Archived: Heron House

Heron House is a residential care home providing care to three people who needed support with their mental health or living with a learning disability at the time of our inspection. The service can support up to six people in two buildings.

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

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.

People were at risk of harm from themselves and each other. When incidents occurred, there was a lack of oversight from the provider, which led to further incidents. The provider had not learnt from incidents. Staff did not have the training or the expertise to support people with their complex needs. There was a lack of guidance for staff to follow on how to support people to de-escalate situations. People were subject to abuse and had been physically harmed. The provider had failed to take action to review people’s welfare and inform the relevant stakeholders.

Risks to people’s health needs were poorly managed. Referrals to healthcare professionals had not been made when required. People told us they were unhappy living at the service. Staff who lacked knowledge about Mental Capacity had placed unnecessary restrictions on people and this had not been identified by the provider. The provider oversight was poor and ineffective. The provider failed to address concerns raised at our last inspection on 4 August 2020. At this inspection we found the service had further deteriorated. People had not been involved in making decisions about the service. When suggestions had been made by people, these had not been implemented by staff and management. There was a negative culture at the service, which was not person centred.

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 guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting the underpinning principles of Right support, Right care, Right culture. People had unnecessary restrictions placed on them, which triggered incidents of behaviour that could be challenging. Some parts of the service were restricted, for example the kitchen, a communal bathroom and the office. Staff did not have the competencies and skills to support people in a person-centred way, which had a negative impact on people. The provider had not taken action to address these shortfalls.

Right support:

• Model of care and setting did not maximise people’s choice, control and Independence

Right care:

• Care was not person-centred and did not promote people’s dignity, privacy and human Rights

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff did not ensure people using services lead confident, inclusive and empowered lives

Following this inspection, we worked closely with the local authority (Kent County Council) to ensure people were safeguarded from ongoing harm. One person was supported to move out of Heron House, and alternative placements are being sought for all service users.

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 Requires Improvement (published 24 September 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about incidents between people, allegations of abuse and staff competencies. A decision was made for us to inspect and examine those risks.

We reviewed the information we held about the service. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Requires Improvement to Inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe 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.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Heron House on our website at www.cqc.org.uk.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified continued breaches in relation to safe care and treatment, staffing, good governance, and new breaches in relation to safeguarding and notifications of other incidents at this inspection.

Following the inspection, we took immediate action to restrict admissions to Heron House. We took action against the provider and cancelled their registration for Heron House. Everyone who received a regulated activity has moved out of the service, and we have de-registered Heron House with the Care Quality Commission.

Heron House is a residential care home providing personal care to three people who need support with their mental health or living with a learning disability at the time of the inspection. The service can support up to five people.

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

People, relatives and staff informed us they had been very unsettled by the lack of continuity with the management and staffing at the service. There had several managers at the service within the past twelve months which people told us was ‘unsettling’.

Risks to people were known, however staff did not have a good understanding of how to manage these risks following an incident, placing the person at potential further harm. Accident and incident records were not reviewed by the provider to make and embed improvements. The provider did not ensure there were sufficient suitably trained staff.

There was a new manager in post at the time of our inspection, who had been introduced to people and their relatives. Staff told us they saw some improvements. However, the provider had not acted quickly enough to address long standing short falls. This included oversight of accidents and incidents and training of staff to support people.

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 Good (published 15 March 2018).

Why we inspected

We received concerns in relation to the management of medicines, staffing and risks to people. 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 at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe 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.

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

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection, the service was rated ‘Good’. At this inspection we found the service remained Good.

Heron House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Heron House provides accommodation and personal care to up to five people who might need support with their mental health or may be living with a learning disability. There were five people living at the service when we inspected.

The 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 using the service can live as ordinary a life as any citizen.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible, the policies and systems in the service supported this practice. People had identified goals they wanted to achieve and had been supported to achieve these. People were able to follow their hobbies, attend higher education and meet friends and family.

People were supported by enough trained staff who knew how to recognise abuse and discrimination. Staff had been recruited safely. Staff knew people well and the support they needed, there was an open and transparent culture within the service. There was mutual trust and respect between people and staff. People’s privacy and dignity was respected. People and staff were seen as equal with everyone’s views being respected.

People’s support plans gave staff clear guidance about how to support people in the way they preferred. Support plans were reviewed regularly with people and their representatives to ensure everyone received the right support. People’s support plans and other records were held securely and people had been asked how they would like to be supported at the end of their life.

The premises suited people’s needs. People were involved in cooking their meals and encouraged to choose the meals they wanted. People received their medicines when they needed them and to attend healthcare appointments to stay as healthy as possible. People were involved in making decisions about the service. Staff managed potential risks to people so they were not restricted. People were encouraged to lead healthy lives and were supported to enjoy swimming and walking.

The registered manager was experienced and skilled at supporting people with learning disabilities. The registered manager and staff had a clear vision for the service and worked as a team to ensure people received the support they needed. Audits and checks were completed, shortfalls were identified and rectified to continuously improve the service. People knew how to complain. Any complaints, accidents and incidents were reviewed and lessons learnt.

The building had been adapted to meet people’s needs and people were able to decorate their rooms as they wanted. People were supported to keep their home clean and complete household tasks.

The registered manager had notified the Care Quality Commission of events that were reportable.

The rating of ‘Good’ was displayed at the service and on the provider website.

People said that they were happy with the care and support they received and that their needs were being met in all areas. They said that the staff treated them with respect, listened to them and supported them to raise any concerns they had about their care. People told us that the service responded to their health needs quickly and that the manager talked to them regularly about their plan of care and any changes that may be needed.

Many comments received were complimentary of the service. One person who used the service said 'I like it here' another said 'We go out with staff and do many things, like doing my own shopping. I love it here. Staff help me with my money and cooking'. Other people were complimentary of the food and had no concerns re the quality of care. Another said 'Staff help me a lot, with my money and things. I am happy here'.

People received support to maintain a healthy lifestyle. They were supported to attend health care checks and community health professionals were involved to provide advice and support when needed. People were supported to express their views and make important decisions because the staff supported them with their communication and spent time with them. People said they felt safe and there were systems in place to make sure people were protected from abuse.

The home was spacious, airy and well maintained. People had their own personal space and could also spend time with each other in the communal parts of the home.

There were plenty of staff to support the people using the service. Staff said they enjoyed working at the home and said they were well supported by the manager.