The Rookery

We found the following examples of good practice.

The service had updated their policies and procedures to ensure infection prevention and control (IPC) processes were robust. The premises had visible signage throughout to inform people and visitors of COVID-19 risks and IPC practices. All visitors had their temperatures checked and were required to carry out a lateral flow device (LFD) test before entering.

Cleaning regimes had been changed to ensure robust processes were in place. High touch surfaces were being cleaned more regularly.

Donning and doffing stations were situated in the service and personal protective equipment (PPE) was available throughout the building. Staff had received training in IPC and PPE in relation to COVID-19.

Social distancing was promoted within the service and in communal spaces.

Heathcotes (Salford) is a residential care home that provides accommodation and personal care for up to seven people living with learning disabilities and autism. At the time of our inspection there were six people living at the service. This is one of many locations that the provider operates nationally.

People’s experience of using this service:

People’s outcomes were consistently good, and people’s feedback confirmed this. One person told us, “I like it here.”

People had detailed person-centred care plans with reference to people's diets, their likes, dislikes and what works well for them. People had ‘development plans’ which celebrated key achievements and looked at future goals.

We observed positive interactions between staff and people. Staff had good relationships with people and were seen to be caring and respectful towards people and their wishes.

Medicines systems were organised and people were receiving their medicines when they should. The service was following safe protocols for the administration of medicines.

The registered manager followed governance systems which provided effective oversight and monitoring of the service.

The service was well led. The registered manager promoted best practice in person-centred care. There was a clear culture based on achieving positive outcomes for people.

The service met the characteristics of Good in all areas; more information is in the full report.

Rating at last inspection:

At the last focused inspection the service was rated Good overall and Requires Improvement in the Well-led domain (report published 21 September 2018). Following this comprehensive inspection, the overall rating remains unchanged, and all domains are rated Good.

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will continue to monitor information and intelligence we receive about the service to ensure good quality care and support is provided to people. We will re-inspect in line with our inspection timescales.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

No concerns had been identified in the remaining Key Questions and none became apparent during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection'

Heathcotes Salford 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 home can accommodate a maximum of seven people. When we inspected there were six people living in the home. Accommodation is provided in a large detached property, over three floors, in single en-suite rooms. There were two communal lounges, a large dining kitchen, utility areas and a garden.

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.

We found people had been protected from the risk of harm and abuse. Where a person had experienced harm or abuse the home had responded appropriately by raising a safeguarding alert and reviewing practice to minimise reoccurrence. The home had ensured risks had been fully assessed and plans developed to manage them. Incidents had been fully recorded and the home had reviewed them regularly to learn and improve. Some staff had not felt safe working in the home and had left, one member of staff we spoke with said they had felt unsafe before but felt safer since there had been an increase in the staffing. The other staff we spoke with all said they felt they were safe and were able to maintain people's safety in the home.

We had received concerns that medicines had been given inappropriately and caused a person to be drowsy. We reviewed the medicines including medicines given when required, for example, to support a person to manage their feelings, and found these had not been used excessively. All as required medicines had been accurately recorded and given according to the agreed protocol. We checked the stocks against the records and found them to be correct.

We had received concerns that there had not been enough food in the home and people had not been able to eat breakfast or lunch. We looked at the food stocks and found these to be sufficient. We reviewed the food and drink records for three people in their daily records and saw a variety of food and drink had been provided at all times. At our previous inspection the home was found to be in breach of the regulations in relation to maintaining nutrition. At this inspection we found the home was no longer in breach of the regulations.

We had received concerns about the skills and knowledge of the staff team and the support and supervision available. We reviewed the training records and found all staff had received an induction and a broad range of training which included supporting people whose behaviours might challenge. We spoke with staff who told us they felt they had the skills and knowledge they needed to provide care and support effectively.

We reviewed the supervision records and found staff received regular supervision which addressed key areas of practice and staff welfare. Staff we spoke with told us they also received additional supervision following an incident or change of someone's care plan.

The home continued to meet its' obligations in relation to the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards(DoLS). DoLS were in place where required and the home had a system to ensure they reapplied for renewals when necessary. People's capacity to make particular decisions had been assessed and where they were found not to have capacity, decisions had been made in their best interests which were also the least restrictive option.

At the last inspection the home was found to be in breach of the regulations in relation to Governance. This was because they had not notified CQC of all the incidents that they should have. There had also been a failure to keep contemporaneous records in relation to medical appointments and some incidents. At this inspection we found the home had addressed these issues. Notifications were being received by CQC when required. The home were maintaining contemporaneous records and had improved the recording in care plans overall. These improvements meant the home was no longer in breach of the regulations. We did not fully review the key question, 'Is the service well led' at our inspection which will therefore remain as Requires Improvement. However, because the home is no longer in breach of the regulations the overall rating for this inspection will be Good. We will check to see whether this rating can be improved at our next inspection.

The whistleblowing concerns we had received related to unsafe staffing levels, unmanaged risks and the lack of up to date information in care plans. There had been safeguarding alerts raised in relation to administration of medication and restrictive practices. In addition, the police had attended the property in response to behavioural support needs. We looked specifically at events detailed in the whistleblowing and found there was no evidence to support the concerns raised.

The Rookery 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 home can accommodate a maximum of seven people. When we inspected there were six people living in the home. Accommodation is provided in a large detached property, over three floors, in single en-suite rooms. There were two communal lounges, a large dining kitchen, utility areas and a garden.

At this inspection we found three breaches of the Health and Social Care Act (2008) in relation to Regulation 14 Meeting nutritional and hydration needs and Regulation 17 Good governance. You can see what action we told the provider to take at the back of the full version of this report. We also found the provider had failed to notify us of specific incidents and we are considering our options in relation to this matter.

We discussed with the local police force their attendance at the property and found the police had attended more regularly than we were aware of. We discussed this with the registered manager who informed us the number of visits by the police had reduced significantly in response to risks being more effectively managed. We will continue to monitor this.

Nutritional and hydration support needs were not evidenced to have been met for one person who had been found to be nutritionally at risk. The home had not kept a contemporaneous record of the support offered.

Records in relation to medical appointments had not contained enough detail to determine the purpose and outcome of the appointment for one person and it was not possible to identify what action or treatment had been recommended.

Records in relation to a specific incident for one person were contradictory. The registered manager gave a different account to what had been recorded in the person’s notes. This meant it was difficult to be certain what may have caused the person to experience distress.

Auditing systems did not identify concerns we had found at the inspection.

Relatives we spoke with expressed a lack of confidence in the service’s understanding of their relative’s needs.

Staff we spoke with were knowledgeable about protecting people from the risk of harm and abuse and were able to explain how they raised a safeguarding concern. Staff also said they felt there were enough of them on duty to ensure people were safe.

Staff had received training appropriate to their roles and had regular supervision and support from the management team.

People’s needs had been assessed in consultation with families, commissioners and specialist learning disability services. Care plans were detailed and contained sufficient detail for staff to know how to provide care and support.

The home was compliant with the requirements of Deprivation of Liberty Safeguards (DoLS) contained in the Mental Capacity Act 2005. Mental capacity assessments and best interest decisions were well documented. Staff were aware of the need to gain consent from people when they provided care and support.

The service was caring, staff were observed to behave with kindness towards people. Communication plans were detailed and complied with the requirements of the Accessible Information Standard.

The registered manager and management team were working closely with families, commissioners and other specialist professionals to achieve better outcomes for individuals. This included when they had identified the need for alternative support.

The general manager had been appointed seven weeks prior to this inspection. One of the relatives we spoke with said they thought the new manager was alright. Another relative said they were not sure who they were because there had been so many changes. The staff spoken with expressed confidence in the management team and reported feeling they were well supported.