Heathcotes Yorkshire Supported Living Office

Heathcotes Yorkshire Supported Living Office provides care and support to people living in their own home with the aim of maximising people’s independence. People lived within 1 of 6 supported living properties. The service provides support to older and younger adults who may be living with mental health needs, a learning disability or autism.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of the inspection, the service supported 4 people with a regulated activity across 2 properties.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and 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 supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support

People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests. The policies and systems in the service did not support this practice. Records were not consistently available to show the service had worked within the principles of the Mental Capacity Act (2005). The provider failed to demonstrate how they were promoting elements of best practice at this service.

Right Care

Staff training was not always completed or up to date to ensure staff had the skills and knowledge needed, which could have compromised people’s safety. The provider did not operate a robust system to review accidents and incidents to consider learning or improvements. Person-centred information was available to guide staff and staff knew the people they supported well. Staff spoke about and with people in a respectful manner and promoted their dignity. People had access to healthcare professionals and information was available about how to monitor and respond to any changes in their health.

Right Culture

There were continued issues with the oversight and management of the service which compromised the quality and safety of the service. Audits had not been used effectively to identify and drive improvements. There had not been sufficient improvement since the last inspection. A high turnover of managers within the supported living settings affected the stability of the service and did aid establishing trusting relationships with people. We received mixed feedback about the service, with some people stating the care had been ineffective and unsafe and this had impacted on people’s health and well-being. Others praised the service and the positive impact the staff had made. Limited feedback was sought from people to understand their experience of the service and consider how this could be improved.

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 07 February 2023). At this inspection we found the provider to be in breach of regulations and the service remains rated requires improvement. The service has been rated requires improvement or inadequate for the last 3 inspections.

At our last inspection we recommended the provider seek advice from a reputable source about guidance for ‘as and when needed’ medicines, how to support people with their fluid intake and the principles of the MCA including understanding of least restrictive practice. At this inspection we found the provider had not fully acted on these recommendations or made sufficient improvements.

Why we inspected

We received concerns in relation to the staff culture and safety of the service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. You can see what action we have asked the provider to take at the end of this full report. Since our inspection, the provider has started to take action to mitigate risks to people

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

Enforcement and Recommendations

We have identified breaches in relation to consent, safe care and treatment and governance at this inspection.

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

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

About the service

Heathcotes Yorkshire Supported Living Office provides care and support to people living in six 'supported living' settings, so that they can live in their own homes as independently as possible. The service supports people with a learning or physical disability, autism or mental health needs.

Not everyone who used the service received personal care. The Care Quality Commission (CQC) only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of inspection, the service was supporting six people with a regulated activity across two of the supported living settings.

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

Right support: Medicines management was not always in line with best practice guidance; staff did not have guidance in place to advise when to give people medicines prescribed ‘as and when required’ (PRN.) Risks to people had been assessed. People accessed specialist health and social care support where appropriate.

Right care: Staff had completed safeguarding training and understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Improvements to staff training and support meant staff had the appropriate skills and knowledge to meet people’s needs and keep them safe. Improved oversight by the provider supported the service to make changes and monitor the impact of these changes within the service, learning from mistakes and continuing to improve practice. Systems to protect people from the risk of infection had improved.

Right culture: The ethos, values, attitudes and behaviours of leaders and care staff were working towards ensuring people using services led confident, inclusive and empowered lives. Relatives felt improvements had been made in the culture of the service, the new manager was approachable and involved relatives in people’s care. However, relatives felt people using the service were not always encouraged to meet their aspirations and goals. People and those important to them, including advocates, were not always involved in planning their care. Reviews of care plans and best interests decisions did not always include relatives or professionals to ensure people received the most appropriate and least restrictive support.

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 (published 16 November 2022).

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.

At our last inspection we recommended that the provider improve practice in the principles of the MCA, dealing with complaints and supporting people to have a healthy diet. At this inspection we found the provider continued to require improvements regarding the principles of the MCA. Improvements had been made in relation to complaints and supporting people to have a healthy diet.

This service has been in Special Measures since 16 November 2022. 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 inspection was carried out to follow up on action we told the provider to take at the last inspection.

The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

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

Recommendations

We have made recommendations in relation to the principles of the MCA, medicines and supporting people to drink enough.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

About the service

Heathcotes Yorkshire Supported Living Office provides care and support to people living in six 'supported living' settings, so that they can live in their own homes as independently as possible. The service supports people with a learning or physical disability, autism or mental health needs.

Not everyone who used the service received personal care. The Care Quality Commission (CQC) only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of inspection, the service was supporting eight people with a regulated activity across two of the supported living settings.

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

Right support: The care provided did not maximise people's choice, control and independence. Support provided did not always promote daily living skills and access to a range of activities and events. Outcomes for people were not always positive.

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

Right care: People did not always receive safe care as staff were not always provided with the correct skills or were suitably deployed to meet the needs of people. Good practice guidance and organisational policies were not always consistently followed. Oversight of the supported living services was inconsistent.

Right culture: The ethos, values, attitudes and behaviours of leaders and care staff did not ensure people using services led confident, inclusive and empowered lives; Relatives spoke negatively about the culture of the service and felt unable to approach management with their concerns. Relatives felt the inconsistency of a management team within the service had impacted negatively on the service.

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 15 September 2021.)

Why we inspected

The inspection was prompted in part due to concerns received about the safety of care received in one ‘supported living’ setting. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.

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

The provider has taken action to mitigate the risks identified during inspection and regular meetings are being held to ensure improvements are made.

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

Enforcement and Recommendations.

We have identified breaches in relation to safeguarding, systems and processes, medicines, iInfection control, staff training and support and quality assurance. We have also made recommendations in relation to the principles of the MCA, dealing with complaints and supporting people to have a healthy diet.

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

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

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 the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Heathcotes Yorkshire Supported Living Office provides care and support to people living in six ‘supported living’ settings, so that they can live in their own homes as independently as possible. At the time of our inspection, the service was supporting 26 people with a learning or physical disability, autism or mental health needs.

Not everyone who used the service received personal care. The Care Quality commission (CQC) only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

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 the underpinning principles of Right support, right care, right culture. People had their own flats and received a personalised service, with choice and control. Staff promoted people’s dignity and privacy and human rights. There was a positive culture, where people and staff felt supported.

People received a responsive service from staff who were appropriately trained and supervised. There were enough staff to meet people’s needs and people received their medicines as prescribed. Staff assessed and mitigated risks to people’s safety and wellbeing.

People were supported with their nutritional and health needs. Staff worked with healthcare professionals and specialists when required, and maintained good records in relation to people’s health needs.

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. Staff sought people’s consent before delivering care and respected their choices.

Support plans contained information about people’s needs, preferences and goals, so staff had access to the information they needed to support people. People accessed activities and facilities in the community and there was a system to ensure any complaints were investigated and responded to.

We have made a recommendation about quality assurance. There was a quality assurance system and policies in place. However, some changes were needed to ensure any identified improvements were always made in a timely way and to make some aspects of policies and quality assurance more appropriate to the service model. The provider was already aware of this issue and working to address it.

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

Rating at last inspection:

This service was registered with us on 20 November 2019 and this is the first inspection.

Why we inspected:

This was a planned inspection based on the date of the provider’s registration.

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.