Archived: Rother Heights

Rother Heights is a care home. People living 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.

Rother Heights can accommodate up to 28 people. At the time of our inspection 23 people were using the service. The service comprises of a complex of four bungalows and an office block. Each bungalow has six bedrooms with en-suite facilities. There are also two other houses nearby which can each accommodate up to two people.

The service has not 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 were not receiving planned and co-ordinated person-centred support that was appropriate and inclusive for them.

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

People were not safe. They were not adequately or effectively protected from the risk of abuse. The registered provider had a system in place to safeguard people from the risk of abuse. However, systems to keep people safe had failed and safeguarding referrals were not always made. Staff did not always communicate effectively to ensure safeguarding concerns were reported to the safeguarding authority. Safeguarding referrals were not consistently made to the local authority safeguarding team when allegations of abuse were made, or incidents were witnessed in the service. During this inspection we identified safeguarding concerns which were reported to the safeguarding authority and an incident that we asked the provider to report to the Police.

The service did not consistently comply with their duty to inform CQC of information relating to the safety of people.

Medicines was not always administered safely. Some medicines prescribed 'as required' were not being managed effectively to ensure people received these as prescribed to ensure peoples safety.

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. We identified there was an excessive use of restraint taking place, without consideration of people’s best interests.

There was a lack of regard for people’s human rights. There was a culture in the service where people were not respected as individuals and their rights were not upheld.

Risks associated with people's care and treatment were not always identified or managed safely. This put people at significant risk of not receiving the right support to meet their needs and showed the registered provider was not doing all that was reasonably practicable to mitigate risks associated with people's care and treatment.

We completed a tour of the home and found a number of environmental risks which had been identified by us on a previous inspection had still not been addressed. We found risks in relation to fire safety had still not been adequately managed.

Accident and incident analysis were still not sufficiently taking place and there was no evidence that trends patterns were being identified, or that actions had been taken to reduce hazards in relation to people's care and treatment. Analysis that had taken place was not effective as it didn’t show a true reflection of the number of incidents that had taken place or take in to consideration the impact from the severity of incidents to reduce risk to people and improve their well-being.

People were not always provided with access to healthcare professionals.

The provider had not ensured that staff received training to carry out their role. Training that had been completed was not effective. Staff told us they received one to one session with their line manager but told us they didn’t feel listened to, so this was also ineffective. We also found there were not enough suitable staff to support people. A large number of regular staff were leaving and there was a high use of agency staff who were not adequately trained to support people who needed specialist interventions to keep them and others safe.

People's needs, and choices were not always assessed, and care and treatment were not always delivered in line with current legislation and best practice standards.

Staff told us people were supported to receive adequate nutrition and hydration that met their needs. There was a plentiful supply of food available, but we saw that people’s choices of what they would like to eat and where they could eat meals being restricted by staff.

We spent time observing staff interacting with people and found there were some kind and caring interactions taking place, however this was not consistent. We also observed some undignified interactions between staff and people. Staff were waiting for incidents to occur rather that ensuring the correct support was in place to minimise triggers which may cause distress to people. People’s behaviour was seen first and foremost, this prevented people from being treated like as individuals in accordance with their own human rights. Staff were custodial in their approach to care for people rather than supporting them to live a full and active life.

Information about people was not kept confidential.

The service rarely 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 did not fully reflect the principles and values of Registering the Right Support for the following reasons. People were restricted by lack of choice, control and community participation, there was limited staff which prevented people from being able to access the community when they chose.

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

Rating at last inspection for this service was inadequate (last report was published 14 February 2019)

At the last inspection we identified eight breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to submit copies of monthly reports for areas of particular concern. The provider had been submitting this information to the Commission.

At this inspection not enough improvement had been made or sustained and the provider was still in breach of regulations and the service had further declined.

Why we inspected

The inspection was prompted in part due to concerns received about staffing, practice concerns and risk. A decision was made for us to inspect and examine those risks.

This inspection identified eight continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and there were significant concerns about the suitability and safety of people.

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 remained inadequate. This is based on the findings at this inspection.

We found evidence during this inspection that people were at risk of harm from the concerns we found. We made commissioners and other stakeholders aware of our concerns.

Enforcement

We identified eight continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Follow up

Following the inspection, we wrote to the provider requiring them to take urgent action to address these risks and protect people from further risks.

Due to the level of our concern, we made an urgent application to the Magistrates Court to immediately cancel the registration of this service. The Order was granted on 10 July 2019 and the remaining people living at the service were moved out that day.

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

The last comprehensive inspection took place in November 2017, when the provider was rated as good. At this inspection we found the service had declined and was rated inadequate. You can read the report from our last inspections, by selecting the 'all reports' link for ‘Rother Heights’ on our website at www.cqc.org.uk.

Rother Heights is a care home. People living 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 care service had not been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. The values of choice, promotion, independence and inclusion, which the guidance promotes were not being provided for people who used the service at Rother Heights. This meant the people they supported with learning disabilities and autism were not able to live as ordinary a life as any citizen.

Rother Heights can accommodate up to 28 people. At the time of our inspection 26 people were using the service. The service comprises of a complex of four bungalows and an office block. Each bungalow has six bedrooms with en-suite facilities. There are also two other houses nearby which can each accommodate up to two people.

At the time of our inspection the service had 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. However, the registered manager was not at the service at the time of our inspection and there were two regional managers overseeing the service.

Risks associated with people’s care and treatment were not always identified or managed safely. This put people at risk of not receiving the right support to meet their needs and showed the registered provider was not doing all that was reasonably practicable to mitigate risks associated with people's care and treatment.

We completed a tour of the home and found a number of environmental risks which had not been identified prior to our inspection.

We found risk in relation to fire safety that had not been managed.

Accident and incident analysis was not taking place effectively and there was no evidence that trends or patterns were being identified, or that actions had been taken to reduce hazards in relation to people's care.

Medication systems were not followed; therefore, it was not evident people received their medication as prescribed.

People were not effectively protected from the risk of abuse. The registered provider had a system in place to safeguard people from the risk of abuse. However, we found staff did not always communicate effectively to ensure safeguarding concerns were reported to the safeguarding authority. During this inspection we identified two safeguarding concerns which were reported to the safeguarding authority.

The provider did not ensure that there were enough numbers of suitable staff to support people to meet their needs. We saw staff took breaks without replacing their role and people were not supported by the assessed number of staff required to meet their needs.

The provider ensured that staff received training to carry out their role. However, training was not effective. Staff told us they received one to one sessions with their line manager but there was no evidence to support this.

People’s needs and choices were assessed but care and treatment was not always delivered in line with current legislation and standards.

People were not always provided with access to healthcare professionals.

People were not supported to have maximum choice and control of their lives and staff did not support people in the least restrictive way possible.

Staff told us people were supported to receive adequate nutrition and hydration that met their needs. However, this was not evident from records or food available in the service.

We spent time observing staff interacting with people and found they were not always kind and caring. Staff were task focused and waited for incidents to occur rather that ensuring the correct support was in place to minimise triggers which may cause distress to people. Staff did not always recognise when people needed support and did not always engage appropriately with family members to ensure their relatives needs were met. Information about people was not kept confidential.

We found people did not receive care and support that was responsive to their needs. Care plans we looked at were not always followed in line with people's current needs.

From our observations people were not being actively supported. Active Support changes the style of support from 'caring for' to 'working with', it promotes independence and supports people to take an active part in their own lives. Active Support enables people with learning disabilities to live ordinary lives.

Audits were in place to ensure the service was working to the providers expected standards. However, checks completed as part of the providers audit systems by staff were not always taking place. Where the checks had been completed they were not effective and did not identify the concerns we had raised as part of this inspection. The registered manager did not have an oversight of the service and the responsibility of completing the checks was left with the house managers.

The provider had a complaints policy and procedure in place. However, we found people were not always listened to and were not confident that if they raised a concern it would be dealt with.

We found eight breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were breaches in; Regulation 9; person-centred care. Regulation 10; dignity and respect. Regulation 11 need for consent. Regulation 12; safe care and treatment. Regulation 13 Safeguarding service users from abuse and improper treatment. Regulation 15; premises and equipment. Regulation 17; good governance, and regulation 18; staffing. You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC's regulatory response to the more serious concerns found during inspections are added to reports after any representations and appeals have been concluded.

The provider has provided an action plan and a new management team has been put in place to support the service to drive improvements.

The overall rating for this service is 'Inadequate' and the service is therefore in 'Special measures.’

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.

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.

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.

Rother Heights provides accommodation for up to 28 people and specialises in care for people with autism. The service is a purpose built complex comprising of four bungalows and an administration block. Each bungalow has six single bedrooms with en-suite facilities. There are also two other houses nearby which can each accommodate up to two people.

There was a registered manager employed at the service. A registered manager is a person who has registered with the CQC 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. The registered manager was responsible for the day to day control of the service.

People continued to receive care and support from staff who understood how to keep them safe. Staff understood how to protect people from abuse and were clear about the steps they would need to take if they suspected someone was unsafe. Staff were available to meet people's needs and understood how to best support people and the risks to their well-being. People were supported by staff to have their medicines as prescribed and checks were made to ensure staff supported people with their medicines appropriately.

People received effective care and support from staff that had the skills to meet their individual needs. Staff were supported by the management team through regular supervisions and staff meetings. Staff understood they could only care for and support people who consented to being cared for and throughout the inspection we saw people supported to communicate their choices. Staff supported people in the least restrictive way possible; the policies and systems in the service supported this practice.

People were supported to have a balanced diet. People were involved in decisions about what they ate. Staff monitored people's nutritional needs to help them stay healthy. Risks to people with complex eating and drinking needs were identified and monitored. We saw people were encouraged to be involved in the preparation of food and drinks. Staff responded when people were unwell and arranged appropriate healthcare appointments in support of people's well-being.

People continued to receive support from caring staff who treated them with dignity and respect. We saw people were happy in the company of staff, who they looked to for support and reassurance when needed. People were involved in how their care and support was received and their choices were respected by staff.

The service remained responsive. Staff provided care that took account of people's individual needs and preferences. People and their relatives were listened to and felt confident they could raise any issues should the need arise and action would be taken.

There was a culture of openness, inclusivity and empowerment which was promoted by staff. Clear visions and values were understood and promoted by staff to make sure people received care and support in a dignified, respectful and compassionate way. Robust auditing processes were in place to check the quality and safety of the service provided. The registered manager had submitted notifications about important events that happened to CQC in an appropriate and timely manner and in line with guidance.