Moulton

Moulton is a residential care home providing personal care for up to 6 people in one adapted building. Moulton is also a supported living service providing personal care to people in their own homes. It provides support to people with a learning disability, autistic people and people living with mental health needs, physical disability or sensory impairment. At the time of our inspection, there were 5 people living at the home.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right Support, Right Care, Right Culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support:

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.

Staff enabled people to access specialist health and social care support in the community. The service worked with people to plan for when they experienced periods of distress so that their freedoms were restricted only if there was no alternative.

Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcome. Staff supported people to play an active role in maintaining their own health and wellbeing.

Improvements were being made to the home environment including, decoration and new flooring. People had a choice about their living environment and were able to personalise their rooms.

Right Care:

People received kind and compassionate care. They understood and responded to people’s individual needs. People’s care, treatment and support plans reflected their range of needs and this promoted their wellbeing

Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. Staff assessed and identified risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks.

The service had enough appropriately skilled staff to meet people’s needs and keep them safe.

Right Culture:

People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff. People received good quality care, support and treatment because trained staff and specialists could meet their needs and wishes

People and those important to them were involved in planning their care. Staff evaluated the quality of support provided to people, involving the person, their families and other professionals as appropriate. The service enabled people and those important to them to worked with staff to develop the service. Staff valued and acted upon people’s views.

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 (published 30 April 2020) and there were breaches of regulation. 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We received concerns in relation to the management of medicines, staffing levels and management oversight. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe, effective and well led sections of this full report.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Heathcotes (Moulton) is a residential care home providing personal care for up to six people in one adapted building. It provides support to people who have learning disabilities and or autism, mental health needs, physical disability or sensory impairment. At the time of our inspection, there were four people living at the home.

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

The provider's quality assurance systems and processes were not always effective at identifying concerns and driving improvement in the service.

Staff were not consistently deployed to provide people with appropriate support. There was a risk people would not receive care that met their needs and staff felt under pressure. Staff were not able to take sufficient rest breaks while working.

Staff received training when they started work with the service. However, training had not always been refreshed at the timescales identified by the provider.

Safe recruitment procedures were followed.

People were supported to eat a balanced diet that met their needs and any associated risks were managed with appropriate specialist input. Staff worked effectively with community health and social care professionals to achieve positive outcomes for people and ensured their health needs were met.

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.

Staff knew the people they supported well and adopted a caring approach towards their work. People were treated with dignity and respect.

People's care plans were individual to them, covered key aspects of their care needs and promoted a person-centred approach. People had support to participate in a range of social and recreational activities.

People and their relatives understood how to raise any concerns or complaints with the provider.

The management team promoted effective engagement with people, their relatives and staff. Staff felt well-supported and valued by the registered manager, but low staffing levels had affected staff morale in the service.

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.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 26 June 2018).

Why we inspected

The inspection was prompted in part due to concerns received about the quality and safety of the care provided to people. A decision was made for us to inspect and examine those risks.

Enforcement

We have identified breaches in relation to staffing and the governance of the service at this inspection. 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 from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection, the service was in breach the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Regulation 12, Safe Care and Treatment and Regulation 17, Good Governance.

We asked the provider to complete an action plan to show what they would do and by when to improve the key questions, ‘Effective’ and ‘Well-Led’ to at least good. At this inspection, we found the necessary improvements had been made, this ensured that people’s long-term healthcare conditions were managed and supported and effective systems were in place to oversee and manage the service.

Heathcotes (Moulton) is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Heathcotes (Moulton) accommodates six people in one adapted building. At the time of our inspection, five people received care at the service.

The service supports people with complex learning disability and autism. 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

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 had individualised health plans in place and were supported to access health appointments when necessary. Health professionals were involved with people’s support as and when required.

Quality monitoring systems and processes were in place and comprehensive audits regularly took place to continually drive improvement of the service. Systems were in place to seek feedback from people using the service and their representatives.

Staff understood the importance of safeguarding people and the procedures to follow to report abuse. Risk assessments covered risks that were present within people’s lives, and were managed in a way that was the least restrictive and promoted independence.

The staffing levels met people's assessed needs and the level of support they required. The staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service.

Systems were in place to ensure medicines were managed safely and people were supported to self-administer their medicines building upon independence.

All areas of the service were clean and tidy. Staff were trained in infection control and used appropriate personal protective equipment (PPE) to perform their roles safely. Regular cleaning took place, to ensure the prevention of the spread of infection.

Lessons were learned and improvements had been made when things had gone wrong. Staff understood their responsibilities to raise safeguarding concerns, to record safety incidents, accidents and near misses. Reflective practice was used to learn from incidents to mitigate the risks of reoccurrences.

People’s needs and choices were assessed and their care, treatment and support was delivered in line with current legislation, standards and evidence-based guidance to achieve effective outcomes.

Staff had the skills, knowledge and experience to deliver effective care and support. Staff were provided with comprehensive induction training and on-going refresher training. Specific training was provided to meet the individual needs of people using the service. Systems were in place to ensure that all staff had regular supervision and appraisals.

People were supported to follow healthy eating plans, to choose their own food and drinks and according to their capabilities, supported to prepare snacks and meals. Staff treated people with kindness, dignity and respect and spent time getting to know them and their specific needs and wishes. People told us the staff provided their care in a respectful and dignified manner.

People's consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 were met. People were supported to make their own decisions in line with relevant legislation and guidance. Where physical restraint may be necessary to protect individuals from harming themselves or others, the service ensured it was used as a last resort in a safe, proportionate, and monitored way as part of a wider person-centred support plan.

People were involved in planning their care as much as they could be. The care plans were detailed and personalised reflecting people’s individuality. People told us they felt in control of their care and staff respected their decisions.

The service had a complaints procedure in place. This ensured people and their families were able to provide feedback about their care and to help the service make improvements where required. The people we spoke with knew how to use it.

The service worked in partnership with other agencies to ensure quality of care across all levels. Communication was open and honest, and the service worked to continually drive improvement.

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.

Improvements were required to the way in which people’s long term healthcare conditions were managed and supported. Guidance was in place to help support people and their conditions however people may benefit from further input from healthcare professionals.

Improvements were required to the quality assurance systems that were in place to ensure the service was providing a good standard of care. Improvements were also required to the records the registered manager completed to show the checks and audits they had completed.

Improvements were required to ensure that actions were followed up in a timely way when improvements had been identified. For example to ensure that staff followed procedures as expected, and people received the support for their care needs without delay.

Improvements were required to the opportunities available to people and their relatives to provide feedback on the care they received. The staffing team communicated updates to people and their relatives however there were limited opportunities for people and their relatives to review the service and the care provided and to give their views.

People were safe in the home. Staff understood the need to protect people from harm and abuse and knew what action they should take if they had any concerns. Staffing levels ensured that people received the support they required at the times they needed. There were sufficient staff to meet the needs of the people and recruitment procedures protected people from receiving unsafe care from care staff unsuited to the job.

People received care from staff that were supported to carry out their roles to meet the assessed needs of people living at the home. Staff received training in areas that enabled them to understand and meet the care needs of each person.

Care records contained risk assessments and risk management plans to protect people from identified risks and helped to keep them safe but also enabled positive risk taking. They gave information for staff on the identified risk and informed staff on the measures to take to minimise any risks.

People were supported to take their medicines as prescribed. Records showed that medicines were obtained, stored, administered and disposed of safely. People were supported to maintain good health and had access to healthcare services when needed.

People’s mental capacity needs were reviewed. There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

Care plans were written in a person centred manner and focussed on empowering people; personal choice, ownership for decisions and people being in control of their life. They detailed how people wished to be supported and people were fully involved in making decisions about their care. People participated in a range of activities and received the support they needed to help them do this. People were able to choose where they spent their time and what they did.

People at the home reacted positively to the registered manager and the culture within the home focussed upon supporting people’s independence and for people to participate in activities that enhanced their quality of life.

We identified that the provider was in breach of two of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.