Middleton

Heathcotes (Middleton) is registered to provide accommodation and personal care for up to 7 people with a learning disability and/or mental health diagnosis. There were 7 people accommodated at the home on the day of the inspection.

People’s experience of the service and what we found:

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessment and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support

Improvements were needed to ensure people’s prescribed medicines were managed and administered safely. People were cared for in a way they wanted and needed. Care records needed updating. A new systems was being introduced to help address this. Staff had received relevant training to help support people in a safe and effective way. Sufficient numbers of staff were now provided so people had access to the support they needed, enabling them to maintain their independence. People were able to receive visitors without restrictions in line with best practice guidance. A good standard of accommodation was provided. Plans were in place to further enhance areas of the home.

Right Care

People were safeguarded from abuse and avoidable harm. Staff understood their responsibilities to raise concerns. Risks were assessed and planned for. Any accidents or incidents were reviewed and reflected upon to help learn and improve the service. 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. People maintained relationships and followed their interests, taking part in activities of their own choosing. People had access to health care professionals when they needed them. People's privacy, dignity and independence were respected and promoted. Safe recruitment processes were followed.

Right Culture

People’s relatives were not clear about the management of the service. The registered manager had recently left the service, a new appointment was to be made. Staff told us morale within the team was improving. Formal support systems, such as team meetings and supervisions session were to be re-established to help promote teamwork. Whilst a range of audits and checks were completed, these were not always effective. An action plan was in place identifying areas of improvement across the service, helping to further enhance people’s experience. Opportunities for people and their relatives to contribute to the running of the home could also be improved.

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 2 July 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Enforcement

We have identified breaches in relation to the management and administration of people’s medicines and good governance.

Please see the action we have told the provider to take at the end of this report.

Follow Up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

People using the service and staff had their temperature taken daily and staff were screened for symptoms of Covid-19.

Staff were seen to be following the current government guidance in relation to the personal

protective equipment (PPE) being used and there was good ventilation around the home

The service was fully engaged with the Covid-19 testing and vaccination programmes. All staff and people were tested in-line with current guidance and vaccinations had been offered to people who wanted them.

People were supported to maintain contact with their families and friends through video calling.

We found that there were not enough bins around the home for disposing of PPE and that clinical waste was not managed well. We raised this issue with the registered manager who agreed to take appropriate actions to remedy this.

At the last inspection of January 2018 the service was rated as good overall but there was a breach of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. This was because recruitment processes were not sufficiently robust to adequately protect people from the risk of unsuitable staff. The service sent us an action plan detailing what improvements they would make to improve recruitment. At this announced inspection we found the service had made the improvements and recruitment was robust.

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

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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. The manager was registered in February 2016.

Staff we spoke with were aware of how to protect vulnerable people and had safeguarding policies and procedures to guide them, which included the contact details of the local authority to report to.

Recruitment procedures were robust and ensured new staff should be safe to work with vulnerable adults. There were sufficient staff to meet people’s needs.

There was a medicines policy and guidance for staff around safe administration. Care givers had undertaken training and competency checks were regularly undertaken.

Staff were trained in infection control topics and issued with personal protective equipment to help prevent the spread of infection.

The service was working within the legal requirements of The Mental Capacity Act 2005 (MCA).

People received a nutritious diet and were encouraged to plan their diet, shop and where possible were supported to make their own meals.

Staff received an induction and were supported when they commenced employment to become competent to work with vulnerable people. Staff were well trained and supervised to feel confident within their roles. Staff were encouraged to take further training in health and social care topics such as a diploma.

People had a range of activities they could attend which was suitable to their age, gender, ethnicity and beliefs.

There was a relevant complaints procedure. There had not been any recent complaints.

There was a recognised management structure. Staff thought the service was well-led and the two people we talked to thought staff were approachable. We observed staff interacting with people who used the service in a friendly and appropriate manner.

There were systems to check the quality of service provision to help management maintain and improve standards.

The service liaised well with other organisations to help meet people’s health and social care needs.

Following the inspection in August 2015 the provider wrote to us to tell us the action they intended to take to ensure they met all the relevant regulations. During this inspection we found the required improvements had been made and the provider was now meeting these regulations.

Heathcotes (Middleton) is a registered to provide accommodation and personal care for up to six people with a learning disability and/or mental health diagnosis. There were six people living in the service on the day of our inspection.

The service had a registered manager in place as required by the conditions of their registration with the Care Quality Commission (CQC). 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. The registered manager had been appointed since the last inspection.

During this inspection we identified one breach of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. This was because recruitment processes were not sufficiently robust to adequately protect people from the risk of unsuitable staff. We did not see evidence that the identity of people sending references from personal e-mail accounts had been verified. The provider had not carried out the required additional checks when people had worked previously with vulnerable adults or children to ascertain why their employment in that service had ended. You can see what action we have told the provider to take at the back of the full version of the report.

People who used the service told us they felt safe with the staff who supported them. They told us staff were always available to support them in the activities they wished to do. People were enabled to make their own decisions and told us staff always promoted their independence. During the inspection we observed staff were caring and respectful in their interactions with people who used the service.

Staff had received training in the safe administration of medicines. The competence of staff to administer medicines safely was regularly assessed.

Systems were in place to help ensure the safety and cleanliness of the environment. People who used the service were encouraged to participate in cleaning the home.

Staff told us they received the training and support they needed to carry out their role effectively. We saw that staff received specialist training to enable them to provide positive support to people whose behaviour might challenge others. There were systems in place to track the training staff had completed and to plan the training required.

All the staff we spoke with told us they enjoyed working in the service and felt valued by the registered manager. Staff felt able to raise any issues of concern in supervision and staff meetings. We saw evidence that the registered manager had taken action in response to feedback received.

Staff we spoke with had a good understanding of the Mental Capacity Act 2005. We saw that appropriate arrangements were in place to assess whether people were able to consent to their care and support. The necessary DoLS applications had been made to authorise any restrictions in place.

People who used the service had health support plans in place. Records we reviewed showed that, where necessary, people were provided with support from staff to attend health appointments. People were also supported by staff as far as possible, to maintain a healthy diet.

Care records we looked at showed people who used the service had been involved in developing and reviewing their care and support plans. Support plans included good information about the way people wanted their support to be provided and their goals for the future. We saw that staff used creative methods to support people to achieve their goals as far as it was possible to do so.

All the people we spoke with told us they felt able to raise any concerns with the registered manager and were confident they would be listened to. We noted systems were in place to encourage people who used the service to provide feedback on the care and support they received.

The service was based on a set of values which were clearly understood and implemented by staff. Quality assurance systems in place were used to drive forward improvements in the service.