Preston

Heathcotes Preston is a specialist care home for adults with a learning disability, mental illness and who may have challenging behaviours and associated complex needs. The service can support up to seven people. At the time of the inspection three people resided at the service. All bedrooms had ensuite facilities. People had access to shared communal areas and a kitchen.

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.

The service was a medium sized house with small areas of communal space. The registered manager told us they would assess people before admission to ensure the environment would be suitable for them in relation to space, stimulation and independence. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

Since the last inspection there had been significant improvements. People told us they felt safe and staff understood the importance of safeguarding people from abuse and avoidable harm. The registered manager had ensured lessons were learnt and risk associated with people’s unpredictable and challenging behaviours were managed in a person-centred and effective way, this had significantly reduced the number of incidents at the service.

Staff were suitably trained and supported. The registered manager listened to staff’s opinions and invested in their professional development. Staff morale had significantly improved.

Staff supported people to access a wide range of health and social care professionals. Staff acted when people’s physical or mental health declined and supported them to follow guidance and advice from professionals.

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 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.

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.

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 positive behaviour support principles to support people in the least restrictive way. No restrictive intervention practices were used.

Since the last inspection the registered manager had developed staff knowledge of supporting people in a person-centred way and had worked closely with them to improve the way staff engaged with people. The organisation deployed a specialist trainer who worked with staff to develop positive intervention strategies, to help de-escalate and reassure people with distressed behaviours. We found examples of how this had created positive outcomes for people.

People told us staff were kind and respectful. The culture within the service was positive and inclusive. Staff supported people to live meaningful lives.

The registered manager demonstrated commitment to providing good care and had made significant improvements since the last inspection. Governance systems were in place and used to highlight and action areas for continued development.

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 (12 July 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.

This service has been in Special Measures since 12 July 2019. 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

This was a planned inspection based on the previous rating. This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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 Preston is a specialist care home for adults with a learning disability, mental illness and who may have challenging behaviours and associated complex needs. The service can support up to seven people. At the time of the inspection four people resided at the service.

All bedrooms had ensuite facilities. People had access to shared communal areas and a kitchen.

People’s experience of using this service

The provider failed to consistently ensure people were protected from avoidable and intentional harm. People were not always effectively risk assessed before admission and this led to placement breakdown.

The provider did not always consider mental health recovery or ensure staff had received necessary training to support people with complex needs.

Staff recruitment was not always safe. New staff were deployed to support people with unpredictable and complex needs before they had undertaken induction training. This placed people at risk of avoidable harm.

The culture at the service required improvement. We observed staff on one-to-one support with people standing over them and they did not always engage with the person despite being in their personal space.

People told us they had built trusting relationships with staff and enjoyed accessing the community with their support. We observed some positive interventions between service users and staff. However, due to the environment being chaotic staff were unable to maintain a consistent approach with people they supported.

People were not consistently supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible; the policies and systems in the service did not support this practice.

The principles and values of Registering the Right Support other best practice guidance ensure people with a learning disability and or autism who use a service can live as full a life as possible and achieve the best outcomes that include control, choice and independence. At this inspection the provider had not always or consistently applied them.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the following reasons; lack of choice and control, an unsettled environment and reduced inclusion because of the heightened needs of one person who had been admitted to the service without a sufficient assessment to check that their needs could be met.

There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

The size of service meets current best practice guidance. This promotes people living in a small domestic style property to enable them to have the opportunity of living a full life. However, due to the complexity of people who resided at the service and limited communal space the provider would need to consider compatibility of prospective service users before they were admitted.

Quality assurance systems were not robust and had not identified the failings found at the inspection. The manager did not always act on their duty of candour responsibilities and safeguarding incidents were not always reported in a timely way.

People were not always safeguarded from abuse and improper treatment.

People were encouraged to maintain an independent lifestyle and undertake shopping and cleaning tasks. Staff promoted people's dignity and respected their culture.

People had access to easy read information including the complaints procedure and statement of purpose. People told us they felt confident to raise their concerns.

Staff received regular supervision with their line manager.

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

Rating at last inspection

This was the first inspection at Heathcotes Preston. The service was registered May 2018.

Why we inspected

This was a planned inspection.

Enforcement

We have identified breaches in relation to; failing to protect people from avoidable harm, failing to effectively risk assess, failing to embed robust governance systems, failing to consistently safeguard people, failing to provide person-centred care and failing to ensure competent and trained staff were deployed at this inspection.

Please see the action we have told the provider to take at the end of this 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.

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 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 terms of their registration within six months if they do not improve.

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.