Enright View

Heathcotes Enright View is a residential service that can accommodate up to seven people. The service accommodates four people in one shared bungalow and three other people in self-contained apartments. The service specialises in caring for people with learning disabilities, autism spectrum disorders and complex mental health needs. At the time of the inspection seven people were living at the service.

Within the same grounds the provider had a second registered location, Heathcotes Enright Lodge, that provided the same service and could accommodate six people.

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

Relatives told us they thought their family members were safe living at the service. People we spoke to told us staff were available when they needed them which made them feel safe. Staff had received training in safeguarding and there were up to date policies and procedures in place to support staff knowledge. Accidents and incidents were monitored and reported.

People’s needs were assessed and managed and support plans were up to date and reviewed regularly. Staff were confident and skilled in managing incidents. Staffing levels had stabilised and staff had received training in how to support most people’s specific needs.

Staff recruitment procedures were in place and staff had a probation period with training and shadow opportunity before they started to support people. Staff received regular supervisions to support and guide their practice.

Medicines were stored, administered and recorded safely.

The service was clean and well maintained. The service was following current guidelines for infection prevention and control.

There was a registered manager in post and staff were very positive about the support they received. Regular quality assurance audits to monitor the quality of the service were in place. Incidents and accidents were recorded and analysed for themes to learn lessons.

The service engaged the views of staff and people to continue improvements to the service.

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 statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. Care was person-centred to support human rights and maximise choice, control and independence. Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives

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 13 September 2019).

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels, staff training and supervision. A decision was made for us to inspect and examine those risks, and we undertook a focused inspection in Safe and Well-led only.

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.

The overall rating for the service has improved to Good. This is based on the findings at this inspection.

We conducted an unannounced inspection at Heathcotes Enright View on 16 and 17 July 2019. The service consisted of one bungalow for four people and three individual apartments in another building. People living at the service had a learning disability and or autism and complex mental health needs. At the time of the inspection, two people were living at the service. Within the same grounds the provider had a second registered location Heathcotes Enright Lodge that provided the same service and could accommodate six people.

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:

Improvements had been made and were ongoing, in how people’s safety needs were assessed and managed. Staff skills and competency had improved in managing incidents where people became highly anxious, and their behaviour became a risk to themselves and others. However, not all staff were confident and there continued to be a high turnover of staff.

Where safeguarding incidents had occurred, the provider had used their safeguarding and staff disciplinary procedures to reduce further risks. The management team had also worked with external agencies, responsible for completing safeguarding investigations.

Improvements had been made to how incidents were managed. This included more robust ways of involving people and staff, with an emphasis on how lessons could be learnt. Staff had received additional training in positive behavioural support. Least restrictive practice in the care and support people received had improved. The management team were working more effectively and being supported by external health and social care professionals.

Whilst improvements had been made to staff recruitment procedures and induction, concerns were identified regarding the transfer of staff internally from the provider's other organisations. Staff training, and support had improved and whilst staff were positive about these improvements, staff morale was generally low. Staff expressed concerns about not being fairly treated and valued.

People received their prescribed medicines safely and when they needed. However, some minor inconsistencies were found in how national best practice guidance was followed. The environment met people’s needs and safety. Improvements had been made to safety of the environment and premises. The service was clean and infection control practice was understood and followed.

People received sufficient amounts to eat and drink. People were involved in menu planning and independence was promoted. However, food stocks were low and repeated concerns were raised about the availability of food. flowing our inspection, the provider took action to make improvements.

People are 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 supported with any health conditions and accessed health services to maintain their health needs.

People were positive about the staff who supported them. Positive engagement was seen between staff and people who used the service, where independence and choice were promoted, encouraged and respected. 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.

Support plans that provided staff with guidance of how to meet people’s needs had improved. However, improvements were required to ensure guidance for staff was sufficiently detailed and up to date.

People received opportunities to pursue interests and hobbies, including social activities and inclusion. People were involved in discussions and decisions about their care as fully as possible.

The provider had an ongoing action plan that confirmed what action had been completed to make improvements with targets for future work. The inspection found improvements and the breaches in legal requirements had been met. However, improvements had been slow in progression and the majority had been completed within a few months prior to this inspection. It was clear more time was required for further improvements to be made and those developed, to fully be embedded and sustained.

Rating at last inspection:

At the last inspection the service was rated Inadequate (published 5 January 2019) and there were multiple 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.

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

Why we inspected:

This was a planned inspection based on the rating of the last inspection. This service has been in Special Measures since December 2018. 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.

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.

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 Enright View is a care home and accommodates up to seven people with a learning disability and or autism and complex mental health needs. The service consisted of one bungalow for four people and three individual flats in another building. Within the same grounds the provider had a second registered location Heathcotes Enright Lodge that provided the same service for six people. The management and staff team managed and worked across both services. People received high levels of staff support. On the day of our inspection, four people were living at Heathcotes Enright View.

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.

There was no registered manager in post at the present time and an interim manager was managing the service with oversight by senior managers. 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 supported by sufficient numbers of staff, and skill mix and competency was a concern. Staff had not all completed an induction on commencement of their employment, due to how the three day induction was delivered. There was high use of agency staff, who did not all have relevant skills and experience in working with people with complex needs. Concerns were also identified in the induction agency staff received. Significant gaps were also identified in the training staff had received, which the provider required staff to complete. Staff did not consistently receive opportunities to discuss their work, training and development needs.

Risks associated with people’s needs were not consistently and effectively managed. Incidents were not sufficiently reviewed and robustly analysed, to consider themes and patterns and how lessons could be learnt and improvements made.

National best practice guidance in the management of medicines was not consistently met. This included how medicines were checked and recorded. Guidance and instruction for staff also lacked detail in places. Whilst some changes had been made to make improvements, these required further time to be fully embedded.

Staff found it difficult to keep the environment clean due to the time available whilst supporting people. Checks associated with legionella was not fully completed. This was in relation to water flushes in unoccupied bedrooms.

The provider recruited staff after completing checks. This ensured, as far as possible, staff were suitable to work with people. Staff could identify the potential signs of abuse and knew who to report any concerns to. Action had been taken to safeguard people when concerns had been identified.

The provider was not consistently working in accordance with the Mental Capacity Act 2005 (MCA). Consent to care was not always sought in accordance with legislation and guidance.

People’s health needs were not consistently met. People had experienced missed health appointments and or, their health needs were not monitored as required and this not been identified by staff. This could have impacted on people’s health and well-being. People had limited access to a choice of foods because food stocks were not managed well.

Staff were kind and caring and respected people’s privacy and dignity. However, the deployment of staff and skill mix, impacted on people receiving consistently good care and support. People were involved as fully as possible in their care and support. Independence was promoted and advocacy information and support was provided to people.

People’s support plans were not easy for staff to follow they were repetitive and lacked guidance in places. People were happy with the activities and opportunities they received and social inclusion was encouraged, people accessed their local community regularly. People had access to the provider’s complaint procedure. At the time of our inspection no person was receiving end of life care, and discussions about end of life was not appropriate given people’s needs and recent transition to the service. However, documents were in place and ready for staff to discuss people’s end of life preferences when deemed appropriate.

The provider’s systems and processes to assess, monitor and improve the service was found to not be fully effective. Staff morale was low with staff concerned about staffing levels and competency, high use of agency staff and poor communication systems. External professional and agencies had significant concerns about how the service was meeting people’s individual needs. However, people who used the service, relatives and advocate we spoke with were overall positive about the care and support provided.

During this inspection we found four breaches of the of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report. 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.

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 act 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 terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will act to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.