Archived: HF Trust - Milton Heights

Updated 16 November 2019

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection team consisted of one inspector and an assistant inspector on the first day of the inspection. The inspector returned alone to complete the inspection.

Service and service type

HF Trust Milton Heights 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. There were 22 people living in accommodation across six separate houses, each of which had separate facilities. The houses were situated on the HF Trust Milton Heights site which also comprises of day support facilities and supported living accommodation.

The service had two registered managers. This means that the registered managers and provider were legally responsible for how the service is run and for the quality and safety of the care provided. One registered manager was responsible one of the houses and the other registered manager for the other five houses.

Notice of inspection: This inspection was unannounced.

What we did before the inspection

We reviewed the information we held about the service and the service provider. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We looked at notifications received from the provider. A notification is information about important events which the provider is required to tell us about by law. This ensured we were addressing any areas of concern. We reviewed the action plan which the provider had submitted following the last inspection. We also reviewed the provider’s previous inspection reports. We used all of this information to plan our inspection.

During the inspection

We spoke with three people and looked at six people’s care and medicine records (MAR). We looked around the homes and observed the way staff interacted with people. We spoke with the two registered managers, the operational development manager and regional manager. We spoke with one senior support worker and two support workers. We reviewed a range of records relating to the management of the homes, including policies and procedures. We looked at two staff files in relation to recruitment and staff supervision.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We sought feedback from the local authority and professionals who work with the service. We had feedback from three relatives and three support workers.

Updated 16 November 2019

About the service

HF Trust Milton Heights is a residential care home providing accommodation and personal care to 24 people with learning disabilities/ or autism at the time of the inspection. The care home can accommodate up to 25 people across six homes on one site.

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.

The service was on a campus type setting (meaning people’s homes were on one site). This setting does not meet current best practice guidance. However, this issue was mitigated as the provider was in the process of identifying alternative accommodation for people to address this. In the interim, the provider was aware of the need to ensure people could access their local facilities with staff support.

The service applied the principles and values of Registering the Right Support and other best practice guidance. This ensured that people using the service could live as full a life as possible and achieve the best possible outcomes that included 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 experience of using this service and what we found

At the last two inspections we found that people’s accommodation needed improvements. At this inspection, the required improvements had been made and the provider was no longer in breach of regulation 15 (Premises and equipment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. However, the provider’s systems and processes to monitor the safety of the environment had not been used consistently. This included weekly and monthly checks to ensure the safety of each of the premises such as fire and water safety. This meant the provider continued to be in breach of regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People’s up to date records were not always available in a format for non-permanent staff to refer to. Medicine records and checks were not always managed safely. However, people received their medicines as prescribed and the service had safe medicine storage systems in place. People and their relatives expressed no concerns about their safety.

The service had not improved the rating of Well Led from Requires Improvement to Good. This was because quality assurance systems had not been used effectively to ensure the health and safety of the environment was safe. Therefore, the provider had not ensured that continuous learning and improving care had taken place to rectify all previous breaches of the regulations.

People and relatives told us they felt the service had a positive culture with good outcomes and staff said they felt supported. People and their relatives had opportunities to provide feedback through surveys. The information gathered was used to improve the service. The service worked in close partnership with the relevant external services to support safe care provision.

Staff were respectful and caring with the people they supported. A person told us, “I love it here, everything about it, the staff are nice”. Staff ensured people received flexible care to support them in areas such as hospital visits. People’s equality, diversity and human rights were respected, and they were treated with dignity.

People received care and support specific to their needs, preferences and routines. People were encouraged to be involved. Care plans included information about people’s personal preferences and were focused on how staff should support individual people to meet their needs. People had information on how they best communicated. Staff supported people to access activities, employment and contact with the wider community.

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.

Rating at last inspection and update

The last rating for this service was requires improvement (published 21 September 2018) and there were two breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found that actions had been met in relation to regulation 15, however we found further additional evidence that the provider continued to be in breach of regulation 17. This service remains rated requires improvement. This service has been rated requires improvement at the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating. We have found evidence that the provider needs to make improvements. Please see the Safe and Well Led sections of this full report.

Enforcement

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

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