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Heathcotes (Wakefield) Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 2 February 2021

About the service

Heathcotes Wakefield is a residential care home providing personal care to 18 people at the time of the inspection. The service can support up to 20 adults with learning disabilities and complex needs.

Heathcotes Wakefield supports people in two single storey houses and a building containing three flats, on shared grounds.

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

Staff deployment to meet people’s needs was not clearly demonstrated, particularly where some people required 2:1 support, or when staff had been deployed from other parts of the service.

Individual risks to people were clearly documented in their support plans and staff were confident in their understanding of these. However, some other risks were not well assessed or managed thoroughly to ensure people’s safety, such as kitchen refurbishment work taking place and the risk of infection from COVID-19.

Many infection prevention and control measures were in place and known by staff, with regular daily regimes including cleaning and health monitoring. However, personal protective equipment was not always worn correctly to prevent the spread of infection.

Safety related training for positive behaviour support and medicines had not been robustly carried out in line with the organisation’s policy. The management team told us this was as a result of training restrictions during the COVID-19 pandemic. Staff reported a lack of confidence in dealing with behaviour that challenged them.

Medicines were managed safely overall, with clear daily recording. People were supported individually to receive their medicine and procedures were clear.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always align with the practice. Positive behaviour support plans were in place, although these were not consistently adhered to and there was a lack of robust debriefing or management scrutiny of incidents where restraint had occurred.

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 not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support:

• Model of care and setting did not always maximise people’s choice, control and independence. People accessed the community only when staff deployment enabled this.

Right care:

• Care was not always person-centred and did not consistently promote people’s dignity, privacy and human rights. Staff interacted with people in positive ways, although spoke about people rather than with them at times. Some interaction did not fully consider people’s rights.

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff had not always ensured people

using services led confident, inclusive and empowered lives. The new manager was working closely with senior managers and support staff to improve the culture in the service.

The service had recently experienced changes in the management and there had been some emerging concerns which had not been identified through the routine quality assurance processes. The provider was swift to act upon concerns and was working hard to address issues raised through safeguarding and the inspection process.

We made recommendations in relation to staff skills, interaction and deployment which impacts upon their ability to provide person-centred care, and closer management scrutiny of risks and incidents.

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 22 May 2018).

Why we inspected

We received concerns in relation to inappropriate use of power and misuse of restraint, poor management and poor staffing culture. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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 coronavirus and other infection outbreaks effectively.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

We have found evidence that the provider needs to make improvements. Please see the key questions sections of this full report.

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 arusing 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 discharge our regulatroy functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identfied breaches in relation to keeping people safe from the risk of infection and providing care which meets people's individual needs and preferences. Please see the action we have told the provider to take at the end of this report.

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

Since concerns were identified and discussed with the provider, there had been closer scrutiny and monitoring of quality in the service, with a change of manager and additional presence of the senior management team.

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

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Inspection areas

Safe

Requires improvement

Updated 2 February 2021

The service was not always safe.

Details are in our safe findings below.

Effective

Good

Updated 2 February 2021

Caring

Good

Updated 2 February 2021

Responsive

Requires improvement

Updated 2 February 2021

The service was not always responsive.

Details are in our responsive findings below.

Well-led

Requires improvement

Updated 2 February 2021

The service was not always well-led.

Details are in our well-led findings below.