Archived: Loundsley House

About the service

Heathcotes Chesterfield (Loundsley House) is a residential care home for people with learning disabilities, and/or autism and complex mental health needs. The care is provided in a purpose-built home for eight people. There were seven people living at the home at the time of our inspection.

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

The provider had made many improvements however some were not yet fully embedded to provide us with assurances to support sustainability. These were in respect of audits of the home and the continued risk management.

Relatives and professionals had reflected on the improvements, however they felt further improvements could be developed in relation to communication.

Staff had been recruited to the service, however not all the required employment checks had been completed to provide assurances about staff being suitable to work with people.

The culture of the home had been improved and reflected the principles in relation to Right support, right care, right culture. 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 guidance CQC follows 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. People were supported to make decisions about the care they received and how they spent their time. Prior to COVID 19 community links had been established and these will be returned to once the restrictions allow.

People received personalised care in an improved homely environment, which had been refurbished in consultation with the people using the service. People were encouraged to make choices about their diet, activities and how they spent their day.

There were sufficient staff to support people and staff now felt supported and received regular supervision for their role. Training had been improved to provide staff with the required skills.

Staff understood how to raise a safeguarding alert or concern. Any received had been investigated and any outcomes had been used to make improvements to people’s safety. Risk assessments had been completed to ensure measures were put in place to mitigate the risks. Referrals were made to obtain health and social care advice and we saw this was recorded and followed. Medicines were managed safely to ensure people received their prescribed medicine.

Relationships had been maintained through the use of technology and outside visits. Social stories had also been used to ensure continued family connections.

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.

The provider had worked in partnership with health and social care professionals, we saw improvements had been made and lessons had been learnt.

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 Inadequate (published 8 September 2020)

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.

This service has been in Special Measures since 19 February 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.

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

Follow up

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

Heathcotes Chesterfield (Loundsley House) is a residential care home for people with learning disabilities, and/or autism and complex mental health needs. The care is provided in a purpose-built home for 8 people. There were 6 people living at the home at the time of our inspection.

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

The outcomes for people using the service didn't reflect the principles and values of Registering the Right Support. The least restrictive options were not always used to protect people from harm. Medicines management was not always picking up potential risks to people’s wellbeing. Risk was not always managed to ensure staff received up to date guidance in supporting people. When incidents occurred, they were not fully reviewed to learn from them and reduce the risk of recurrence.

Staff were not following the government guidance to manage infection control during the Covid 19 pandemic. The provider had not given sufficient guidance and support to ensure this was adhered to. Additional staffing was provided by staff from other locations and the risk of cross contamination across homes had not been sufficiently assessed and addressed.

The systems in place to have oversight of staffing, medicines management and risk to people were not thorough enough to manage and improve the service. Some staff and families felt they could give feedback openly; but others felt the turnover of leadership at the home impacted on maintaining improvements.

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

Rating at last inspection

The rating at the last inspection was inadequate (published 19 February 2020)

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.

Why we inspected

We received concerns in relation to the management of medicines, infection control and management in the home. We reviewed the information we held about the service. We completed a risk assessment relating to the Covid19 pandemic that was ongoing at the time this inspection was completed. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. Ratings from previous comprehensive inspections for the other key questions were used in calculating the overall rating at this inspection.

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

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 monitor the service and 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 continued breaches in relation to risk management, safeguarding people from harm, staffing levels and support, and good governance at this inspection.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service remains 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 Chesterfield (Loundsley House) is a residential care home for people with learning disabilities, and/or autism and complex mental health needs. The care is provided in a purpose-built home for 8 people. There were 7 people living at the home at the time of our inspection.

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

The outcomes for people using the service didn’t reflect the principles and values of Registering the Right Support. Choice and control were not central to support provided and some people had not consented to interventions used to protect them. The least restrictive options were not always used to protect people from harm. Risk was not managed to ensure staff received up to date guidance in supporting people. When incidents occurred they were not fully reviewed to learn from them and reduce the risk of recurrence. Staff had not received adequate training to support people with complex health needs.

Assessments were not always in line with best practise guidance and some plans were not in place to direct staff; for example, how to support people with their diet in a positive way. This increased the risk that they were not always receiving care and support which met their preferences. Some people had communication systems in place and others were being developed although it was taking a prolonged time.

The provider did not have adequate oversight of the home despite an internal review noting there were significant improvements required. Staff were working consecutive days without a break leading to low morale. They did not have confidence in the responsiveness of the provider. There had been limited improvements since our last inspection.

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 requires improvement (published 7 March 2019)

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement:

We have identified breaches in relation to risk management, safeguarding people from harm, staffing levels and support, consent to care and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

We inspected the service on 16 August and 8 September 2018. The inspection visits were unannounced on both days. This was the first inspection of the service.

The service did not have a 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. A manager was in post and plans to apply to the Care Quality Commission for registration.

People had not always been kept safe through the use of effective care planning and risk assessment and management. There was not always sufficient trained staff who were given clear directions on how to care for people with complex needs. The provider did not always have systems in place to recognise when they could no longer meet people’s needs.

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Staff were not always deployed in the best interests of people and they worked very long hours without a break. Records did not always reflect what was happening in the service such as staffing levels and staff hours worked. They had not always been supported in a manner that enabled them to learn and flourish as staff members.

Care plans were basic and they did not always give staff clear directions on how to care for people who had complex needs. This impacted on risk assessments as up to date information on risk was not always available. Due to the lack of consistent management communications were not always effective. Staff said they had improved with the appointment of the new manager.

People’s dignity was promoted and staff were caring in their interactions with people. However people's independence was not always promoted as there was not always enough staff to ensure they had an active social life at a time they wanted outside the service.

There was a complaints process in place. There was a quality assurance process in place. However it was not always effective and had not reflected the concerns raised during this inspection process. The new manager reviewed incidents and acted to reduce them.

The service was clean and fresh and there were processes in place to keep the service infection free.

Medicine was stored and administered as prescribed. People's consent to care was sought for daily personal care activities. 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. The provider was working in accordance with the Mental Capacity Act 2005 (MCA), and people had their rights respected in this regard.