any issues raised.

People and staff were regularly asked for their views of the service. There were effective systems in place to monitor and improve the quality of the service provided. Safety and maintenance checks for the premises and equipment were in place and up to date. The service had up to date policies and procedures which reflected current legislation and good practice guidance.

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 engage with the local community and become more independent.

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 12 April 2018).

Why we inspected

The inspection was prompted in part due to concerns with the provider regarding poor risk management, inappropriate use of restrictive interventions and ineffective governance systems.

We found no evidence during this inspection that people were at risk of harm fr

Inspection carried out on 8 March 2018

During a routine inspection

This comprehensive inspection took place on 8 March 2018 and was unannounced.

Heathcotes Sheffield 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. The service can accommodate up to 16 people in two houses.

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.” Registering the Right Support CQC policy

At the last comprehensive inspection in December 2015, the service was rated Good. At this inspection we found the service remained Good.

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

The service had two registered managers in post at the time of our inspection. 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 continued to feel safe. Staff understood their roles and responsibilities to safeguard people from the risk of harm and risks to people were assessed and monitored regularly.

Staffing levels ensured that people's care and support needs continued to be met safely and safe recruitment processes continued to be in place.

People continued to receive their medicines in a safe manner and received good healthcare support. People received a nutritious and balanced diet and their dietary needs and choices were met.

The service was well maintained and clean. Infection control was adhered to by staff.

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.

There were systems in place to monitor incidents and accidents. There were arrangements in place for the service to make sure that action was taken and lessons learned when things went wrong, to improve safety across the service.

We observed people had good relationships with the staff, who were caring and kind. Staff respected people’s privacy and dignity and promoted their independence.

The service had an open and inclusive culture which encouraged communication and learning. People, relatives and staff were encouraged to provide feedback about the service and it was used to drive improvement.

There were policies in place that ensured people would be listened to and treated fairly if they complained about the service.

We saw that the registered provider continued to effectively monitor and audit the quality and safety of the service and that people who used the service and their relatives were involved in the development of the home and were able to contribute ideas.

Further information is in the detailed findings below

Inspection carried out on 20 September 2016

During an inspection looking at part of the service

We undertook a focused in inspection on the 20 September 2016. There had been some significant incidents reported by the registered provider so we wanted to check people living at the service were safe. A notification must be sent to the Care Quality Commission every time a significant incident has taken place, for example where a person who uses the service experiences a serious injury or there has been an incident involving the police. We had also received some concerns from members of the public about the service. This was an unannounced inspection which meant the staff and provider did not know we would be visiting.

Heathcotes-Sheffield is a care service that provides care for up to 16 people. The service consists of two purpose built houses, one called Norton House and the other Woodseats House. At the time of our inspection ten people were living at the service; two of those people were away on holiday. People living at the service had complex needs and some had behaviour that could challenge.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection on the 14 December 2015, by selecting the 'all reports' link for ‘Heathcotes – Sheffield’ on our website at www.cqc.org.uk.

There was a manager at the service who was registered with CQC. 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 and associated Regulations about how the service is run.

During the inspection we were not able to speak with some people using the service because we were unable to communicate verbally with them in a meaningful way. Staff were respectful and treated people in a caring and supportive way.

Three people we spoken with did not express any concerns about their safety. One person told us they went to their room if people started shouting at each other. Another person told us they felt ‘safe’ and they would speak with staff if they had any worries or concerns. They thought the staff were ‘brilliant’ and really supportive.

Staff had received training in non-abusive psychological and physical intervention (NAPPI) to enable them to support people appropriately.

Staff told us they had undertaken safeguarding training and would know what to do if they witnessed any type of abuse. Staff had a good understanding about the provider’s whistle blowing procedures and felt confident that senior staff would listen.

We looked at the communal areas and spoke with staff about plans to reduce risks to people with a known history of self-harm. We saw people at risk were supervised during daylight hours on a one-to-one basis with hourly checks overnight.

We saw each person’s risk assessment and support plan showed how people may behave when they were well or when they may becoming unwell. Support plans gave guidance to staff in how they should respond to promote well-being and how they should react to de-escalate increasing agitation and anxiety.

Our scrutiny of support plans indicated the risk assessment processes and staff actions were successful in minimising the risks to people, other service users, the staff and public.

Whilst not observing the administration of medicines we looked at the medication administration records MAR charts for five people. We saw the medication administration records (MAR) sheet was complete and contained no gaps in signatures for the administration of oral medicines. However we saw the recording of the application of creams and lotions was less well recorded. We shared this information with the registered manager.

Whilst we saw ‘as necessary’ (PRN) protocols existed we found some were incomplete, some were misleading and some PRN prescriptions were not supported by a protocol. A protocol is to gui

Inspection carried out on 14 December 2015

During a routine inspection

Heathcotes (Sheffield) is a care service that provides care for up to eight people with a learning disability. People living at the service had complex needs and some had behaviour that could challenge. The service is purpose built and situated in a residential area of Sheffield. At the time of our inspection six people were living at the service.

We carried out a comprehensive inspection of this service on 30 April 2015. Six breaches were identified in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider sent us an action plan identifying actions to be taken and timescales for completion, in order for them to become compliant.

This comprehensive inspection took place on 14 December 2015 and included checks to confirm the service had followed their action plan and met legal requirements. This was an unannounced inspection which meant the staff and provider did not know we would be visiting. This report covers our findings in relation to the comprehensive inspection on 30 April 2015. We found appropriate actions had been taken to ensure regulations were being met.

There was a manager at the service who had commenced in post on 6 July 2015. The manager confirmed he had applied to register with us. 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 and associated Regulations about how the service is run.

People spoken with said they felt safe living at Heathcotes (Sheffield) and they could talk to staff if they had any worries. People were observed freely approaching staff and interacting with them.

There were procedures to follow if staff had any concerns about the safety of people they supported.

We found systems were in place to make sure people received their medicines safely.

There were sufficient staff with the right skills and competencies to meet the assessed needs of people living in the home. Recruitment procedures were in place and appropriate checks were undertaken before staff started work. This meant people were cared for by suitably qualified staff who had been assessed as safe to work with people.

A varied and nutritious diet was provided to people that took into account dietary needs and preferences so that health was promoted and choices could be respected. People we spoke with told us they enjoyed all of the meals provided at the home.

People’s physical and mental health needs were monitored. There was evidence of involvement from professionals such as doctors, opticians, tissue viability nurses and speech and language practitioners in people’s support plans.

Staff were provided with relevant training to make sure they had the right skills and knowledge for their role. Staff supervision and appraisal meetings took place on a regular basis to ensure staff were fully supported. Staff told us they could raise any concerns with the manager or provider and felt that they were listened to.

We observed people’s needs were met by staff that understood how care and support should be delivered.

The service followed the requirements of the Mental Capacity Act 2005 (MCA) Code of practice and Deprivation of Liberty Safeguards (DoLS). This helped to protect the rights of people who may not be able to make important decisions themselves. Staff had some understanding of the MCA and DoLS so that they had the knowledge needed for their role and to make sure people’s rights were upheld.

We saw people participated in a range of daily activities both in and outside of the home, according to their choice, which were meaningful and promoted independence.

There were systems in place to monitor and improve the quality of the service provided. Checks and audits were undertaken to make sure full and safe procedures were adhered to.

People and their relati

Inspection carried out on 30 April 2015

During a routine inspection

This inspection took place on 30 April 2015. This was an unannounced inspection which meant the staff and provider did not know we would be visiting. This was the first time the service had been inspected.

Heathcotes-Sheffield [Norton House] is a care service that provides care for up to eight people. It is a purpose built care service. At the time of our inspection four people were living at the service. People living at the service had complex needs and some had behaviour that could challenge.

There was a registered manager for this service but they were no longer in post at the time of the inspection. The regional manager informed us that the registered manager was in the process of cancelling their registration. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

During the inspection we observed that one person’s ensuite room floor had items on the floor which were a hazard. For example, bottles of shampoo. We also noted that the person’s bedding required changing. We spoke with the acting service manager as staff had failed to identify that the person required support in these areas.

Our observations and the feedback from staff told us that people’s needs fluctuated on a daily basis. Some people living at the service required one or two staff members to support them. We saw there were not appropriate arrangements in place for staff to call for another staff member’s assistance. We spoke with the acting service manager who told us that they were obtaining walkie talkies for staff to use to call for assistance. People did not have access to a call bell in their rooms if they were able to use one.

There was a process in place to record and monitor accidents and untoward occurrences. We found the provider had failed to put adequate arrangements in place to ensure that untoward occurrences were monitored to ensure appropriate action was taken after the former manager left in February 2015.

The arrangements in place to ensure minimum staffing levels were maintained. However, when there was unexpected staff absence, arrangements needed to be more robust.

Our discussions with staff told us they were aware of how to raise any safeguarding issues and were confident the senior staff in the service would listen. We were not able to speak with some people using the service because we were unable to communicate verbally with them in a meaningful way. From our observations we did not identify any concerns regarding the safeguarding of people who used the service.

The service did not have appropriate arrangements in place to manage medicines so people were protected from the risks associated with medicines.

Recruitment procedures were in place and appropriate checks were undertaken before staff started work. This meant people were cared for by suitably qualified staff who had been assessed as safe to work with people.

Some people had personalised their rooms and they reflected their personalities and interests. People were supported to keep in regular contact with their family members.

One person told us they were satisfied with the quality of care they had received and made positive comments about the staff.

Two people had recently come to live at the service. One person had visited the service prior to living there. They had told us that they had liked their room and the staff. They had been living at the service for just over a week. We found they did not have a support plan in place and a risk assessment for only one identifiable risk area had been completed. It is important that individual risk assessments are completed for all areas so that identifiable risks are managed effectively.

We found that the provider had failed to assess whether the environment was safe for one person living at the service and ensure that robust arrangements were in place so they received the level of support they needed from staff when they came to live at the service.

There was evidence of involvement from other professionals such as doctors, optician, tissue viability nurses and speech and language practitioners in people’s support plans.

People’s nutritional needs were not monitored so actions could be taken where required. The menu being provided by the service had not been nutritionally assessed. We saw that people did not have access to drink or food when they wanted them.

Staff told us they enjoyed caring for people living at the service. Staff were able to describe people’s individual needs, likes and dislikes. However, we found that people were not treated with dignity and respect because of the actions of some staff. For example, we saw that some staff directed people in what they should say and/or action they should take; a staff member telling a person to go to their room and another staff member asking a person to say please and thank you. We also noticed that some people’s access to food and drink was limited because the kitchen was kept locked.

Staff completed induction, training and received ongoing support. Staff received specialised training to meet the needs of people they supported. However, we found that some staff had not followed some of the provider’s procedures. For example, handling service user’s monies and completing medication administration records.

We saw the service provided support for people to go on daytime activities which included going to the local shop, park and visiting inner city farms. People also had access to a computer, games, music and sensory objects within the service. One staff member described the activities one of the people like to participate in; the person liked to visit an inner city farm and go for walks. However, they were unable to describe how the person was involved in choosing which activity to participate in.

The provider had a complaint’s process in place. We reviewed the service’s complaints file. We noted that a decision had been made not to share the outcome of one person’s complaint as it may have caused them distress. We could not see how this decision had been made as the person no longer lived at the service.

Regular meetings with people living at the service were not held. This showed there were not robust arrangements in place to seek people’s views so they could share their experience of care.

We saw no evidence that family members were regularly contacted to share their experience of their family members care.

Although regular checks had been completed by senior managers within the service, our observations and findings showed they were ineffective in practice.

We found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

Ensure that providers found to be providing inadequate care significantly improve

Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

The overall rating for this service is ‘Inadequate’ and theservice is therefore in 'Special measures'. The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.