The Heathers

The Heathers is a residential care home providing personal care to up to 12 people. The service provides support to older people and people who have a learning disability. At the time of our inspection there were 8 people using the service.

People’s experience of the service and what we found

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 statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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.

People received care and support to maintain an environment suited their needs and preferences.

Staff supported people to make decisions following best practice in decision-making. Staff supported people to access health and social care services. Staff supported people with their medicines safely and in their preferred way.

Right Care

Staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse and they knew how to apply it. The service employed skilled staff to meet people's needs and keep them safe.

People's care plans reflected their needs and wishes and promoted their wellbeing. Risks that people may face were appropriately managed.

Right Culture

The ethos, values, attitudes and behaviours of the registered manager and staff team ensured people lead confident, inclusive and empowered lives

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 09 November 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We undertook a focused inspection to review the key questions of safe and well-led only. For those key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for The Heathers 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.

We found the following examples of good practice.

¿ Staff were observed to wear the correct Personal Protective Equipment (PPE) in line with government guidance. PPE was accessible throughout the service.

¿ There was a clear process for visitors, which included a symptom check, temperature check, the wearing of PPE and use of hand sanitiser.

¿ People were supported to maintain contact with family members and friends via phone, video calling and socially distanced out door visits. The service had updated its visitors policy in line with changes to government guidance.

¿ When people returned to the service or returned from hospital, government guidance was followed

to support them self-isolate for the required period of time. They were also required to have a negative test

result prior to admission. This reduced the risk of transmission of Covid-19.

¿ Cleaning schedules had been increased to ensure high touch surfaces were cleaned regularly. Additional cleaning had been introduced to maintain good hygiene standards.

¿ The service had adequate space to enable people to maintain a social distance within the service.

¿ The service had considered the individual support people would need if there was a Covid-19 outbreak.

¿ The provider regularly sent a ‘Frequently asked questions’ document to registered managers, keeping them updated about organisational changes and government guidance.

¿ Testing was completed in the home weekly for staff and monthly for people using the service. This meant prompt action could be taken should anyone test positive for Covid-19. The service planned to implement improvements in line with the Mental Capacity Act 2005 for testing.

¿ The service was observed to be clean and there was an up to date infection control policy. Infection control audits were undertaken, the service planned improvements to these.

Further information is in the detailed findings below.

On the day of our inspection 10 people were using the service.

The care service had not originally 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. However, people were given choices and their independence and participation within the local community encouraged.

At our last inspection on 11 August 2016 we rated the service good. At this inspection we found the evidence continued to support the rating of 'good' overall but there had been a deterioration in well led which was rated as ‘requires improvement’. 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.

People continued to receive a safe service where they were protected from avoidable harm, discrimination and abuse. Risks associated with people’s needs including the environment, had been assessed and planned for and these were monitored for any changes. People did not have any undue restrictions placed upon them. There were sufficient staff to meet people’s needs and safe staff recruitment procedures were in place and used. People received their prescribed medicines safely and these were managed in line with best practice guidance. Accidents and incidents were analysed for lessons learnt and these were shared with the staff team to reduce further reoccurrence.

People continued to receive an effective service. Staff received the training and support they required including specialist training to meet people’s individual needs. People were supported with their nutritional needs. Staff identified when people required further support with eating and drinking and took appropriate action. The staff worked well with external health care professionals, people were supported with their needs and accessed health services when required. 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. The principles of the Mental Capacity Act (MCA) were followed.

People continued to receive care from staff who were kind, compassionate and treated them with dignity and respected their privacy. Staff had developed positive relationships with the people they supported, they understood people’s needs, preferences, and what was important to them. Staff knew how to comfort people when they were distressed and made sure that emotional support was provided. People’s independence was promoted.

People continued to receive a responsive service. People’s needs were assessed and planned for with the involvement of the person and or their relative where required. Some care plans were not user friendly or up to date but staff knew and understood people’s needs well. People received opportunities to pursue their interests and hobbies, and social activities were offered. There was a complaint procedure and action had been taken to learn and improve where this was possible.

The service was rated ‘requires improvement for ‘well led’ at this inspection. The monitoring of service provision was not always effective because repeated shortfalls were not identified or resolved. There was an open and transparent and person-centred culture with adequate leadership. People were asked to share their feedback about the action was taken in response.

Further information is in the detailed findings below

The service is registered to provide accommodation and personal care for up to 12 people with mental health or learning difficulties. At the time of our inspection there were 10 people living there, some of whom had lived there for a number of years.

The service has 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 were well supported and cared for and appeared relaxed and responded positively towards staff.

There were appropriate recruitment processes in place and people felt safe in the home. Staff understood their responsibilities to safeguard people and knew how to respond if they had any concerns.

People received care from staff who were kind and considerate and who were committed to respecting their individuality and promoting their independence. Their needs were assessed prior to coming to the home; individualised care plans were in place and were kept under review. Staff had taken time to understand peoples likes, dislikes and past lives and enabled people to pursue their interests and hobbies.

Staff were supported through regular supervisions and undertook training which focussed on helping them to understand the needs of the people they were supporting. People were involved in decisions about the way in which their care and support was provided. Staff understood the need to undertake specific assessments if people lacked capacity to consent to their care and / or their day to day routines. People’s health care and nutritional needs were carefully considered and relevant health care professionals were appropriately involved in people’s care.

People were cared for by staff who were respectful of their dignity and who demonstrated an understanding of each person’s needs. This was evident in the way staff spoke to people and engaged in conversations with them. Relatives commented positively about the care their relative was receiving and it was evident that people could approach management and staff to discuss any issues or concerns they had.

There were a variety of audits in place and action was taken to address any shortfalls. The registered manager was visible and open to feedback, actively looking at ways to improve and develop the service.

Is the service safe?

We found that the registered manager had initiated improvements to keep people safe such as the safe storage of medication. We saw that essential repairs to the property or the furnishings had been reported and completed promptly.

Is the service effective?

Staff had received training and annual refresher updates. This ensured they had the right knowledge and skills to identify and report concerns with the way that medicines were stored or managed.

Is the service caring?

The manager told us that the redecoration of the premises had been completed after people's views and choices of colours had been taken into consideration.

Is the service responsive?

The maintenance log that we looked at showed that prompt action had been taken when repairs and general maintenance to the home had been required.

Is the service well led?

The registered manager was able to provide us with evidence that confirmed that improvements had been made following the last inspection. We noted that new procedures had been put in place to sustain the improvements made to date.

The expert by experience said that she was only able to speak with two people. This was because other people had communication difficulties. The people she spoke with told her that staff were friendly and had been meeting their needs.

We also spoke with two people who lived in the home. They told us that staff were very friendly and tried to help them as much as they could.

We spoke with four relatives who confirmed that the service was very good. One relative said: 'The help staff give is impressive. There have been no problems'.

This was a largely a positive inspection. Everyone we spoke with said that care that staff supplied was good.

There were issues that needed to be dealt with. Medication systems need improvement to ensure people always received their prescribed medication. Premises issues needed improvement to ensure that anything affecting the decor and equipment are quickly attended to.

There were a small number of suggestions: more trips out to go shopping and to go to the cinema for example, for the home to have another vehicle with wheelchair facilities, for staff to be around lounge areas to make sure people were all right, and to have more in-house activities for people.

We found that there had been progress in addressing the issues from the last inspection. Work had been carried out in replacing a heavily stained carpet. There was extra heating available if needed. There was evidence in place that work had been ordered to rectify the central heating system in the ground floor extension.

People spoken with told us they liked the staff. One person said; ''They make sure I'm alright''. Everyone confirmed that they were happy living in the home.

One person said that she was worried about the behaviour of another person, as this person had hit her. We spoke to the manager about this situation. We found that action had been taken to try to prevent this from happening again.

We spoke with four relatives. They were all satisfied with the support their relatives received. One relative told that staff were; "always friendly and professional. They know what they are doing'.

One person was concerned about the lack of activities for her daughter. The manager said that this issue was regularly discussed and would be looked at again.

There was one comment about the lack of staffing when staff were sick. We followed this up with the manager who said that action was taken to fill the shortfall if possible. We looked at a staff rota which indicated the level of staffing able to meet people's needs.

Our main concern was about maintenance arrangements. We found that issues identified in the last inspection had been followed up. However, there were other maintenance issues found to be deficient on this inspection. Current procedures do not produce swift arrangements to ensure good maintenance. We have required more effective action to ensure that systems produce swift action.