Agbrigg and Sandal

Heathcotes (Wakefield) is a residential care home providing personal to 18 people living with a learning disability at the time of the inspection. The service has two houses known as Agbrigg House and Sandal House. Each house can accommodate up to 8 people. The service also has 4 individual flats where people live semi-independently. The service can support up to 20 people.

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 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.

The service was designed to support people living in two eight bedded homes and four individual flats which promoted people’s independence. People had access to outside space, and this had been designed to meet their needs. People were supported to maintain a clean home with assistance from the staff team. People received their medicines as prescribed.

Right Care

People received support from staff who knew them well and understood their needs and considered their preferences. Staff interacted well with people and had a caring and respectful approach.

We found healthcare professionals had been referred to appropriately and staff ensured their advice was followed.

Right Culture

People were supported to lead lives that were person-centred and inclusive. People were involved in planning their support and deciding how they wanted staff to support them to meet their outcomes and achieve their goals.

Overarching governance systems included a series of audits which checked areas such as medication management, infection control and care planning. Action plans were used to develop and improve 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 and update

The last rating for this service was requires improvement (published 1 February 2021) and there were two breaches of regulation. 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.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions of Safe, Responsive and Well-led which contain those requirements.

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 changed from requires improvement to good. This is based on the findings at this inspection.

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 COVID-19 and other infection outbreaks effectively.

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

Follow up

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

Heathcotes Wakefield is a residential care home providing personal care to 18 people at the time of the inspection. The service can support up to 20 adults with learning disabilities and complex needs.

Heathcotes Wakefield supports people in two single storey houses and a building containing three flats, on shared grounds.

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

Staff deployment to meet people’s needs was not clearly demonstrated, particularly where some people required 2:1 support, or when staff had been deployed from other parts of the service.

Individual risks to people were clearly documented in their support plans and staff were confident in their understanding of these. However, some other risks were not well assessed or managed thoroughly to ensure people’s safety, such as kitchen refurbishment work taking place and the risk of infection from COVID-19.

Many infection prevention and control measures were in place and known by staff, with regular daily regimes including cleaning and health monitoring. However, personal protective equipment was not always worn correctly to prevent the spread of infection.

Safety related training for positive behaviour support and medicines had not been robustly carried out in line with the organisation’s policy. The management team told us this was as a result of training restrictions during the COVID-19 pandemic. Staff reported a lack of confidence in dealing with behaviour that challenged them.

Medicines were managed safely overall, with clear daily recording. People were supported individually to receive their medicine and procedures were clear.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always align with the practice. Positive behaviour support plans were in place, although these were not consistently adhered to and there was a lack of robust debriefing or management scrutiny of incidents where restraint had occurred.

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 some of the underpinning principles of Right support, right care, right culture.

Right support:

• Model of care and setting did not always maximise people’s choice, control and independence. People accessed the community only when staff deployment enabled this.

Right care:

• Care was not always person-centred and did not consistently promote people’s dignity, privacy and human rights. Staff interacted with people in positive ways, although spoke about people rather than with them at times. Some interaction did not fully consider people’s rights.

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff had not always ensured people

using services led confident, inclusive and empowered lives. The new manager was working closely with senior managers and support staff to improve the culture in the service.

The service had recently experienced changes in the management and there had been some emerging concerns which had not been identified through the routine quality assurance processes. The provider was swift to act upon concerns and was working hard to address issues raised through safeguarding and the inspection process.

We made recommendations in relation to staff skills, interaction and deployment which impacts upon their ability to provide person-centred care, and closer management scrutiny of risks and incidents.

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 22 May 2018).

Why we inspected

We received concerns in relation to inappropriate use of power and misuse of restraint, poor management and poor staffing culture. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led. 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.

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.

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

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

We have found evidence that the provider needs to make improvements. Please see the key questions sections of this full report.

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 arusing 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 regulatroy functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identfied breaches in relation to keeping people safe from the risk of infection and providing care which meets people's individual needs and preferences. Please see the action we have told the provider to take at the end of this report.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the key questions sections of this full report.

Since concerns were identified and discussed with the provider, there had been closer scrutiny and monitoring of quality in the service, with a change of manager and additional presence of the senior management team.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Heathcotes Wakefield 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.

Heathcotes (Wakefield) 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 provides residential care for up to 20 adults with learning disabilities and complex needs, and is located in a quiet area close to the centre of Wakefield. The service is split into two houses and a building containing three flats. These buildings are within shared grounds. There were 19 people using the service when we inspected.

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 were two registered managers in post when we inspected. 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 was an excellent, person-centred culture in the service, driven by a committed management team that led by example and supported their staff at all times. Staff were passionate about providing excellent care and support that was tailored to and respected each person’s individual needs and preferences. People’s care plans were detailed, person-centred and the provider ensured key information was available for people in formats accessible to them.

Staff were recruited safely, well trained and told us they were proud of the work they did. Staff were deployed in sufficient numbers to provide safe support when people needed it, and we saw staff managed challenging behaviours confidently and effectively. There was a low level of use of ‘as and when’ medicines in the management of behaviours that challenge. Staff training and practice meant people were safeguarded from potential abuse.

There were good controls in place to ensure the safe ordering, checking, storage and recording of people’s medicines. We saw records were fully completed with no gaps, and saw staff had a detailed handover of medicines at each shift change to ensure any issues were identified in a timely way.

People lived in a well maintained home and were encouraged to help in keeping it clean. The home had a very relaxed atmosphere, which we observed people were comfortable in. Staff and people who used the service clearly knew each other well and we observed appropriate banter which people enjoyed.

People were able to maintain and develop activities they enjoyed and encouraged to increase their independence whenever they were able. This included accessing local amenities and experiences of working in environments meaningful to the individual. 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.

There were clear processes in place to ensure concerns and complaints from people or their relatives were investigated and actioned as necessary, with people being updated as to the outcome. Some concerns which people expressed indirectly were addressed through changes to care plans and other routines, meaning the service was responsive to feedback received in a number of ways.

The provider had mechanisms in place to ensure people who used the service, staff and other people such as commissioners, social care professionals and families could provide feedback which helped drive improvements in the service. People were asked for feedback and we saw action was taken as a result. Staff told us their suggestions were welcomed and respected. Where people may have had concerns about the service or wished to make a formal complaint we saw there were processes in place which ensured concerns were addressed and the quality of the service improved.

The management team were highly committed to making continual improvements to the service, and had very effective systems in place to monitor quality and take action when needed. There was a very person centred culture in the service, and we found everyone who worked at Heathcotes (Wakefield) was committed to delivering a high standard of care and life experience for people. We saw examples of good partnership working with other agencies and professionals involved in people’s care, and evidence of good equality and diversity training and practices in place.

A family member of a person who used the service told us “I can’t praise the managers and the staff team here enough. They have been outstanding with (relative); they made more progress with them in a short time than anyone else ever has.”

Health professionals who worked with people who use the service told us “The registered manager is really good. They always make time to have a meeting with me when I come into the service, so they know what is happening with people who use the service.” “The service is really pro-active; they are always suggesting and trying new ways to help people. The thing I like most about the service though is that they don’t give up at the first hurdle like a lot of places do, they persevere and make a real difference to the lives of the people they support.”

Staff told us, “The manager is brilliant, they get involved and their door is always open. I feel safe working here as I am supported by the manager and the rest of the staff team.”

The atmosphere in the homes was warm and welcoming from the people who used the service and the staff team. The staff team worked well as a team and communicated effectively to pass on information they needed to keep everyone safe without people who used the service feeling they were being talked about, or hearing information about others which would have been inappropriate.

Staff told us that the registered manager was very visible and accessible; we saw this to be the case during the inspection. Staff understood their roles and responsibilities which meant people were able to work cohesively as they were clear about what was expected from whilst they were on duty.

Communication throughout the staff team was open and staff demonstrated their understanding of the responsibility they had to make sure that people were safe and were supported to make positive changes to their lives and achieve their potential. The staff team were passionate about their roles and were proud of the service they provided.

The registered manager and the regional manager were committed to the continuous improvement of the service Heathcotes was providing. They understood the importance of accountability and were able to evidence that there were processes in place which assured where necessary people were held accountable for their actions. We found the home was meeting the registration requirements as a registered service provider, as they were sending in notifications to tell us when a notifiable event had occurred.

Heathcotes employed a behavioural psychologist, who had previously worked with people in the service as a community based health professional. The purpose of their appointment was to work with people who had personality disorders which caused them to display suicidal behaviour or to harm themselves. There was a group starting which was based outside of Heathcotes in a community setting to work with an identified group to improve their self-image, allow them to understand their emotions and to prepare them for more traditional forms of counselling in the future if this was required. As part of this project there were opportunities being offered to existing staff to become involved in the group and to undertake specialist training to become skills trainers to share this valuable knowledge to other staff in the home. This showed that the registered provider was looking for ways to work in partnership with others and to offer opportunities for staff to develop and progress within the organisation.

We asked staff about the organisations visions and values, staff told us, “The vision is for us to support people to have a better quality of life.” Another member of staff told us “We take people when they are at a low point, sometimes because their previous placement has broken down, and we support them to make a difference to how they live their life.”

We looked at the auditing and oversight which was in place. The registered manager told us there was an auditing team who regularly visited the home and carried out extensive auditing, looking at all areas of the provision. The frequency of the visits was reliant on the score which was achieved at each visit. We reviewed the audits which had been carried out by the auditing team and found them to be extremely thorough. The external auditing team looked at all the internal audits which had been carried out by the registered manager; they also independently audited records and documents to check that the audits were accurate.

The report which was created highlighted areas of good practice and gave actions for any areas which were identified for improvement. The actions were then followed up at the next visit and via contact with the registered manager between visits for anything with a shorter deadline. The report also contained useful graphs showing the scores which had been achieved in each area by visit to allow the reader to instantly see whether there was improvement or deterioration. This meant that the registered manager and the registered provider had clear oversight of all aspects of the quality of the service being delivered and there were measures in place to ensure that all required improvements were made in a timely manner.

The health professionals we spoke with told us the registered manager and staff team at Heathcotes were proactive and dedicated. They told us they worked very well with community based health professionals and they were always made welcome when they visited people they supported at the home.

People's comments included:

'I like it here. Staff are good.'

'The staff are great they are there when you need them.'

We saw staff being kind and respectful towards people. We observed that staff and service users had positive relationships and people appeared comfortable with their surroundings; with staff and the activities they were engaged in.

We saw that people's rooms were personalised to reflect their individual tastes and interests, which made their rooms more personal and homely.

We saw written risk assessments had been completed which showed potential risks, and how they could be minimised. We found risk reduction plans were put in to place for different activities with different people. Specific activities and support had been risk assessed and showed what action should be taken to ensure that people were safe without restricting their independence.

We spoke with a relative of people who receive support within their own homes. They spoke very highly of the service and said they could not praise the staff highly enough for the way they relate and support their relative.

The valuing of people's diversity and human rights was evident within care planning and in how support was offered.