Archived: Heightlea

Updated 15 October 2022

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 Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by an inspector and an inspection manager.

Service and service type

Heightlea is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Heightlea is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 14 June 2022 and we continued to request information from the service and provider until 7 July 2022. We visited the service on 14 June 2022.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.

During the inspection

We spoke with each person. They could only tell us limited information about their experience of living at the service, so we also observed how staff interacted with them. We spoke with five staff, including the registered manager. We reviewed a range of records including information about how people spent their time and their medicines records, staff records and audits and checks of the service.

Following the site visit we continued to request information from the service and the provider. We reviewed a range of records including people’s care plans, the staff rotas, meeting minutes and people’s financial records. We spoke to three people’s relatives and a professional who knew the service.

Updated 15 October 2022

About the service

Heightlea is a residential care home providing personal care to five people with a learning disability or autistic people. It is part of the Spectrum (Devon and Cornwall Autistic Community Trust) group, a provider with several similar services across Cornwall. Heightlea is close to the city of Truro.

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

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.

Right Support

The model of care did not maximise people’s choice, control and independence. Staff told us they were committed to finding new activities and opportunities that met people’s preferences. However, people received limited support to identify long term goals. This meant activities and how they spent their time were not always part of a clearly laid out plan to ensure they lived a meaningful life. How people spent their time was also sometimes limited by the number of staff or vehicles available.

People were not always supported to develop their independence or to increase the control they had over their own lives. People’s care plans did not focus on people’s strengths or identify areas where people wanted to develop skills.

People who experienced periods of distress had plans in place which ensured physical restraint was only used by staff if there was no alternative. However, there were several restrictions in place in the service that were not the least restrictive options or in people’s best interests.

People had some choice about their living environment and were able to personalise their rooms. People were able to socialise in the living areas and enjoyed the privacy of their own rooms when they chose.

People were supported to use community health and social care services when needed.

Staff supported people safely with their medicines.

Right care

The provider had not given sufficient support to the service. This meant staff did not always recognise poor care or take action to make appropriate changes. People did not always receive support that focused on their quality of life and followed best practice. There was an overly cautious culture in the service that did not enable people to take positive risks.

Information shared by the provider regarding people’s finances showed the provider’s systems were not robust and did not protect people adequately from the risk of financial abuse.

The service was understaffed and did not always provide the number of hours to each person they had been assessed as needing.

People received kind care from staff who valued their relationships with people.

People were able to communicate with staff and understand information given to them by staff who understood their individual communication needs.

Right culture

People did not lead fully inclusive or empowered lives. The ethos and culture of the service were paternalistic which limited the opportunities people were offered.

Staff knew and understood people well, however the provider had not ensured they had a good understanding of best practice models of care. This meant staff did not consistently support people’s aspirations to live a quality life of their choosing.

There was a culture of improvement within the service; however staff did not always have the skills and knowledge to identify all areas for improvement.

People’s views as well as the views of those who were important to them were respected and listened to.

People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support best practice.

Rating at last inspection and update

The last rating for this service was requires improvement (published 19 February 2022) and there were breaches of regulation in staffing, good governance and safe care and treatment.

We specified a date by which the provider needed to meet the requirements of the regulations regarding good governance.

At an inspection in June 2021, due to concerns about staffing, we required the provider to share monthly reports detailing the numbers and training of staff in the service each day, including the number of management hours the registered manager completed. Concerns about staffing were again identified at the February 2022 inspection so the provider was required to continue sending monthly reports.

At this inspection we found the provider remained in breach of regulations.

The last two ratings for this service were requires improvement (published 15 November 2022 and 19 February 2022). The service has now deteriorated to inadequate and has therefore been rated below good for the last three consecutive inspections.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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, caring, responsive and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to person centred care, safe care and treatment, ensuring all decisions are in people’s best interests, staffing and governance of the service.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'.

Following this inspection the provider decided to transfer the service to another provider.