Heaton House

About the service

Heaton House is a residential therapeutic placement for children aged under 18 with emotional and mental health needs. The primary regulator is Ofsted because Heaton House is categorised as a children's home. However, the provider, Nestlings Care Ltd, is also registered with the Care Quality Commission because they carry out the regulated activity 'Treatment of disease disorder or injury' from this location.

Heaton House is a home providing accommodation for up to four children. At the time of our inspection there were three children living at Heaton House.

Children’s experience of using this service and what we found:

Children told us that they felt included in their care. They understood their treatment plans and they felt able to raise concerns when they needed to.

The location had recently undergone some refurbishments. The children spoke positively about the changes that had been made. Children had choices about what they ate and took an active role in choosing daily activities.

Children told us that they didn’t always hear the outcome when they give feedback on their care. This limits their ability to be fully included in their home life. We have made a recommendation to the provider to address this.

We have also recommended that the provider review their complaints process to make it easy to see what complaints have been made and how they have dealt with them.

Children 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.

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.

Based on our review of Effective and Well Led key questions, the service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• The provider used positive behaviour support plans and there was careful transition planning when children moved into the home. Children know what they can ask for help with and this maximised their opportunities for support and independence.

Right care:

• Care planning and communication to all staff promoted people’s dignity, privacy and human rights.

Right culture:

• Leaders and care staff were open and honest. People knew they could raise concerns, and this was important to support inclusion.

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)

At the last inspection of this service (published 17 December 2020) there was one breach of regulation (regulation 10). The provider completed an action plan after the last inspection to show what they would do and by when to improve. We reviewed this breach (published 16 September 2021) and found that the provider had made improvements and were no longer in breach of this regulation.

Why we inspected

We received concerns in relation to staffing and the impact on patient care. As a result, we undertook a focused inspection to review the key questions of effective 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.

We have found evidence that the provider needs to make improvement. Please see the well led sections of this report.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for

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.

We have identified breaches in relation to good governance at this inspection. This was due to a lack of effective systems to assess and monitor improvement at this location.

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

Follow up

We will request an action plan to address the concerns that we have identified at this inspection. 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.

About the service

Heaton House is a residential therapeutic placement for children aged under 18 with emotional and mental health needs. The primary regulator is Ofsted because Heaton House is categorised as a children's home. However, the provider, Nestlings Care Ltd, is also registered with the Care Quality Commission because they carry out the regulated activity 'Treatment of disease disorder or injury' from this location.

Heaton House is a home providing accommodation for up to four children. At the time of our inspection there were three children living at Heaton House.

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

When we inspected the service on 1 and 2 October 2020, we found that the provider’s Covid-19 plans meant that children were unnecessarily restricted from undertaking activities outside of their home. The provider developed an action plan to address the shortfalls. They reported that they had met the actions and that meant that children were able to access activities.

At this inspection we found improvements had been made. Children told us how they planned their activities, how they accessed them and how this helped them.

We completed this inspection remotely by reviewing the action plan, activity documents, speaking to the acting registered manager, speaking to two young people and their social workers.

Why we inspected

We undertook this targeted inspection to check whether the requirement notice we previously served in relation to Regulation 10 HSCA RA Regulations 2014 Dignity and respect had been met. At the last comprehensive inspection we identified that the provider was not supporting the autonomy, independence and involvement in the community of children living there. There were robust plans to keep residents safe from Covid19 that ensured they mostly remained in the home. This meant that they had not been able to participate in external activities such as shopping or other activities that were enriching, which met their individual needs, or which supported them in transitioning to adulthood and adult services.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about.

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.

About the service

Heaton House is a residential therapeutic placement for children aged under 18 with emotional and mental health needs. The primary regulator is Ofsted because Heaton House is categorised as a children’s home. However, the provider, Nestlings Care Ltd, is also registered with the Care Quality Commission because they carry out the regulated activity ‘Treatment of disease disorder or injury’ from this location.

At the time of our inspection there were three children with a range of emotional and mental health needs living at Heaton House. Our inspection focused on the care, support and treatment they received to meet those needs.

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

Children told us they felt safe at the home and that staff supported them positively with their behaviour and in the least restrictive way. Children also told us that they received medicines on time and when they needed it. We found that the service had good processes to keep children safe and protected and that they learned from incidents. We have made a recommendation about ensuring each shift has a member of staff on duty with a first aid qualification.

Children, their social workers and their Independent Mental Health Advocate (IMHA) said that the care and treatment provided at Heaton House was effective and that the children had experienced some good outcomes whilst staying there. Children said that they were enabled to provide consent to their care and treatment. We found that the service carried out effective assessments and planned care and treatment to meet children’s needs. The service positively supported children with behaviour that challenged.

Children told us that they were treated with dignity, respect and compassion and this was confirmed by their social workers. We found that staff were caring and kept children at the centre of what they did.

Children said that their choices were respected and they were consulted about their treatment plans through regular meetings with the clinical team. We found that care and treatment was person-centred and supported the children positively. However, children said they did not have enough activities to do outside the home because of the Covid restrictions. Social workers said they had limited access to the children because of those restrictions. We have required the provider to make improvements regarding this.

Children liked the manager and the staff and told us that routines were helpful. One child specifically told us that they thought staff cared a great deal about their work and their responsibilities to the children. We found a positive culture at Heaton House with well-motivated staff who were supported by good leadership and processes.

Choice, control, independence and inclusion

Children were mostly supported to have choice and control of their lives. Two of the children were subject of Court of Protection orders that restricted their behaviour, although staff supported them in the least restrictive way possible. The policies, systems and culture in the service enabled this practice because:

• The care provided and the setting itself mostly maximised children’s choice, control and independence; except that children had limited choices about the activities they could participate in outside the home.

• The care and treatment was person-centred and promoted children’s dignity, privacy and human rights.

• The ethos, values, attitudes and behaviours of leaders and care staff ensured children living there were mostly enabled to lead confident, inclusive and empowered lives.

Previous inspections and ratings

This service was registered with us on 10 July 2019 and this was their first inspection.

Why we inspected

We carried out this inspection because they had not yet been inspected since their first registration and because we had become worried that the provider was not able to safely meet the needs of the children living there. This was because the provider had told us about several repeated incidents where children had harmed themselves. We wanted to find out if the procedures for managing these risks were working well and if there were enough well-trained staff to meet the emotional and mental health needs of the children living there.

We also looked at infection prevention and control measures. We look at this in all inspections of residential settings, even if no concerns or risks have been identified before. This is to provide assurance that the service can respond effectively to Covid-19 and other infection outbreaks.

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

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