Archived: Heathcotes (Erdington)

Heathcotes (Erdington) is a residential care home providing personal care to five people under the age of 65 years, at the time of the inspection. The service can support up to eight people.

The service was registered with us prior to Registering the Right Support and other best practice guidance being introduced regarding the design of care homes for people with a learning disability. The principles and values that underpin this guidance reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes.

The service did not consistently apply the principles and values of Registering the Right Support and other best practice guidance. People using the service did not always receive person-centred support that was appropriate and inclusive for them.

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

People were not 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 provider had policies and systems in place, but the staff did not always support this practice.

The service did not always apply the principles and values of Registering the Right Support and other best practice guidance. These ensure people who use the service can live as full a life as possible and achieve the best possible outcomes which include control, choice and independence.

People had been put at risk by the poor culture at the home. The providers' governance systems had not ensured people's safety, health and wellbeing were always protected. Poor record keeping meant not all incidents had been reviewed and monitored.

People had not been kept safe from harm and abuse. Staff had failed to ensure risks to people were always minimised. People required one to one and two to one staff support and there were not enough staff to ensure this happened.

Staff deployment did not facilitate safe support, as some staff did not have the skills to support people's specific needs. Not all people got their medicines as prescribed because they were not managed safely. The use of restraint was not always recorded and monitored to ensure it was appropriate.

Staff did not always treat people with respect. Some staffs attitude towards the people they cared for did not show they treated them as equals or involved them in their own care. People did not always receive person-centred care.

People were not supported to maintain a healthy diet and menu planning was not structured to ensure this happened. People's needs were assessed and holistic care plans put into place. However, people's compatibility with others already living at the home had not been fully considered. People's healthcare needs were not fully met because best practice for people with learning disabilities and autism were not always followed.

People's communication needs were assessed and staff knew how best to communicate with each person. The provider had complaints processes in place and most were dealt with at a local level. People's wishes for end of life care had started to be looked at and discussed with people and their immediate family.

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 9 August 2019).

Why we inspected

The inspection was prompted in part due to concerns we received about inadequate staffing, people not being protected from abuse, inappropriate restraint being used and people not receiving care which was centred on them and their needs. A decision was made for us to inspect and examine those risks.

We found evidence the provider needs to make significant improvements.

Following our inspection and at our request, the provider took action to reduce the immediate risks we found.

Enforcement

We have identified breaches in relation to the management of risk and medicines, staff not treating people with respect or dignity and not providing person-centred care, inadequate staffing and staff skills and poor governance at this inspection.

You can see the enforcement action we took at the end of this report.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Heathcotes (Erdington) is a residential care home providing personal care to two people at the time of the inspection. The service is able to support up to eight people from the ages of 13 to 65 years old.

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.

The service was a large home, bigger than most domestic style properties. There were no identifying signs to indicate it was a care home. Staff did not wear clothing which suggested they were care staff when going outside the home with people.

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

The provider had not made all the necessary improvements since our previous inspection and people continued to be put at risk of unnecessary harm and abuse.

Although the culture at the home had improved since our previous inspection, there was further improvement needed to ensure people’s safety and wellbeing was kept risk free.

People were not safeguarded against the risk of inappropriate restraint. Although people had clear support plans, risk assessments and guidance in place, these was not always followed. The provider did not monitor people’s liquid medicines to ensure they had received them as required. Staffing levels were improved and people were supported by enough staff. The provider identified lessons to be learnt from incidents but improvement had not been made.

Staff did not always demonstrate respect towards people because some restraint was not necessary and they did not follow their individual guidance. However, during our inspection we did see caring interactions between staff and the two people who lived at the home.

Staff received the training they needed to support people, but this was not always put into practice. People’s care plans were detailed, holistic and showed staff worked with other health professionals. People were supported to eat and drink enough.

People were not 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 provider had policies and systems in place, but the staff did not always support this practice.

The service did not consistently apply the principles and values of Registering the Right Support and other best practice guidance. These ensure 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 of Registering the Right Support by promoting choice and independence, but not always control. People's support focused on them having opportunities and to become more independent.

People's care was planned around them as an individual. People's communication needs were assessed and staff knew how best to communicate with each person. The provider had a complaints process in place and most were dealt with at a local level.

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 inadequate (published 14 January 2020), and there were multiple breaches of regulation and the service was placed in special measures. At this inspection sufficient improvement had not been made and the provider was still in breach of regulations.

Following our last inspection, we imposed a condition on the provider's registration so they could not accept any new admissions to Heathcotes (Erdington).

Why we inspected

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

Enforcement

All representations and appeals have been concluded and we have imposed conditions onto the provider's registration in respect of the regulated activity, accommodation for persons who require nursing or personal care, at Heathcotes (Erdington).

Follow up

The overall rating for this service remains as ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under close review to check for significant improvements.

If the provider does not meet the conditions of their registration we will begin the process of preventing the provider from operating this service.

Heathcotes (Erdington) is a care home for up to eight people living with learning and physical disabilities. At the time of our visit there were six people living at the location

The service has been developed and designed in line with the principles and values of registering the Right Support and good 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 difficulties 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.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.

People’s experience of using this service:

The service was not consistently well led. We identified inconsistencies in contingency protocol when the manager was absent, and some concerns regarding record keeping and data protection.

People were kept safe and secure from risk of harm. Potential risks to people had been assessed and managed appropriately by the provider. People received their medicines safely and as prescribed and were supported by sufficient numbers of staff to ensure that risk of harm was minimised.

Staff had been recruited appropriately and had received relevant training, so they were able to support people with their individual care and support needs.

Staff sought people’s consent before providing care and support. 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.

People were treated with kindness and compassion. People’s rights to privacy and their dignity was maintained and respected by the staff who supported them. People were supported to express their views and be actively involved in making decisions about their care and support needs.

People’s choices and independence were respected and promoted. Staff responded appropriately to people’s support needs. People received care from staff that knew them well.

People using the service were confident about approaching the manager if they needed to. The provider had effective auditing systems in place to monitor the effectiveness and quality of service provision. The views of people on the quality of the service was gathered and used to support service development.

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.

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

Rating at last inspection:

At our last inspection in December 2017 [published 24/01/2018] we rated the service as good. 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 ongoing monitoring that demonstrated serious risks or concerns.

Why we inspected:

The inspection was prompted in part due to concerns received about an allegation of abuse towards a person living at the location by a staff member using inappropriate restraint techniques. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the Safe and Effective sections of this full report.

At the last inspection the service was rated as Good. The service remained rated as Good overall.

Follow up:

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

Heathcotes (Erdington) 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 care home comprises of one purpose built building which is registered to accommodate up to eight people who require support associated with their learning disabilities. At the time of our inspection, there were five people living at the home. 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.

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.’

However, the service had experienced a high turnover of manager’s in its first year of service. We found that the current registered manager had been absent from work since registering with us in November 2017 and there was an acting manager in post. This was the fourth manager to work at the service. It was evident from speaking with relatives, staff and visiting professionals that the inconsistent leadership within the service had, at times, had an impact on the quality of the service being provided to people within its first year. Nevertheless, everyone we spoke with without exception, were extremely positive about the influence that the new acting manager had had on the service and acknowledged the improvements that had been made since their arrival as a team leader, prior to taking on the role as an acting manager.

We found that people were protected from the risk of abuse and avoidable harm because safeguarding systems and processes were in place and implemented effectively. People were supported by sufficient numbers of staff who had the knowledge and the skills they required to care for people safely and effectively.

People were also protected against any risks associated with their health and care needs because risk assessments and associated care plans were developed holistically, reviewed and monitored. This ensured that people received the support they required to remain safe. People and their relatives were involved in this process alongside any key professionals and care staff, to ensure that care was person-centred and any decisions made in respect of their care and support needs, were done so within their best interests and in accordance with the Mental Capacity Act 2005. Where people were assessed to lack the capacity to consent to the support they received, the provider had followed key processes to ensure that care was provided in the least restrictive ways possible. Applications had been made and authorisations received to safeguard people against the unlawful deprivation of their liberty, where necessary. People’s privacy, dignity and independence were respected at all times.

The premises and equipment were well maintained, clean and had been adapted to ensure people were supported to remain safe within their home environment. Staff were also aware of risks to people when supporting them outside of the home in order to promote people’s safety within the community.

People received support from staff to take their prescribed medicines as and when required. Systems and processes were in place to ensure medicines were managed safely and only senior members of staff who had undergone specific training and supervision were permitted to administer medicines within the home.

Staff sought the expertise of specialist services and health and social care professionals to ensure that the care they provided to people was in keeping with legislation and best practice guidelines. This included advice and support specific to learning disabilities, autistic spectrum disorders and any associated symptoms, including behaviours that can be considered challenging. Where incidents had occurred within the home which had amounted to actual or potential harm, such as accidents or incidents whereby a person may have presented with violence or aggression, it was evident that this had been reviewed, analysed and monitored so that lessons could be learned and improvements made.

People were supported to maintain a healthy diet and all health needs were met with the support from staff. It was evident that people had developed positive relationships with staff and there was a friendly, calm, relaxed atmosphere within the home. Staff knew people’s likes, dislikes and preferences well and supported them to engage in activities of interest. People lived active and fulfilling lives and were supported to maintain and develop relationships with their relatives and friends. Visitors were always made to feel welcome.

Systems and processes in place to monitor the safety and quality of the service included the involvement of people, relatives and other stakeholders. The provider ensured that information was available in different formats to meet the needs of people and promoted their involvement in providing feedback on the care and support they received. Relatives we spoke with knew how to complain and were confident that any concerns that rose would be dealt with efficiently and effectively under the new management. Staff were complimentary of the leadership and management style of the acting manager; they found them to be supportive and approachable with an ‘open-door’ policy.