Woodseats and Norton

Woodseats and Norton is a residential care home providing accommodation for people requiring personal and nursing care to 16 people. The service provides support to people with a learning disability and autistic people. At the time of our inspection there were 16 people living at the service.

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.

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

Right Support: People’s independence was promoted by the provider and staff. The provider had maintained a consistency in staff who worked with people and this meant people were supported by staff who knew them well. People were encouraged and supported to express their choices and we observed people being supported to access the community and activities. We observed staff skillfully managing situations where people expressed anxiety or periods of time where they felt upset.

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.

Right Care: People received kind and compassionate care. People and relatives told us support was provided safely. Staff understood how to protect and promote people’s privacy and dignity. Staff varied their approach to working and communicating with people and demonstrated an understanding of people’s preferred way of communication. People’s medicines were managed safely and we observed peoples as required (PRN) medication was reviewed regularly. When accidents and incidents occurred information was recorded accurately and later analysed by registered managers to identify any trends or areas of staff practice which could develop.

Right Culture: Staff feedback on working in partnership with the provider was positive and staff felt they were supported by a strong management team. Two registered managers were in post one [registered manager 1] to oversee the management of the Woodseats service and the other [registered manager 2] to oversee the management of the Norton service. They told us they tried to arrange absences from work to ensure there was always a registered manager across both services. The provider had a robust auditing system in place and registered managers evidenced consistent checks and oversight of practice in all areas. In some areas this had not always been captured in an audit template; however, we reviewed evidence of data being collected and analysed and checks being completed.

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 good (published 30 July 2019)

Why we inspected

We received concerns in relation to safeguarding, closed cultures and staffing. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe, effective and well-led sections of this full report.

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 remained as good. 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 Woodseats and Norton 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, Sheffield is a residential care home providing personal care and support to people with a learning disability and/or autism. The care home accommodates up to 16 people in two separate buildings (Norton and Woodseats). There were 15 people living at Heathcotes, Sheffield at the time of this inspection.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

There were systems in place to help keep people safe. Staff understood how to protect people from abuse. There were enough staff available to ensure people’s needs were met. The provider had effective recruitment procedures in place to make sure staff had the required skills and were of suitable character and background. Medicines were stored safely and securely, and procedures were in place to ensure people received their medicines as prescribed. The premises were clean and well maintained.

Staff understood the requirements of the Mental Capacity Act 2005. 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 interest; the policies and systems in the service supported this practice.

People were supported to access relevant health and social care professionals to ensure they were getting the care and support they needed to best meet their needs. Staff were provided with relevant training and ongoing support to make sure they had the right skills and knowledge for their role.

Positive and supportive relationships had been developed between people and staff. People told us they were treated with dignity and respect and we saw this throughout the day of the inspection. People were supported to engage in meaningful and social activities that were important to them. There was an up to date complaints policy and procedure readily available to people in a variety of formats. People and staff told us all the managers were approachable and responsive to any issues raised.

People and staff were regularly asked for their views of the service. There were effective systems in place to monitor and improve the quality of the service provided. Safety and maintenance checks for the premises and equipment were in place and up to date. The service had up to date policies and procedures which reflected current legislation and good practice guidance.

The service applied 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 using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to engage with the local community and become more independent.

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 12 April 2018).

Why we inspected

The inspection was prompted in part due to concerns with the provider regarding poor risk management, inappropriate use of restrictive interventions and ineffective governance systems.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe, effective and well-led sections of this full report.

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.

Thematic review

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 registered managers 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.

Heathcotes Sheffield 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 can accommodate up to 16 people in two houses.

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.” Registering the Right Support CQC policy

At the last comprehensive inspection in December 2015, the service was rated Good. At this inspection we found the service remained Good.

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

The service had two registered managers in post at the time of our inspection. 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 continued to feel safe. Staff understood their roles and responsibilities to safeguard people from the risk of harm and risks to people were assessed and monitored regularly.

Staffing levels ensured that people's care and support needs continued to be met safely and safe recruitment processes continued to be in place.

People continued to receive their medicines in a safe manner and received good healthcare support. People received a nutritious and balanced diet and their dietary needs and choices were met.

The service was well maintained and clean. Infection control was adhered to by staff.

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 systems in place to monitor incidents and accidents. There were arrangements in place for the service to make sure that action was taken and lessons learned when things went wrong, to improve safety across the service.

We observed people had good relationships with the staff, who were caring and kind. Staff respected people’s privacy and dignity and promoted their independence.

The service had an open and inclusive culture which encouraged communication and learning. People, relatives and staff were encouraged to provide feedback about the service and it was used to drive improvement.

There were policies in place that ensured people would be listened to and treated fairly if they complained about the service.

We saw that the registered provider continued to effectively monitor and audit the quality and safety of the service and that people who used the service and their relatives were involved in the development of the home and were able to contribute ideas.

Further information is in the detailed findings below

Heathcotes-Sheffield is a care service that provides care for up to 16 people. The service consists of two purpose built houses, one called Norton House and the other Woodseats House. At the time of our inspection ten people were living at the service; two of those people were away on holiday. People living at the service had complex needs and some had behaviour that could challenge.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection on the 14 December 2015, by selecting the 'all reports' link for ‘Heathcotes – Sheffield’ on our website at www.cqc.org.uk.

There was a manager at the service who was registered with CQC. 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 and associated Regulations about how the service is run.

During the inspection we were not able to speak with some people using the service because we were unable to communicate verbally with them in a meaningful way. Staff were respectful and treated people in a caring and supportive way.

Three people we spoken with did not express any concerns about their safety. One person told us they went to their room if people started shouting at each other. Another person told us they felt ‘safe’ and they would speak with staff if they had any worries or concerns. They thought the staff were ‘brilliant’ and really supportive.

Staff had received training in non-abusive psychological and physical intervention (NAPPI) to enable them to support people appropriately.

Staff told us they had undertaken safeguarding training and would know what to do if they witnessed any type of abuse. Staff had a good understanding about the provider’s whistle blowing procedures and felt confident that senior staff would listen.

We looked at the communal areas and spoke with staff about plans to reduce risks to people with a known history of self-harm. We saw people at risk were supervised during daylight hours on a one-to-one basis with hourly checks overnight.

We saw each person’s risk assessment and support plan showed how people may behave when they were well or when they may becoming unwell. Support plans gave guidance to staff in how they should respond to promote well-being and how they should react to de-escalate increasing agitation and anxiety.

Our scrutiny of support plans indicated the risk assessment processes and staff actions were successful in minimising the risks to people, other service users, the staff and public.

Whilst not observing the administration of medicines we looked at the medication administration records MAR charts for five people. We saw the medication administration records (MAR) sheet was complete and contained no gaps in signatures for the administration of oral medicines. However we saw the recording of the application of creams and lotions was less well recorded. We shared this information with the registered manager.

Whilst we saw ‘as necessary’ (PRN) protocols existed we found some were incomplete, some were misleading and some PRN prescriptions were not supported by a protocol. A protocol is to guide staff how to administer those medicines safely and consistently. For example, how the person communicated they were in pain which could be for example by facial expression. We spoke with the registered manager who assured us that the protocols would be reviewed.

We saw evidence that staff were following the providers policies and procedures on safeguarding people’s finances.

We carried out a comprehensive inspection of this service on 30 April 2015. Six breaches were identified in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider sent us an action plan identifying actions to be taken and timescales for completion, in order for them to become compliant.

This comprehensive inspection took place on 14 December 2015 and included checks to confirm the service had followed their action plan and met legal requirements. This was an unannounced inspection which meant the staff and provider did not know we would be visiting. This report covers our findings in relation to the comprehensive inspection on 30 April 2015. We found appropriate actions had been taken to ensure regulations were being met.

There was a manager at the service who had commenced in post on 6 July 2015. The manager confirmed he had applied to register with us. 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 and associated Regulations about how the service is run.

People spoken with said they felt safe living at Heathcotes (Sheffield) and they could talk to staff if they had any worries. People were observed freely approaching staff and interacting with them.

There were procedures to follow if staff had any concerns about the safety of people they supported.

We found systems were in place to make sure people received their medicines safely.

There were sufficient staff with the right skills and competencies to meet the assessed needs of people living in the home. Recruitment procedures were in place and appropriate checks were undertaken before staff started work. This meant people were cared for by suitably qualified staff who had been assessed as safe to work with people.

A varied and nutritious diet was provided to people that took into account dietary needs and preferences so that health was promoted and choices could be respected. People we spoke with told us they enjoyed all of the meals provided at the home.

People’s physical and mental health needs were monitored. There was evidence of involvement from professionals such as doctors, opticians, tissue viability nurses and speech and language practitioners in people’s support plans.

Staff were provided with relevant training to make sure they had the right skills and knowledge for their role. Staff supervision and appraisal meetings took place on a regular basis to ensure staff were fully supported. Staff told us they could raise any concerns with the manager or provider and felt that they were listened to.

We observed people’s needs were met by staff that understood how care and support should be delivered.

The service followed the requirements of the Mental Capacity Act 2005 (MCA) Code of practice and Deprivation of Liberty Safeguards (DoLS). This helped to protect the rights of people who may not be able to make important decisions themselves. Staff had some understanding of the MCA and DoLS so that they had the knowledge needed for their role and to make sure people’s rights were upheld.

We saw people participated in a range of daily activities both in and outside of the home, according to their choice, which were meaningful and promoted independence.

There were systems in place to monitor and improve the quality of the service provided. Checks and audits were undertaken to make sure full and safe procedures were adhered to.

People and their relatives had been asked their opinion of the quality of the service via a survey undertaken by the providers.