Archived: Heathcotes (Hollyfield House)

Heathcotes (Hollyfield House) is a residential care home providing personal care to 6 people at the time of the inspection. Heathcotes (Hollyfield House) accommodates up to 9 people in one adapted building.

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

People were kept safe from the risks of infection by staff who adhered to infection prevention and control measures in place.

People were supported to maintain relationships with people who were important to them. Staff had completed thorough risk assessments to facilitate people being able to see their families.

Staff completed regular cleaning of the service. However, they did not always record the cleaning they had done.

People and staff were supported to engage with testing for Covid19 in line with government guidance.

Some staff had attended training in Covid19 but not all staff. The manager had explained infection prevention control measures in staff meetings.

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.

This inspection was a targeted inspection and so did not consider all the areas required to make a judgement about whether the service was adhering to the underpinning principles of Right support, right care, right culture.

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 22 August 2019).

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about staff adherence to Personal Protective Equipment guidance. The overall rating for the service has not changed following this targeted inspection and remains Requires Improvement.

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. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

Heathcotes (Hollyfield House), is a residential care home providing 24-hour support for adults with a learning disability, autism, epilepsy and associated challenging behaviour. The service has nine en-suite bedrooms over three floors. It has two lounges, two kitchens and a well-maintained garden area. At the time of our inspection eight people were using the service.

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

Risk assessments in place were detailed and person centred. However, some people’s risk had not been identified and some equipment that was used to help manage people's risk was not checked or working as it should do. People received their medicines when they needed them but the room people’s medicines were kept in was too hot and no measures were in place to reduce the temperature. This meant some people’s medicines may not be safe or work very well.

There were enough staff to keep people safe. However, some staff did not always receive their induction training before they started to work at the service and some mandatory training for existing staff had not been completed or had not been refreshed. This meant some staff may not have the skills and knowledge they needed to support people.

The service applied the principles and values of Registering the Right Support. This meant people who used the service were able to live as full a life as possible and achieve good outcomes that include control, choice and independence. However, some best practice and legislation around how people were supported in the least restrictive way possible and in their best interests had not been followed.

Staff knew how to keep people safe and used many different ways to communicate with people to find out how they were feeling and what choices they wanted to make. Care records helped staff know what was important to people and how they wanted to be supported. Information was available for people in a way they could understand.

Staff supported people to follow their interests in the community and at the service. They helped people keep in contact with their family and friends. During our inspection people were very active getting ready with staff to go out or making plans for their day.

The manager had joined the service in the last six months and people and staff liked him. He was working hard to make the improvements needed. The provider was making regular checks on the service to make sure people had the care and support they needed. When issues were identified they were working with the manager to make things better for people.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.

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 (report published 09 January 2018).

Why we inspected

The inspection was prompted in part by risks identified at other Heathcotes services, these included risks around poor restraint practices, risk management, staff training and governance. A decision was made for us to inspect and examine those risks as part of a comprehensive inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective 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 acted to reduce the risk to people and has supplied full details of how they are making changes to make things better or people.

Enforcement

We have identified breaches in relation to people’s risk, staff training and support, people being deprived of their liberty unlawfully and how the service is managed.

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 for the provider to understand what they will do to improve the standards of quality and safety. 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.

Heathcotes, Hollyfield House, is a specialist residential care home providing 24 hour support for adults with a learning disability, autism, epilepsy and associated challenging behaviour. The service has nine en-suite bedrooms over three floors. It has two lounges, two kitchens and a well maintained garden area. At the time of our inspection nine people were using the service. 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.

We met with the manager at this inspection who was in the process of becoming a registered manager with the CQC. Shortly after our inspection we received confirmation that they had successfully registered for the service.

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.

Staff knew how to keep people safe at Heathcotes, Hollyfield House. Systems and processes were in place to protect people from harm and people and staff were encouraged to raise concerns.

People were protected from risk, while minimising restrictions on people’s choice and control. Staff knew how to support people and manage their risks while giving them the independence and freedom to try and experience new things.

There was enough staff to keep people safe and meet people’s individual needs and people were supported by a consistent staff team that gave people continuity of care. Staff attended training which gave them the knowledge and skills to support people effectively. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible.

Staff actively encouraged and supported people to be involved in the interests and activities they enjoyed.

Medicines were managed safely and people received their medicine when they needed it. The service was clean and well maintained.

Staff worked hard to ensure people had a choice of food and were able to try and experience different food and flavours if they wanted to and different food choices were also available. Staff supported people to access the healthcare services they needed to maintain their health and referred people to specialist support when necessary.

Care records were focused on each person and gave a complete picture of the individual including their physical, mental, emotional and social needs. Staff understood the best ways to communicate with people and used a range of techniques including visual systems to help people communicate their needs. Recognised techniques were used to enable staff to support people as individuals when they became upset or anxious so people experienced positive outcomes in terms of managing behaviour which challenged others.

The provider listened to and acted on complaints. Information was available for people and their relatives to make a complaint and relatives were confident the registered manager would respond appropriately if they raised any concerns.

Leadership was visible across the service and the registered manager, regional manager and staff had a good understanding of their roles and responsibilities. The provider had a range of audits in place to assess, monitor and drive improvement. When things had gone wrong lessons were learned and this was shared across the service.