You are here

Heathcotes Grove House Inadequate

Reports


Inspection carried out on 23 June 2020

During an inspection looking at part of the service

About the service

Heathcotes Grove House is a large detached house near the town centre. It is registered for the support of up to eight adults and children of 16 years and over. Support is provided for people with learning disabilities and other complex needs. One person was using the service at the time of our inspection.

The service is bigger than most domestic style properties and is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. 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

Systems in place had not always protected people from abuse. People had not been asked if they felt safe or what they could do if they worried or concerned. A relative told us they did not feel their family member was always safe at the service. Staff told us they had not felt safe when incidents happened at the service.

The provider had not always dealt with incidents appropriately to minimise people’s risks. Some restrictive practices had been in use that were not in line with current legislation and national guidance and staff had not received training in this area.

People were not always helped to communicate their needs. Although guidance had been given to staff about ways to communicate with people, information was not always available to people in a format they could understand.

Risk assessments in place were detailed and person centred. However, people’s individual risks related to COVID-19 had not been identified. Medicines were not always managed safely. Medicine records were poor and this meant it was hard to tell what medicines people had received. During our inspection we found the provider had identified issues with people’s medicine records and had started to make changes to put things right.

Staff did not follow safe infection prevention and control practices or follow up to date COVID-19 guidance to help stop the spread of infection.

Staffing numbers were adequate but new staff were covering shifts, without adequate training. There were periods where no senior leadership was in place and staff rostered to work did not always have the skills and knowledge they needed to support people. This meant people were at risk of unsafe care and treatment.

Governance arrangements at the service were not sufficient or robust enough to monitor and assess the quality and safety of the service or the welfare of people. Staff did not receive effective support from the management team to keep people safe. The lack of robust management meant there was no consistent oversight of the service.

The quality of care people received had deteriorated since our last inspection. The provider failed to act on all of the concerns we raised previously or to learn lessons when things went wrong. Where improvements had been made, they were not adequately embedded within the culture of the service.

Rating at last inspection

The last rating for this service was requires improvement (published 28 January 2020).

Why we inspected

We received concerns in relation to the reporting of incidents and how these were acted upon, infection control procedures and risk management, medicine management and lack of staff training and skill mix. As a result, we undertook a focused inspection to review the key questions of 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 a

Inspection carried out on 10 December 2019

During a routine inspection

About the service

Heathcotes Grove House is a large detached house near the town centre. It is registered for the support of up to eight adults and children of 16 years and over with learning disabilities including autism. Two people were using the service at the time of our inspection.

The service is bigger than most domestic style properties and is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. 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

The quality and the safety of the service had improved since our last inspection. The numbers of people living at the service had reduced. This gave the provider and the registered manager the time to make the improvements they needed to make following concerns we found at our previous inspection.

Staff were confident they would be listened to if they reported any concerns to the registered manager. The provider had put new systems in place to make sure any accidents, incidents or safeguarding concerns were dealt with quickly and appropriately to minimise people’s risk.

Staff had been provided with training to help them manage when people became anxious or upset. This helped keep people and staff safe. 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.

Risks to people had been identified and this was updated when people’s needs changed. People received their medicines when they should and medicines were managed safely. Medicine records had improved. When we identified one missing record staff were able to explain why and this was amended immediately.

Staffing levels were safe and the same staff team made sure people had the support they needed. When agency staff were needed the registered manager asked for the same staff so people knew them and would feel less anxious. Staff and agency staff received an induction before they started to work with people. All staff training was up to date and monitored to make sure staff received refresher training when they needed it. This made sure staff were up to date with the skills and knowledge they needed to support people.

Staff knew people well and were confident about the improvements made and the support they were able to provide to people. We observed staff were kind and caring. They respected people’s privacy and dignity and encouraged people to be as independent as they could be. Communication methods had improved and people were supported to express their views and be involved in their care. Staff helped people follow their interests and hobbies.

The provider had improved the way it recorded, monitored and acted on complaints. Information was available for people to raise concerns if they wanted to and staff made sure they listened and reported any to concerns to the registered manager.

Since our last inspection the provider had changed the management structure of Heathcotes. Managers had a clear view of what they needed to do to make sure people were safe and how they would make continuous improvements. There was a new registered manager at Heathcotes Grove House and they had worked hard to change the culture of the service. Staff told us this was having a positive impact on them and people’s care. After our last inspection the provider kept us up to date with their action plan and the improvements they had made. There were plans in place to make sure lessons had been learnt and the same failures we

Inspection carried out on 10 May 2019

During a routine inspection

About the service:

Heathcotes Grove House is a large detached house near the town centre. It is registered for the support of up to eight adults and children of 16 years and over with learning disabilities including autism. Five people were using the service at the time of our inspection. The service comprised eight bedrooms with en-suite facilities, two lounges, a conservatory, kitchen and dining room. To the rear was a patio area leading to a large lawn and garden with seating.

People’s experience of using this service:

Systems in place had not always protected people from abuse. People had not been asked if they felt safe or what they could do if they worried or concerned.

Staff felt that sometimes people may feel unsafe while living at the service. Although staff told us they knew how to protect people from harm, some training in safeguarding had not been completed. When incidents happened sometimes these had not been dealt with appropriately to minimise people’s risk. Some restrictive practices had been in use that were not in line with current legislation and national guidance. During our inspection the provider was making changes to make sure people were safe.

Risk assessments in place were detailed and person centred. However, some people’s risk had not been identified or assessments were out of date. Medicines were not always managed safely. Medicine records were poor and this meant it was hard to tell what medicines people had received. During our inspection we found the provider had identified issues with people’s medicine records and had started to make changes to put things right.

Staffing levels were safe but because of staff changes new staff and staff from other Heathcotes services were covering shifts. This meant people did not always have the continuity of care that they needed.

Staff did not always receive their induction training before they started to work at the service and some mandatory training had not been completed or had not been refreshed. This meant some staff may not have the skills and knowledge they needed to support people.

The staff we spoke with were knowledgeable about people’s needs and told us about the risks they faced. They told us they wanted the best outcomes for people and were working hard to achieve these. Recent changes in management meant staff were receiving more support to do their jobs well and staff comments confirmed this.

Complaints had not always been recorded or responded to in a consistent way.

People were not always helped to communicate their needs or be involved in how the service was run. Although guidance had been given to staff about ways to communicate with people, this was not always followed. Information was not always available to people in a format they could understand.

Following concerns raised, the provider had taken clear action to provide strong leadership at the service. This included a new management team and additional support for people and staff. They had made changes to the staff team and changed the way they checked the service was run so they could make things better for people. There was now an emphasis on creating an open and transparent culture. Although the changes being made were positive, these changes were new and we needed to be sure they have time to work properly. This is reflected in the rating we have given.

The provider was working with other authorities including the CQC to make sure improvements were made.

Rating at last inspection:

This was the first inspection for this service.

Why we inspected:

This inspection was brought forward due to information of risk or concern. Following an incident, we received information from the provider regarding concerns about the service. We completed this inspection based on these concerns. At the time of the inspection, we were aware of incidents being investigated by another agency.

Enforcement

The service met the characteristics of Inadequate in two key questions of sa