Preston

Updated 14 December 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

This inspection was conducted by two inspectors.

Service and service type

Heathcotes Preston 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.

The service had a manager registered with the Care Quality Commission. 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.

Notice of inspection

Both days of the inspection were unannounced.

What we did before the inspection

Our planning considered the information we received from the registered manager since the last inspection which included; safeguarding incidents, police involvement and serious incidents. We also received information from local authority commissioners.

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.

During the inspection

We spoke with three people who used the service about their experience of the care provided. Throughout this report we will not use quotations from people we spoke to because this may identify them. We spoke with nine members of staff including the registered manager and two senior managers.

We reviewed a range of records. This included three people’s care and medication records. We looked at three staff files in relation to recruitment, supervision and training. A variety of records relating to the management of the service, including audits, meetings and health and safety.

After the inspection

We spoke with two members of staff and one professional who was responsible for oversight of commissioning from the local authority.

Updated 14 December 2019

About the service

Heathcotes Preston is a specialist care home for adults with a learning disability, mental illness and who may have challenging behaviours and associated complex needs. The service can support up to seven people. At the time of the inspection three people resided at the service. All bedrooms had ensuite facilities. People had access to shared communal areas and a kitchen.

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 a medium sized house with small areas of communal space. The registered manager told us they would assess people before admission to ensure the environment would be suitable for them in relation to space, stimulation and independence. There were deliberately no identifying signs, intercom, cameras, industrial bins 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

Since the last inspection there had been significant improvements. People told us they felt safe and staff understood the importance of safeguarding people from abuse and avoidable harm. The registered manager had ensured lessons were learnt and risk associated with people’s unpredictable and challenging behaviours were managed in a person-centred and effective way, this had significantly reduced the number of incidents at the service.

Staff were suitably trained and supported. The registered manager listened to staff’s opinions and invested in their professional development. Staff morale had significantly improved.

Staff supported people to access a wide range of health and social care professionals. Staff acted when people’s physical or mental health declined and supported them to follow guidance and advice from professionals.

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.

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.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people. The service used positive behaviour support principles to support people in the least restrictive way. No restrictive intervention practices were used.

Since the last inspection the registered manager had developed staff knowledge of supporting people in a person-centred way and had worked closely with them to improve the way staff engaged with people. The organisation deployed a specialist trainer who worked with staff to develop positive intervention strategies, to help de-escalate and reassure people with distressed behaviours. We found examples of how this had created positive outcomes for people.

People told us staff were kind and respectful. The culture within the service was positive and inclusive. Staff supported people to live meaningful lives.

The registered manager demonstrated commitment to providing good care and had made significant improvements since the last inspection. Governance systems were in place and used to highlight and action areas for continued development.

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

Rating at last inspection and update

The last rating for this service was inadequate (12 July 2019) and there were multiple breaches of regulation. 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 improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 12 July 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating. This inspection was carried out to follow up on action we told the provider to take at the last 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.