Wigston

About the service

Heathcotes (Wigston) is a residential care home providing personal care. It is registered to support up to eight people with a learning disability or autistic spectrum disorder. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of our inspection there were seven people using the service, five of these people received personal care.

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

The service was able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right Support

We made a recommendation about clarifying reporting arrangements for Deprivation of Liberty Safeguards (DoLS) conditions. However, staff supported people to have the maximum possible choice and control over their own lives and to be independent. Staff supported people in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff supported people to make decisions following best practice in decision-making.

Improvements were needed to record keeping in relation to lessons learned following accidents and incidents. The service worked with people to plan for when they experienced periods of distress so that their freedoms were restricted only if there was no alternative. Staff did everything they could to avoid using restrictions on people’s freedom. The service recorded when restrictive practices were used, and staff learned from those incidents and how they might be avoided or reduced.

People had health action plans in place, these did not always contain up to date information about their health appointments. Annual health checks were overdue but were booked during the inspection.

People had a choice about their living environment and were able to personalise their rooms. Staff supported people to take part in activities and pursue their interests in their local area.

Staff communicated with people in ways that met their needs. They supported people with their medicines in a way that promoted their independence and achieved the best possible health outcome.

Right Care

There was no system in place for staff to request support if they were unable to ‘breakaway’ in an unsafe situation. During the inspection the provider ordered radio-controlled devices for staff to use. Improvements were needed to record keeping systems relating to accidents and incidents, restrictive practice interventions and debriefs to record in detail lessons learned.

The service had enough appropriately skilled staff to meet people’s needs and keep them safe. There had been a high use of agency staffing during the beginning of the year. However, staffing had improved, and no further agency staff usage was planned, following the inspection. There were enough staff that had been safely recruited to meet people’s needs.

Staff promoted equality and diversity in their support for people. They understood people’s cultural needs and provided culturally appropriate care. People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs.

Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

People who had individual ways of communicating, using body language, sounds, Makaton (a form of sign language), pictures and symbols could interact comfortably with staff and others involved in their care and support because staff understood their individual communication needs.

People could take part in activities and pursue interests that were tailored to them. The service gave people opportunities to try new activities. Where appropriate, staff encouraged and enabled people to take positive risks.

Right culture

People were supported by staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have. This meant people received compassionate and empowering care that was tailored to their needs.

Staff turnover had been high resulting in a number of staff vacancies at the beginning of the year. This had improved, which meant the consistency of care people received had improved and they were supported by staff that knew them well.

The service enabled people and those important to them to work with staff to develop the service. Staff valued and acted upon people’s views. Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity.

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 29 December 2018).

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support right care right culture.

The inspection was prompted in part due to concerns received about people’s safety. A decision was made to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe section of this full report.

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.

We have found evidence that the provider needs to make improvements. 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.

We found the following examples of good practice:

¿ Visitors followed the provider’s infection prevention and control procedures which included temperature checks, hand washing and sanitising and wearing PPE (personal protective equipment).

¿ People using the service were risk assessed to ensure that if they did see relatives and friends this was done as safely as possible.

¿ People using the service socially distanced. Communal areas had been re-configured to make it easier for people to do this.

¿ Where necessary people’s one-to-one hours were increased to reduce the risks of social isolation and enable them to leave the service accompanied by staff for exercise.

¿ Staff who previously worked at another of the provider’s services on the same site no longer did this to ensure infection prevention and control guidelines were followed.

¿ Systems were in place to shield and isolate people where necessary considering their rights and best interests.

¿ Staff were trained in infection prevention and control. Essential face-to-face training in restraint was provided in a socially distanced format.

¿ Staff were regularly tested for COVID-19. People were risk assessed regarding testing as not all wanted to take part in the testing programme.

¿ The premises were well-ventilated, clean and hygienic. Staff used effective cleaning products to prevent and control infection.

¿ Staff had supervisions and meetings to support their well-being and keep them up-to-date with the latest IPC guidance.

Further information is in the detailed findings below.

The service is registered to provide accommodation and personal care for up to eight adults with learning disabilities and autism. At the time of our inspection there were seven people using the service.

Heathcotes - Wigston 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.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good. 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.

Staff had received training to enable them to recognise signs and symptoms of abuse and felt confident in how to report these types of concerns.

People had risk assessments in place to enable them to be as independent as they could be in a safe manner. Staff knew how to manage risks to promote people’s safety, and balanced these against people’s right to take risks and become more independent.

There were sufficient staff with time to support people with their required needs. Effective recruitment processes were in place and followed by the provider. Staff were not offered employment until satisfactory checks had been completed.

Medicines were managed safely. The processes in place ensured that the administration and handling of medicines was suitable for the people who used the service. Effective infection control measures were in place to protect people.

People were supported to make decisions about all aspects of their life; this was underpinned by the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff were knowledgeable of this guidance and correct processes were in place to protect people. Staff gained consent before supporting people. People were encouraged to have choice and control of their lives and staff supported them in the least restrictive way possible; policies and systems in the service supported this practice.

Staff received an induction process and on-going training. They had attended a variety of training to ensure they were able to provide care based on current practice when supporting people. Staff were also supported by managers through supervisions.

People were able to make choices about the food and drink they had, and staff gave support when required to enable people to have a balanced diet.

People were supported to access a variety of health professionals when required, including opticians and doctors to make sure people received healthcare to meet their needs.

Staff provided care and support in a caring and meaningful way. They knew the people who used the service well. People and relatives, where appropriate, were involved in the planning of their care and support.

People’s privacy and dignity was maintained. Care plans were written in a person-centred way and were responsive to people’s needs. People were supported to follow their interests.

There was a complaints procedure which was accessible to all. Complaints had been responded to appropriately.

Quality monitoring systems were in place. A variety of audits were carried out and used to drive improvement.

The registered manager did not manage the service as they had moved to another post in the company. The acting manager was responsible for the management of the home and stated that they were in the process of applying to be the registered manager. We will monitor this as it is a condition of registration that the service has a registered manager in post.

Further information is in the detailed findings below.

The service provides accommodation for up to eight people living with a learning disability and/or autistic spectrum disorders. There were eight people using the service at the time of our inspection. The accommodation was over three floors and all the bedrooms had an en-suite washroom facility.

The service had 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 safe using the services at Heathcotes Wigston. They felt safe due to staff ability and knowledge to meet the needs of people using the service. They were also confident in staff skills to protect them from avoidable harm and abuse.

There were enough staff to keep people safe and meet their individual needs. The registered manager determined staffing levels based on people’s assessed needs. The provider had a safe recruitment process to ensure that they employed staff who had the right skills and experience, and as far as possible were suited to supporting the people who use the service. They involved a person using the service in the recruitment process.

People received their medicines as prescribed. The provider had effective protocols for their safe management.

Staff received the training they required to provide support that met people’s individual needs.

Staff had a good understanding of the relevance of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards to their work. They supported people in accordance with relevant legislation and guidance.

People were supported to have a healthy balanced diet that they enjoyed. They were supported to access health care services when they needed to.

Staff were caring. They also treated people with dignity and respect. They were knowledgeable about the needs of the people they supported. Staff communicated effectively with people who used the service and supported them to be involved in decisions about their care.

People’s care plans reflected their individual needs and preferences. People’s relatives were actively involved in the development of their relative’s care plans.

People had access to a variety of activities. They were supported to be part of the community.

Staff provided support that was tailored to people’s individual needs. They also supported people in ways that met their cultural and religious needs.

Staff felt supported by the registered manager. The registered manager fulfilled the requirements of their role.

The provider had effective procedures for monitoring and assessing the quality of service that promoted continuous improvement.

Is the service safe?

People told us they felt safe with the staff that supported them. People were helped to take part in activities that were of interest to them and used other community facilities such as the leisure centre. Throughout our visit we saw staff treated people with respect. Staff helped people with their daily living skills and to do things that promoted their independence.

People told us they felt safe and secure because they were cared for in an environment that had been maintained. People were able to access all areas of home safely. Communal areas were suitably furnished, which made it homely and comfortable. People had decorated and personalised their room to reflect their interests and other things that were important to them. All the bedrooms had an en-suite washroom facility, which promoted their privacy and dignity.

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.

The staff at Heathcotes (Wigston) 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?

People told us that staff supported them with their daily care needs. Staff were attentive and understood the support each person required. People told us that staff helped to promote their independence, supported them to take part in meaningful activities and to access other social amenities in the community. Records we looked at confirmed that people's care needs were met safely and that they had access to a range of health care professionals. It was clear from our observations that staff had a good understanding of people's needs and that they knew them well.

Staff were trained and qualified for their job role. Staff understood how to support each person, which helped to ensure that any risks identified could be managed. The staff training matrix we reviewed showed that the provider had taken steps to ensure staff kept their knowledge and skills up to date and in line with current best practice.

Is the service caring?

People were supported by kind and attentive staff. Staff recognised how each person communicated and expressed themselves. This helped to ensure that people's comments and views about how they were cared for would be acted on. Staff were caring and vigilant to any potential risks that could be harmful to people. We saw staff helped people individually and in a manner that respected the person as an individual. People were involved to make decisions about their care needs, lifestyle and aspirations. Records we looked at showed people's views and preferences were taken into account and respected.

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. People told us that staff helped them to keep in contact with their family, which helped to promote their wellbeing and family identity.

People were given information about the advocacy service when they moved to the home. Information was produced in a format so that it was suitable for the person to understand, which included the use of pictures and photographs. This meant that people could access additional support and advice when required. Staff had received ongoing training to provide people with the care they needed and knew how to access support from other health and social care professionals when required.

Is this service responsive?

People had the opportunity to visit the home to make sure it was the right place for them and that their needs would be met. People's needs had been assessed before they moved to the home. Staff had been trained to safely provide the care and support that people needed. People had access to health care professionals such as the doctor, to meet their health needs. Records confirmed people's preferences and expectations had been recorded, and the care and support had been provided in accordance with their wishes.

We talked to one person about life at Heathcotes (Wigston). They told us what they liked about the home and how the staff helped them. Their comments confirmed that their experience of living at Heathcotes (Wigston) had had a positive impact on them.

Staff were trained to support people safely and recognised signs that would indicate someone may be unhappy or had a concern. It was clear from our observations that staff understood their responsibility and how to protect people from any unforeseeable harm or risks.

Is this service well led?

People's personal care records and other records kept in the home were accurate and up to date. People knew about the information in their care records because it was produced in a format that they could understand and the content was discussed with them. People's care needs were reviewed regularly 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. They also had the opportunity to comment on any proposed changes to the home that could affect their wellbeing. The complaints policy and procedure were used effectively for the benefit of people living at the home and for making continued improvement 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.