St Anne's Community Services - Heatherstones

About the service

Heatherstones is a residential home providing personal and nursing care to people with learning and physical disabilities. The service can accommodate up to a maximum of 8 people. At the time of our inspection, there was 7 people using the service. The home accommodates people on one floor with communal areas and bathrooms.

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

Right Support: Medicines were not managed safely. We found concerns with medication administration records, controlled drugs, and use of thickeners. There was no call bell system in place. It was unclear how staff were alerted of any emergencies or upon request by people. It was unclear if and how people had been involved in making decisions about their care. There was no evidence in care plans of this. There was a lack of involvement from people around choosing their meals. The service cared for people in a clean and well-maintained environment that met their physical needs. Safety checks were taking place on the equipment. Personal emergency evacuation plans had been updated to include more information about how people should be supported. People were not always supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Care: People were safeguarded from the risk of abuse. People had care plans and risk assessments in place outlining how they should be supported. People were supported to routine health appointments. Health concerns were raised with professionals promptly. Staff supported people in a dignified way. Appropriate DoLs applications were in place for people.

Right Culture: There was no use of signs, pictures or aids to navigate people around the home. We made a recommendation that easy read signs are used around the home to orientate people. There was a lack of documents available in different formats for those who had communication needs. Attempts were made to gather feedback from people; however, this did not capture everyone’s views as the surveys were not adapted to those who were non-verbal. Staff were able to request additional training and support if needed. Staff felt supported by the registered manager and had received regular supervisions. People were supported to maintain relationships with their families and friends and take part in meaningful activities at the service and in the community.

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 8 August 2018).

Why we inspected

We inspected due to the length of time since the last 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 see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified breaches in relation to management of medicines, communication and audit systems at this inspection.

Please see the action we have told the provider to take at the end of this report.

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

We found the following examples of good practice.

Professional visitors and relatives were tested for COVID-19 at the service. Visiting professionals and staff provided evidence of their vaccination status to the registered manager before entering the service.

Systems were in place to keep people's friends and relatives informed about visiting arrangements.

The registered manager had identified, assessed and mitigated all COVID-19 related risks to people, staff and visitors.

Staff wore appropriate PPE and had access to this throughout the home. Staff had received additional training during the pandemic about correct PPE usage and infection prevention and control.

Heatherstones is registered to provide a service to eight adults with learning disabilities. The service is a purpose built home consisting of two interconnected bungalows. Each one had four bedrooms, a kitchen, lounge and communal bathroom. There is a conservatory which serves as the manager’s office and there is an enclosed garden which is accessible to people living in the home.

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.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

This inspection took place on 26 June 2018 and was unannounced which meant the provider did not know we would be visiting.

A registered manager was in post. 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 told us they were confident people were safe. They understood safeguarding and whistle blowing procedures. The provider had effective arrangements in place to manage risk. People lived in a clean environment which was well maintained. Staffing arrangements ensured people received safe care from a consistent workforce. The provider reported issues and concerns to relevant agencies, although they had failed to notify us when Deprivation of Liberty Safeguards were authorised in 2017/18. The registered manager rectified this as soon as it was brought to their attention. Medicines were usually well managed although some issues were noted with topical creams and lotions. The registered manager shared a new more robust medicine audit which would pick up the issues we identified.

Through effective training and supervision staff were equipped with the skills to do their job well. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People received a balanced and varied diet, and accessed services which ensured their health needs were met.

People were treated with kindness and respect. Staff knew people well and understood their preferences and what was important to them. The provider promoted people’s rights and had systems in place to ensure people were not discriminated against.

People received care that was person centred. Support plans were comprehensive and reviewed regularly. People had opportunity to engage in varied in house and community activities. They were supported to maintain relationships.

The service was well-led. The registered manager worked closely with people who used the service and staff, and promoted a person centred approach. The provider had systems and processes in place to make sure safe quality care was being provided. People were encouraged to share their views and help drive improvement.

Further information is in the detailed findings below.

The last inspection was in January 2014 and at that time the provider was meeting all the regulations inspected.

St Anne’s Heatherstones is a purpose built home consisting of two interconnected bungalows. Each one had four bedrooms, a kitchen, lounge and communal bathroom. There is a conservatory which serves as the manager’s office and there is an enclosed garden which is accessible to people living in the home. The home provides personal and nursing care to adults with learning disabilities. At the time of the inspection there were eight people living in the home.

There was 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.

People told us the service was safe. We found staff knew how to recognise and report any concerns about people’s safety and welfare. The provider had updated the policies and procedures around protecting people from abuse and staff had received training to make sure they understood their responsibilities. The provider followed safe recruitment processes and all the required checks were done before new staff started work.

Staff were trained and supported which helped to make sure they had the right knowledge and skills to meet people’s needs. There were enough staff to provide people with the support they needed and to make sure they had plenty of opportunities to take part in social and leisure activities.

Overall people's medicines were managed safely. However, there were some concerns around the lack of protocols for some 'as required' medicines and the recording of information about medication changes.

People were supported to meet their health care needs and had access to the full range of NHS services. When people had to go into hospital staff at the home worked closely with the hospital to make sure they got the right support. One person who lived at the home had made a film about one aspect of their experience as a patient. With the support of the registered manager they had attended various conferences and events to help raise awareness of the challenges which people with learning disabilities can experience when they need medical treatment.

The home was clean, generally well maintained and well equipped to meet people’s needs. This included specialist baths, ceiling track hoists and pressure relieving mattresses. People’s bedrooms were furnished and decorated to reflect their tastes and interests.

The service was working in line with the principles of The Mental Capacity Act 2005 and this helped to make sure people’s rights were protected and promoted. People were asked for their permission before care and support was provided. When people did not have the capacity decisions the right procedures were followed to show how decisions had been made in their best interests.

People were offered a variety of food and drink and their likes and dislikes were catered for. However, when people’s fluid intake was being monitored the recording was not always accurate.

People’s needs were assessed and each person had their own care and support plan which included detailed information about their needs, abilities and preferences. The care and support people received was person centred, they were supported to make decisions and be in control of their lives. People were supported to make the most of their abilities and to be as independent as possible. People who lived at the home and their families were involved in planning how their care and support was delivered.

Staff were kind and compassion and treated people with respect and dignity. We observed staff were attentive to people’s needs and understood people’s individual ways of communicating.

People received excellent end of life care and their families were supported with sensitivity. The service has won awards for the quality of the end life care provided.

People had the opportunity to take part in varied range of social and leisure activities inside and outside the home and people were supported to go on holiday.

There was a complaints procedure in place and information was made available to people in a suitable format. There had not been any complaints since the last inspection.

The registered manager was open, transparent and enthusiastic about their role. They were approachable and supportive and interacted with people in a positive way which provided a good role model for staff.

The home was calm and friendly and people were comfortable with the staff. People who used the service, their families, carers and other stakeholders were given the opportunity to say what they thought about the service and offer suggestions for improvements.

The provider had systems and processes in place to monitor and assess the safety and quality of the services provided. However, we found some improvements were needed in how they were operated to make sure they were consistently effective.

There was one breach of regulation. You can see the action we have asked the provider to take at the back of the full inspection report.

We used a number of different methods to help us understand the experiences of people who used the service because people who used the service had complex needs which meant they were not able to tell us their experiences.

Care records recorded information on people's daily routine. They described what time people liked to get up, what they liked to eat and drink, and how they liked to spend their day. We saw that care records recorded information on maintaining people's dignity by knocking on doors before entering, covering people up with towels when providing personal care and treating people as individuals.

We looked at three care records and saw that people's needs were assessed and care and treatment was planned in line with their individual care plan.

Care plans had information on assessments being carried out in areas such as personal care, mobility, communication and eating and drinking. We saw that risk assessments had been carried out in areas such as nutrition, tissue viability, moving and handling and pressure area care.

We saw from training records that all staff had received training in safeguarding, mental capacity and deprivation of liberty safeguards.

We saw that an up to date safeguarding and whistleblowing policy was in place.

We looked at three staff records which demonstrated that effective recruitment and selection procedures were in place.

We asked how the provider monitored the quality of the care delivered. We spent time observing the care and interaction between staff and people who use the service. We spoke with staff and the manager about the care and wellbeing of people who use the service. We also gathered evidence of people's experiences of the service by reviewing care records and quality assurance documentation.

Our observations of the service found that the environment was clean and tidy and that people's bedrooms were personalised in a way that reflected their taste.

We observed people were well cared for. They were dressed appropriately for the temperature of the home and staff responded to their needs in a caring and sensitive manner. Everyone had a care plan which was up to date. The care records identified the persons needs, associated risk and how to minimise the risk.

Staff told us they received regular supervision and training. The staff records we looked at confirmed this.