Blythe Bridge

Heathcotes (Blythe Bridge) is a residential care home registered to provide accommodation and personal care to up to eight people who have a learning disability. At the time of the inspection five people were in residence. Three people were away on holiday.

Heathcotes (Blythe Bridge) is located on two floors which is accessed via stairs. All bedrooms are single occupancy. Bath/shower rooms were located on both floors. People had access to communal areas and a garden at the rear of the property. People who use the service do not have any physical disability. Hence, there were no aids or adaptations in place.

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 and what we found

At our previous inspection we found there were insufficient staffing levels to meet people’s assessed needs. At this inspection the provider had taken action to ensure there were enough staff on duty. At our last inspection we identified that the provider’s governance was not entirely effective to monitor the staffing levels in the home. The provider had now taken sufficient action to address this.

People were protected from the risk of potential abuse because staff were aware of how to safeguard them. Risk management was effective to reduce the risk of harm to people. People’s prescribed medicines were managed by skilled staff. People were supported by staff to keep their home clean.

The undertaking of a care assessments ensured people received a service specific to their needs. Staff were skilled and had access to supervision sessions. New staff were provided with an induction to ensure they had the skills to care for people. People were supported by staff to purchase, prepare and to cook their meals. The registered manager worked with other agencies to ensure people received a safe and effective service. People were supported by staff to access relevant healthcare services when needed. The environment was equipped with all the essential furnishings to ensure people’s safety and comfort.

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.

People were cared for by staff who were kind and attentive to their needs. People were encouraged to be involved in decisions about their care which was delivered in a way that promoted their right to privacy and dignity.

People’s involvement in their assessment ensured their needs were met appropriately. People were supported by staff to pursue their interests. Complaints were listened to, taken seriously and acted on. At the time of our inspection no one was receiving end of life care.

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 service promoted a positive culture and the management team was described as supportive and approachable. Staff were clear of their roles and understood their responsibilities under the duty of candour. The provider engaged people and worked in partnership with others. The registered manager could demonstrate continuous learning to ensure people received a service specific to their needs.

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 9 November 2018).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

Heathcotes (Blythe Bridge) is a ‘care home’. 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.

The service accommodates up to eight people in one adapted building and at the time of this inspection, there were eight people living at Heathcotes (Blythe Bridge). 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.

There was a registered manager. 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.

At the last inspection, the service was rated as inadequate. This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

This is the first time the service has been rated Requires Improvement.

At the last inspection we found a number of breaches of regulations. At this inspection, sufficient improvements had been made to show the provider was no longer in breach of regulations, however further improvements and monitoring were required to ensure that improvements were sustained and built upon.

Improvements had been made to staffing levels to ensure there were enough staff to safely meet people’s needs. However, further work was required to ensure a consistent staffing level and to ensure staff were all suitably trained to provide safe and effective care.

People received their medicines as required, though more detail was required to ensure staff knew when, where and how to apply people’s prescribed creams.

People were treated with kindness and compassion, however there were some examples of staff using undignified language. We have made a recommendation about this.

People were safeguarding from abuse and the risk of harm. Their risks were assessed and managed to help keep them safe whilst protecting their freedom. People were protected from the spread of infection and the provider had learned lessons and made improvements when things had gone wrong.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. People’s needs were holistically assessed and met, including healthcare needs and they had access to healthcare professionals. The design and adaptation of the service met people’s needs.

Staff worked together and with other agencies and professionals to provide effective support. Staff had access to training and support to equip them with the skills and knowledge to care for people. People had access to a well-balanced diet, had choices and their independence was promoted.

People received personalised care as staff knew them well and supported them to access activities that interested them. People and relatives were involved in developing and reviewing their care and support plans. People had been supported to consider their wishes for end of life care.

People felt confident to complain if they needed to and felt the registered manager was approachable and supportive. Opportunities to provide feedback were available and feedback was used to make changes to the service.

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 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. 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 take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

Heathcotes (Blythe Bridge) provides accommodation and personal care for eight people who have learning disabilities and associated complex needs. 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. At the time of the inspection eight people were using the service.

There was a registered manager in post. 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.

There were insufficient numbers of staff to meet people's assessed needs and people were not being safeguarded from the risk of abuse due to a lack of staff to keep them safe. People's risk assessments were not always followed to minimise the risk of harm. This had resulted in people being harmed in the home and continuing to be exposed to the risk of harm. People's medicines were not always being administered safely.

The systems the provider had in place to monitor the quality of the service had not been effective. Prompt action had not been taken to improve the service for people. The provider had not taken action following incidents to protect people. The provider had not considered people’s experience of living in the home.

People's needs were not always identified and assessed effectively to ensure they would be met safely.

The provider was not effectively following the principles of the Mental Capacity Act 2005 and ensuring that when people lacked the mental capacity to agree to their care they were supported to do so in their best interests.

People who used the service were not always treated with dignity and respect. Staff did not always refer to people respectfully or understand their specific needs.

When people became unwell the appropriate health care support was gained in a timely manner and people were supported to eat and drink sufficient amounts to remain healthy.

People were offered choices and these choices were respected and people's right to privacy was supported.

The provider had a complaints procedure and responded to concerns raised appropriately.

People who used the service would be supported with decisions about how they wished to be cared for at the end of their life.

New staff were employed using safe recruitment procedures to ensure they were of good character to work with people who used the service.

Staff at the service felt that the registered manager was approachable and supportive and people who used the service were comfortable in the presence of the registered manager.

The registered manager knew their responsibilities in relation to their registration with us.

During our inspection we spoke with four people who used the service and five members of staff. The registered manager 'Ann Plant' was not on shift at the time of our inspection. People told us they were happy with their care. One person said, "I like being with the staff". Another person said, "I am happy now and I like my room".

We saw that people were involved in making decisions about their care and support. Effective systems were in place to enable staff to support people who found some decision making difficult.

The home was well led. We observed people being treated with care and compassion, by staff who had received training and support to enable them to meet people's individual needs. There was an effective system in place to ensure that people's care records contained accurate and up to date information to ensure people were kept safe.

People were supported to access food and drink, and staff were responsive to people's feedback about the food that they ate.

The home was suitably designed to meet the needs of the people who used the service. Effective systems were in place to check that the building was safe and in good condition.

On the day of our inspection we met four people using the service and observed how staff supported and cared for people. Three other people were engaging in activities in the community and were not present during our inspection.

We reviewed information about two people's care and found that their care needs were planned. We found that the staff understood people's care needs and how to protect them from risk and harm.

We saw staff respected people's privacy and dignity, and took account of what people had to say in relation to the way their care was provided. For example, we saw staff encouraged people to make informed choices about the food they ate and the social activities they participated in each day. We also saw people were actively encouraged and given support to maintain their independence and so far as possible to learn new skills.

The staff told us they enjoyed working at the home. We saw that all the checks were made to ensure they were fit to do their job.

There were systems in place to ensure people could raise concerns and improve the quality of the care received. We saw information which confirmed complaints were responded to and people were able to voice their opinions.