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Inspection carried out on 23 April 2019

During a routine inspection

About the service: Heathcotes (Moorgreen) is a care home that provides care and support to up to eight people living with personality disorders. There were seven people living at the home at the time of our inspection visit.

People’s experience of using this service: People had a positive experience of living at Heathcotes (Moorgreen). People told us they felt safe and staff, and the manager, had a good understanding of safeguarding adults. Risks to people’s safety were managed in a way that promoted their independence. Changes had been made after incidents to reduce the risk of the same thing happening again. People received their medicines as required. The home was clean and hygienic and people were protected from environmental risks.

Further work was needed to ensure people’s rights under the Mental Capacity Act (2005) were respected. We made a recommendation about this. Staff were trained and felt supported in their roles. People had a choice about what they ate and were supported to make healthy choices. People had access to healthcare when they needed it, and advice was sought from specialist health professionals.

People were supported by staff who were kind and caring, staff knew people well and people were involved in making decisions about their care. People were treated with dignity and respect and their right to privacy was upheld.

The service was flexible to meet people’s needs. Staff had a good understanding of how to support people and people chose how they spent their time. There were systems in place to respond to complaints and concerns.

Since our last inspection, improvements had been made to the governance and leadership of the home, consequently, we found the home was well led. There were effective systems to ensure the safety and quality of the service, staff understood their roles and the new manager had had a positive impact on all areas of the home. People and staff were involved in the running of the home.

Rating at last inspection: Requires Improvement (Report published on 15 December 2018).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

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

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Inspection carried out on 23 October 2018

During an inspection looking at part of the service

We conducted an unannounced inspection at Heathcotes (Moorgreen) on 23 and 25 October 2018. Heathcotes (Moorgreen) is a ‘care home’. 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. Heathcotes (Moorgreen) provides short term treatment, support and accommodation for up to eight people who have a diagnosis of personality disorder. On the day of our inspection, six people were using the service.

We carried out an unannounced comprehensive inspection of this service in March 2018. Two breaches of legal requirements were found in relation to; risk management and staff recruitment. The service was rated as Requires Improvement.

Since our March 2018 inspection we received concerns in relation to the safety of care provided at Heathcotes (Moorgreen). As a result, we undertook this focused inspection to look into those concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Heathcotes (Moorgreen) on our website at www.cqc.org.uk. This is the third time this service has been rated as requires improvement.

There was a registered manager 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.

During our inspection we found the service was not consistently safe. People told us they sometimes felt safe at Heathcotes (Moorgreen), this depended on the behaviour of others. Referrals had not always been made to the local authority safeguarding adults team, this meant there was a risk safeguarding incidents may not be appropriately investigated. The local authority safeguarding adults team had recently investigated several concerns and found evidence of neglect of people’s health needs. Staff did not always have sufficient training to ensure people were safely supported with behaviours that could place them or others at risk. There were systems in place to learn from accidents and incidents; however, actions taken to reduce the risk of repeat events were not always clearly recorded.

In contrast, in other areas we found staff had a good knowledge of how to manage risks associated with people’s care and support. Further work was needed to ensure people were protected from the risk of Legionella. Other environmental risks were managed safely. There were enough staff available to meet people’s needs and ensure their safety. Since our March 2018 inspection improvements had been made to ensure safe recruitment practices were followed. Overall medicines were managed safely and records showed people received their medicines as prescribed. Good hygiene practices were followed and overall the environment was clean and hygienic.

Heathcotes (Moorgreen) was not consistently well led. Auditing systems were not fully effective in addressing areas for development because actions planned to address areas of concern had not always been completed. Records of people’s care and support were not always accurate and up to date. In addition, incident records had not always been fully completed to show what action had been taken in response to adverse events. We found staff did not all have sufficient knowledge or training to enable the provider to deliver the specialist aspects of the service. The provider had not notified us of all significant incidents in the home, as required by law. Feedback about the registered manager was positive from both people living at the home and staff. People were involved in the running of the home and their feedback

Inspection carried out on 12 March 2018

During a routine inspection

We conducted an unannounced inspection at Heathcotes (Moorgreen) on 12 March 2018. Heathcotes (Moorgreen) 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. Heathcotes (Moorgreen) provides short term treatment, support and accommodation for up to eight people who have a diagnosis of personality disorder. On the day of our inspection, five people were using the service.

Heathcotes (Moorgreen) was rated as requires improvement at our last inspection which was in March 2017. During this inspection we found we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This breach was in relation to safe care and treatment. You can see what action we told the provider to take at the back of the full version of the report

There was a registered manager in post at the time of our inspection visit, however following our inspection visit we were notified that the registered manager was absent from the service. The provider had put temporary management cover in place in the absence of the registered manager. 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.

During this inspection we found the service was not consistently safe. Staff did not always have an adequate understanding of people’s health conditions and this had resulted in incorrect medicines being administered when their health needs deteriorated. In addition, staff did not always have clear information to guide the administration of these medicines which meant there was a risk people may not receive these when required. Guidance for staff about physical interventions was not always clear which meant there was a risk of inappropriate and potentially unsafe, techniques being used. Systems to review and learn from accidents and incidents were not consistently effective which meant opportunities to reduce the risk of reoccurrence and improve practice may have been missed. People told us they felt safe and there were measures in place to minimise the risk of people experiencing abuse.

Staff were not always effectively deployed, this had been identified and action was underway to address this. There was a risk people may be supported by unsuitable staff as safe recruitment practices were not always followed. The home was clean and hygienic.

Care and support was not always properly planned and co-ordinated when people moved between different services and this had a negative impact on their wellbeing. People were supported to have maximum choice and control of their lives and overall staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People’s day to day health needs were met. However, there was a risk that people may not receive the support they needed with specific health conditions as care plans lacked details and staff knowledge was variable. People had enough to eat and drink. Further improvements were needed to ensure people were protected from risks associated with eating. People had access to specialist therapeutic support to aid their recovery, people were very positive about the impact of this support. People were supported by staff who had the skills, knowledge and training to provide safe and effective support. However, some further work was required to ensure staff had a sufficient knowledge of people’s mental health support needs and therapeutic aspects of the service. Staff felt supported, however, we found records of staff ‘debriefs’ after potentially stressful incidents were m

Inspection carried out on 1 March 2017

During a routine inspection

We carried out an unannounced comprehensive inspection of this service in November and December 2016 and found breaches of regulation. We also carried out a focused inspection in January 2017 where we found continued breaches of the legal requirements. Following both of the above inspections the provider submitted action plans stating what improvements would be made. We undertook this comprehensive inspection check how the provider was progressing with their action plan and to see whether they were now meeting the legal requirements.

We inspected the service on 1 March 2017. The inspection was unannounced. Heathcotes (Moorgreen) provides short term treatment and support for up to eight people who have a diagnosis of personality disorder. On the day of our visit three people were using the service.

Heathcotes (Moorgreen) was rated as inadequate at our last inspection. During this inspection we found that there had been improvements made and further improvements were underway. We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This breach was in relation to safe care and treatment. You can see what action we told the provider to take at the back of the full version of the report

There was a registered manager in place at the time of our inspection but they were not present during the inspection. They did not work in the service every day and so were supported by another manager who was managing the service on a daily basis, following our inspection we received an application to register this person as manager. 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.

During this inspection we found that although many improvements had been made, systems intended to reduce the risks associated with people’s care and support were still not always effective.

People felt safe in the service and there were systems and processes in place to minimise the risk of abuse. There were enough staff to provide care and support to people when they needed it.

People received their medicines as prescribed and medicines were stored and administered safely. People were supported to eat and drink enough. People had access to healthcare and their health needs were monitored and responded to.

Staff did not always receive suitable training or support to enable them carry out their duties effectively and meet people’s individual needs.

People who lacked the capacity to make certain decisions were protected under the Mental Capacity Act 2005. Where people had capacity they were enabled to make choices about their care and support.

Staff were kind and compassionate and treated people with respect. People were enabled to have control over their lives and were supported to be as independent as possible, their rights to privacy and dignity were promoted and respected.

Although people had detailed, up to date care plans people were at risk of inconsistent support as staff did not always have a good knowledge of people’s support needs.

People had the opportunity to take part in some activities, however they were not consistently provided with the opportunity for meaningful activity. People were supported to maintain relationships with people who were important to them.

People were supported to raise issues and concerns and there were systems in place to respond to concerns and complaints. People and staff were involved in giving their views on how the service was run.

Clear and accurate records were still not consistently kept of care and support provided and issues related to the day to day practice of staff were not always identified.

The management team were passionate about making improvements to the service and had

Inspection carried out on 25 January 2017

During an inspection looking at part of the service

We carried out an unannounced comprehensive inspection of this service in November and December 2016 and found breaches of regulation. After the inspection, the provider wrote to us to say what they would do to meet the legal requirements. We undertook this focused inspection to follow up on information of concern received by CQC and check how the provider was progressing with their action plan. 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 Heathcotes (Moorgreen) on our website at www.cqc.org.uk.

We inspected the service on 25 January 2017. The inspection was unannounced. Heathcotes (Moorgreen) provides short term treatment and support for up to eight people who have a diagnosis of personality disorder. The service was relatively new having only been registered since August 2016 and on the day of our visit three people were using the service.

There was a registered manager in place at the time of our inspection. They did not work in the service every day and so were supported by another manager who was managing the service on a daily basis. 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.

We found that systems in place to reduce the risks associated with people’s care and support were not always effective and this exposed people to the risk of harm. People were still not adequately protected from risks associated with the environment.

There were not always enough staff to provide care and support to people when they needed it and staff did not always have the skills to ensure the safety of people who used the service. Staff did not always receive suitable training or support to enable them carry out their duties effectively and meet people’s complex needs.

There was a risk that people may not receive their medicines as prescribed and medicines were not stored or managed safely.

People were supported by staff who knew how to recognise and respond to abuse and systems were in place to minimise the risk of abuse. Safe recruitment practices were followed.

People who lacked the capacity to make certain decisions were protected under the Mental Capacity Act 2005. Where people had capacity they were enabled to make choices about their care and support.

People were supported to eat and drink enough. People had access to healthcare and people’s health needs were monitored and responded to.

People and staff were involved in giving their views on how the service was run.

There was an ongoing lack of effective risk management and this placed people who used the service at risk of harm. Action was underway to make improvements but this had not yet been fully effective. Systems in place to ensure the safe running of the service were not effective.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to safe care and treatment, staffing and good governance.

The overall rating for this service remains ‘Inadequate’ and the service therefore remains in ‘Special measures’. Services in special measures 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. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of

Inspection carried out on 24 November 2016

During a routine inspection

We inspected the service on 24 November and 12 December 2016. The inspection was unannounced. Heathcotes (Moorgreen) provides short term treatment and support for up to eight people who have a diagnosis of personality disorder. The service was relatively new having only been registered since August 2016 and on the day of our visits three people were using the service.

The service had a registered manager in place 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 were not protected from risks associated with the environment. Risks in relation to people’s care and support were not assessed or planned for appropriately. Staff did not always follow guidance to minimise risks to people.

There was a risk that people may not receive their medicines as prescribed and medicines were not stored or managed safely.

Staff did not always receive suitable training or support to enable them carry out their duties effectively and meet people’s complex needs. There were not enough staff to provide care and support to people safely. Safe recruitment practices were not always followed.

People who lacked the capacity to make certain decisions were not protected under the Mental Capacity Act 2005. However, where people had capacity they were enabled to make choices about their care and support.

People were at risk of receiving inconsistent support as care plans contained contradictory information and staff did not always follow guidance in care plans. People did not always receive the support they required as staff we not always available to meet their needs.

People were supported to eat and drink enough. People had access to healthcare and people’s health needs were monitored and responded to. Staff were kind and caring and treated people with respect and people’s rights to privacy and dignity were promoted and upheld.

People were supported to raise issues and concerns and there were systems in place to respond to concerns and complaints. People were involved in giving their views on how the service was run.

Where possible people were involved in planning their care and support, staff knew people’s individual preferences. People were supported to maintain relationships with people who were important to them.

Governance systems in place to ensure the safe and effective running of the service were not adequate and this put people at significant risk of harm. Timely action was not taken by the provider in response to known issues which resulted in negative outcomes for people who used the service. Management structures in place at Heathcotes (Moorgreen) were not effective and appropriate policies and procedures were not always in place.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to safe care and treatment, staffing and good governance.

The overall rating for this service is 'Inadequate' and the service is therefore in 'Special measures'. Services in special measures 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. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the ter