Aylestone

Heathcotes Aylestone is a residential care home.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to seven people and seven people were using the service. This is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

People were safe at the service and family members trusted and had confidence in staff. Staff knew how to minimise risks to people and followed good practice guidance as detailed within their risk assessments. People were supported by sufficient numbers of staff who had undergone a robust recruitment process. People had their medicines safely when they needed them. People lived in a service which was maintained and clean.

People’s needs were met by staff who had the necessary skills and knowledge and were supported through ongoing training and supervision to enable them to provide good quality care. Staff promoted people’s health by supporting people to access health care services and by encouraging people to eat a healthy diet.

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 gain new skills and become more independent.

People were supported to have maximum choice and control of their life 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.

Family members spoke favourably about staff and the positive and supportive relationships they had developed with their relative. Staff supported people to maintain relationships with their family members. Staff communicated effectively with people to enable them to meet their needs.

People’s relatives were involved in their care and support. Staff responded to people’s needs by following their individual support plans, which reflected their hobbies and interests and encouraged people to access a wide range of community based activities.

Family members and staff were positive about the appointment of a registered manager and the continued development of the service, which followed a period of managerial changes. The registered manager was aware of their role and responsibilities in meeting their legal obligations and were supported by staff from other departments of the provider to achieve these. Systems to monitor the quality of the service were used to drive improvement and included seeking the views of people, family members and stakeholders.

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 on 6 April 2018.

Why we inspected

This was a planned inspection.

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.

Heathcotes (Aylestone) 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.

Heathcotes (Aylestone) is registered to accommodate up to seven people. The service support people with autism and a learning disability. The accommodation includes shared lounge, dining room and kitchen facilities and bedrooms with an ensuite shower and toilet. At the time of our inspection there were seven people in residence.

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.

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.

At our last inspection in December 2015 we rated the service overall as ‘Good’. At this inspection we rated the service overall as ‘Good’.

People continued to feel safe using the service. Risk assessments were completed, managed and reviewed regularly. Staff knew how to keep people safe and understood their responsibility to protect people from the risk of abuse. People received their medicines at the right times. People’s nutritional and cultural dietary needs were met and they had access to a range of specialist health care support that ensured their ongoing health needs were met.

Staff were recruited safely. There were sufficient numbers of staff available who worked flexibly to support people. Staff continued to be supported in their role and received regular training and supervision to meet people’s needs effectively.

People continued to be involved and made decisions about all aspects of their care and were encouraged to take positive risks. They 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.

People continued to receive good care and their privacy and dignity was respected. Staff had developed positive trusting relationships with people. Staff’s skilful interactions promoted people’s wellbeing and independence. The design and homely environment promoted people’s privacy.

People continued to receive care and support that was responsive to their individual needs. Staff promoted and respected people’s cultural diversity and lifestyle choices. People were supported to access the wider community, education and other leisure activities. People maintained relationships with their family and friends. Care plans were personalised and provided staff with clear guidance as to how people wished to be supported. Information was made available in accessible formats to help people understand the care and support agreed.

People knew how to raise a concern or to make a complaint. The provider’s complaint procedure was followed and all complaints were fully investigated. Relatives spoke positively about the staff team, management and the quality of care. Staff were confident to make suggestions to improve the service and enhance people’s quality of life.

The registered manager was aware of their legal responsibilities and provided leadership and supported staff and people who used the service. The registered manager and staff team were committed to providing quality care. They continued to incorporate best practice and worked with outside agencies to continuously look at ways to improve the experience for people.

The provider promoted a culture of openness; continuous learning and development of quality care and service and works in partnership with other agencies. The service learnt lessons from incidents and made improvements when things went wrong. The provider’s governance system to monitor and assess the quality of the service was used effectively to improve the service and looked at ways in which people were supported to achieve greater independence.

Heathcotes (Aylestone) is registered to provide residential care and support for up to seven people who have an autistic spectrum disorder or a learning disability and who may present behaviours that challenge or have complex needs. People live in a home that blends in with other private dwellings in a residential area. The accommodation has three lounges with dining rooms. The bedrooms are over two floors and the upper floor is accessible using the stairs. All the bedrooms have ensuite shower facilities. At the time of our inspection there were seven people using the service.

The service has a manager who was registered with Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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. However, they no longer work for the service and have not yet cancelled their registration. We spoke with the provider representative about this and advised us that the registered manager has been informed to cancel their registration.

A manager has been appointed by the provider and had been in post for two months at the time of our inspection. The manager advised us of their intention to submit an application to the Care Quality Commission to become registered.

Following our inspection visit a registered manager application had been submitted to the Care Quality Commission. The application was successful and confirmed the service has a registered manager in post which ensured that the service is managed well.

People’s relatives told us that their family member’s safety was promoted by the staff that supported them. Staff were trained in safeguarding (protecting people who use care services from abuse) and knew what to do if they were concerned about the welfare of any of the people who used the service. Where people were at risk, staff had the information they needed to help keep them safe.

Staff recruitment practices were robust and appropriate checks were carried out before people started work. People were supported by a dedicated team of staff that provided person centred care and support, which promoted their wellbeing, self-esteem and independence.

Staff provided tailored and individual support to keep people safe and appropriate support when their behaviour became challenging. People were supported to take ‘positive risks’ to promote their independence and personal development.

Medicines were stored safely and people received their medicines at the right time. People’s capacity to make informed decisions about taking some medicines had been assessed and best interest decisions had been made. This was to ensure people’s needs were met when they themselves were not able to promote their own safety and welfare by making an informed decision.

People were supported by knowledgeable staff who understood people’s individual and diverse needs. Staff were well trained and had the knowledge and skills to care for people effectively. There was a culture of continual learning and personal development for staff which brought about improvements to people’s quality of life.

People received effective care that was centred on their individual care and support needs. People using the service and their relatives were involved in the development of their support plans to ensure care provided was tailored and took account of people’s diverse needs. Support plans provided staff with clear guidance about people’s needs which were monitored and reviewed regularly.

We found the requirements to protect people under the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) had been followed. Staff had received training on the MCA and DoLS. Capacity assessments had been carried out on aspects of people’s care and support and where those assessments identified that people did not have the capacity to make an informed decision, then their relatives and others consulted as part of their best interest meeting. The best interest decisions were recorded and used to develop support plans which were regularly reviewed to ensure any decisions made on behalf of people remained in their best interest.

People’s relatives spoke positively about the staff’s attitude and approach, and had developed good working relationships with them. They told us staff were caring and recognised their role in improving people’s lives. We observed staff maintained and respected people’s rights, privacy and dignity at all times.

People were provided with a choice of meals that met their dietary needs to maintain their health.

Records showed people were supported to access the appropriate medical care and support from health care professionals and they had regular health checks

We saw people were supported by staff who had developed positive and trusting relationships with them and their relatives. Care and support provided was centred on the each person, their needs, lifestyle, and interests. Staff told us that part of their role was to be creative in supporting people to develop their daily living skills and build their confidence, and in promoting their independence to access the wider community to encourage social interaction.

People and their relatives were encouraged to influence the support they received. They were involved in regular meetings with the staff and other health care professionals to ensure the care and support provided continued to meet their individual needs and provided an opportunity to look at improving people’s quality of life.

People’s support plans were comprehensive, tailored to meet their needs and reflected all aspects of their life. Support plans were individualised in relation to their communication needs and support to manage behaviours that challenge. Records showed staff supported people to take part in activities and hobbies that were of interest to people which also improved their wellbeing and quality of life.

People using the service and their relatives were asked for suggestions on all aspect of the service including meals, activities and décor. People’s relatives were confident to raise concerns. Relatives had regular contact with the manager and staff which meant any issues could be discussed and ideas shared for the benefit of those using the service.

Staff spoke positively about the manager in relation to the support provided. They told us that there were effective systems which enabled them to communicate well with their colleagues to ensure that people received the support they needed. Staff were confident to raise any issues with the manager and their views were sought in how to improve the service and the lives of people who used the service.

The provider had a robust quality assurance system which assessed the quality of the service. Information gathered as part of the quality audits was used to continually develop the service and look for ways in which people using the service could achieve greater autonomy.

Is the service safe?

People received the care and support that they needed. They were helped to take part in activities that were of interest to them at home or by using the community amenities. Throughout our visit we saw staff treated people with respect. Staff understood people's needs and knew how each person communicated because people had limited verbal communication skills. Staff helped people with their daily living skills and to do things that promoted their independence.

Relatives we spoke with had high praise about the care and support provided to their family member. Comments received included: 'He's helped with most things and tends to have a great social life' and 'The staff really do care about them because everyone is treated as person.'

We, the Care Quality Commission, monitor the operation of the Deprivation of Liberty Safeguards (DoLS), which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Staff training records showed staff had been trained in Mental Capacity Act 2005 and DoLS. This meant that people could be confident that their best interests would be represented and that their wellbeing would be met reliably.

People lived in an environment that had been suitably furnished and well maintained, which made it safe, homely and comfortable. People were able to access all areas of home and garden safely. Individual bedrooms had been personalised to reflect each person's interests and other things that were important to them. People's privacy and dignity was promoted because all the bedrooms had an en-suite shower, toilet and washbasin.

The staff at Heathcotes (Aylestone) had been recruited properly. Checks had been carried out on their background to help ensure they were fit and safe to work with people who used the service.

Is the service effective?

We saw staff helped people with their daily needs. Relatives were involved and attended the review meetings to make sure their family member received the appropriate support. The records we reviewed showed that people's care needs were met reliably and that they had access to a range of health care professionals. From our observations it was evident that staff had a good understanding of people using the service and that they knew them well.

Staff were attentive and responded promptly to ensure people were supported appropriately. Because some people were unable to communicate verbally it was important that staff recognised and responded in a timely manner. This helped to ensure that they were protected from any risks and those that had been identified could be managed.

Is the service caring?

Staff were caring, kind and attentive. People were involved to make decisions about their care needs, lifestyle and aspirations. Each person benefitted from support tailored to their individual needs, which promoted their independence and wellbeing.

Relatives told us they had no concerns about the quality of care and support provided to their family members. They all told us that their family member had 'a good quality of life'. Comments received included, 'The care is very good' 'The staff know and understand each person and seem to be really confident in what they do' and 'He gets to do things like any other young person.'

Staff were aware of people's preferred routines and interests. This included support to attend college, day centres and to use other community amenities. Staff encouraged people to be involved in daily living tasks to help promote their independence. We saw one person liked to help staff to prepare meals and they also did their own laundry.

Is this service responsive?

Relatives told us that they had visited the home to make sure it was the right place for their family member. People's needs had been assessed before they moved to the home. People's preferences and expectations had been recorded and the care and support had been provided in accordance with their wishes.

Staff were confident to seek the appropriate support if they had any concerns about people's wellbeing or health. They understood their responsibilities to act quickly in the event a person became unwell or needed medical treatment. Care records we looked confirmed that people had access to health care professionals such as the doctor, as and when required.

Throughout our visit the atmosphere in the home was happy and relaxed. We observed how staff supported each person and also worked well together. It was evident that there were good relationships between them, which had a positive impact on the wellbeing of people who used the service.

Relatives were confident that any concerns or suggestions made to improve the quality of care would be acted on promptly. The home's complaints procedure was also produced in a suitable format for people to understand and given to them when they moved to the home. Staff told us that they recognised if someone was unhappy and were confident to act on any concerns to protect the person's wellbeing. All complaints were handled and responded to promptly and in a consistent way.

Is this service well led?

People's personal care records and other records kept in the home were accurate and up to date. Care plans were produced in an alternative format to help people understand the how their care and supported needs were to be met. People's care needs were reviewed regularly with the support of their relative. This helped to make sure any new needs could be met reliably. Records showed the home's staff worked with other agencies and services to help ensure people received their care and support that was co-ordinated and managed.

The home had a system in place to assure the quality of service they provided and acted on any feedback and comments received. Satisfaction surveys were used to gather the views of people who lived at the home and their relatives. Regular meetings were held with people who used the service and their relatives where they could make comments and give feedback on the quality of service provided. The complaints procedure was used effectively to ensure continued improvements to the quality of service provided.

The provider and manager carried out regular checks to help ensure people's health, safety and wellbeing were protected. Staff received regular training to ensure people's needs could be met safely and reliably. Information from incidents and accidents had been analysed and used to identify changes and improvements, and minimise the risk of them happening again. Prompt action had been taken to improve the quality of service provided and put right any shortfalls that were found.

Staff were familiar with people's individual needs and preferences. They were able to communicate effectively with people using the service and involved them in making choices and decisions.

Support plans were well detailed and gave relevant and useful information to help ensure that people received the care and support they needed.

Staff understood the potential risks to the safety and wellbeing of the people using the service and would take action if they had any concerns about a person's safety.

Arrangements for the safekeeping and administration of medication were reliable.

Sufficient staff were available to help provide the support and care people required.

There were arrangements in place to help monitor the quality of the service and to secure improvements, when needed.