Archived: Heathers

Updated 21 October 2020

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Due to the Covid 19 epidemic the first day of inspection was carried out by visiting the service. The second days were carried out remotely. This means we made calls to staff and relatives away from the site and asked for documents to be sent to us.

Inspection team

This inspection was carried out by two inspectors.

Service and service type

Heathers 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.

The service did not have a manager registered with the Care Quality Commission. A registered manager and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. The registered manager had left at the time of the last inspection and the provider had placed an interim manager in the service. The provider’s operations manager was also based at the service and the chief operating officer was supervising the interim manager.

Notice of inspection

This inspection was unannounced.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority. The provider was not asked to complete a Provider Information Return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with one person who used the service and three relatives about their experience of the care provided. We emailed all staff at the service for feedback and received responses from 10 staff.

We spoke with 10 members of staff some of these were staff who had provided email responses, other staff we spoke to when we visited the service including the interim manager, the operations manager, deputy manager, and care workers.

We reviewed a range of records. This included five people’s care records and multiple medication records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We gained feedback from three professionals who regularly visit the service.

Updated 21 October 2020

About the service

Heathers is a residential care home providing personal care to eight people with learning disabilities, autism and mental health conditions at the time of the inspection. The service can support up to nine people. The care home accommodates people in individual self-contained apartments with ensuite bathrooms, kitchen and living area. Two apartments are in the main ‘farmhouse’ and the remaining accommodation is around an adjacent courtyard. There is communal outdoor space and a communal activity room.

The service had not been developed and designed in line with the principles and values that underpin Registering the Right Support. The service was in an isolated location at the end of a mile long un-made road. There was no nearby local community for people to engage with. People were supported on a one to one basis in their own self-contained apartments and little attempt was made to help them socialise with each other.

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

At our last inspection we found evidence of a closed culture where staff failed to report concerns and escalate them to managers. There was evidence of incidents of abuse by staff. At this inspection while we found that some staff had left the service which improved the atmosphere in the short term, the provider had failed to address the concerns about the poor culture. They had not ensured staff understood how to report and escalate safeguarding concerns. There was no clear leadership in the service, with repeated changes of management. The provider had poor oversight of the service and had not identified that their own targets and timescales for change had not been met. Communication with people and their relatives was poor. The service did not actively engage the support of professionals to improve the quality of care for people unless it was at crisis point.

Action was not taken in response to safeguarding recommendations. The service failed to properly assess and manage risks, particularly risks in relation to people’s distressed behaviours. People’s risk assessments and care plans were out of date and did not contain accurate guidance on how to support people. Records were not reviewed following incidents. The provider had not reviewed the guidance and assessed risks in relation to Covid 19. Staffing levels had improved since the last inspection, however there were still significant gaps in the evenings where there were insufficient staff to support people safely. There were occasions at night when there were not enough staff on duty and on one of these occasions a serious incident had occurred which could have resulted in harm to people living at the service and staff.

The service did not apply 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. There was a closed culture that did not support people to have choice and control. People were not supported to engage in meaningful activities either within the service itself or in the local community. People were not supported to develop skills to support their independence.

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 inadequate (published 16 April 2020) and there were multiple 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 enough improvement had not been made and the provider was still in breach of regulations.

This service has been in Special Measures since 15 April 2020.

Why we inspected

The inspection was prompted in part by concerns relating to notification of an incident which could have resulted in serious harm to staff and people using the service. These concerns related to the management of risk in relation to people’s behaviours. When we followed up our concerns it became apparent the provider had not made the improvements they said they would make following our last inspection. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

The overall rating for the service has stayed the same. This is based on the findings at this inspection.

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

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 breaches in relation to safe care and treatment, safeguarding, staffing, governance, notification of other incidents and duty of candour at this inspection.

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.

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.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.