Heathcotes Yorkshire Supported Living Office

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We rated safe as Good. We assessed 8 quality statements. We found improvments had been made within the service since the last inspection and the provider was working hard to ensure people were safe and staff felt supported. We found that staff were competent and had the right skills to meet people’s needs. Staff worked well with external agencies and professionals to provide safe care and treatment. Communication between staff, families and professional had improved and staff were honest when things went wrong. The environment was safe, personalised and well maintained. There appeared to be sufficient staff to meet the needs of people, however rotas were not kept up to date and accurate.There were still areas where improvement was needed relating to issues in record keeping and assurance processes, however due to these concerns being prodominently a governance issue we have followed these up in the Well-led domain.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Families told us they were informed when there was an incident within the service involving their family member and we saw this documented within records. People or those who represented them were given an apology and an explanation when there had been an incident, or a person had been put at risk of harm.

Staff were confident to report incidents and knew what they should report and when to do this. Staff told us they weren’t always aware of learning from incidents especially when they were not directly involved. They also told us there was no formal process for de-briefs after an incident. Staff told us information would be handed over informally between themselves or written in a communication book.

Professionals working with the service were positive about the care and communication between the service and themselves and were updated following any incidents.

Accidents and incidents were completed by staff onto the electronic care records. The process required these to be reviewed and signed off by managers. We found that incidents were not always reviewed and signed off by an appropriate person in a timely manner and it wasn’t always clear what actions had been taken from the accident and incident reviews. There was no formal process in place to provide staff and people with a de-brief following an incident. Behavioural incidents were also reviewed by a team of positive behavioural specialists at 1 of the 2 services we inspected. This was scheduled to start at the second service after the inspection. It wasn’t always clear from records that advice and recommendations made in these meetings had been actioned.

People were supported to access external clinical support and attend appointments. Transitions and discharges were supported by staff familiar to the person and in a way that supported the person and their individual needs. Where possible, staff had continued to work with the person despite moving to a new provider to ensure consistency of care. This had positively impacted the transition process for the person supported.

Staff and leaders told us how they worked with other partner agencies to ensure people’s needs were met. Staff told us that some residents they supported in the past had not always been appropriately placed and staff weren’t able to safely meet their needs which had impacted the overall safety and quality of the service. This had improved following recent discharges.

A professional involved in a person’s discharge was very complimentary of how the service had handled the process, in particular the communication with family members and other professionals.

Care plans were detailed and included continuity of care; however, we found some areas of the care plans contained inconsistent information which needed review to ensure all the persons care needs were correctly recorded and accurate. The service communicated well with all other agencies involved providing regular updates.

Staff took action to ensure people were protected from harm and abuse. Where people lacked capacity, the service had worked with the local authority and families to apply for a deprivation of liberty safeguarding order. Families told us they had no concerns with staff.

Staff told us they felt people were safe and well looked after. Staff had received training in safeguarding adults and were able to explain what they would do if they had concerns. Staff told us they had confidence that the management team would listen and act on any concerns they raised and knew how to escalate concerns further if they were not satisfied.

People appeared happy and comfortable with the staff that were supporting them on the days we visited the services. Inspectors observed staff on the day of the inspection and found interactions between staff and people to be positive and respectful. We saw how people had raised concerns when they had them, and appropriate action was taken to investigate these.

On most occasions, staff had completed mental capacity assessments supported by best interest decisions for specific situations where needed. However, we found no mental capacity assessment or best interest decision for one person who was wearing a lap belt in their wheelchair, which is a form of mechanical restraint. Similar concerns were raised in the warning notice from the last inspection. The provider recified this on the date of the inspection and correct documenation was put in place. Documentation for DoLS was not always uploaded to the electronic records. The providers internal auditing systems had failed to highlight these concerns. Improvements had been made in staff training, with 100% of staff completing capacity and decision-making training. Leaders had promoted the principles of ‘Stop The Over Medication of People with learning disabilities and autism’ (STOMP). Staff were knowledgeable about this guidance, and this was having a positive impact on the service and the people. There was clear evidence in the reduction of the use of physical and chemical restraint used in the service.

People were involved with managing the risks to them and their families were asked to contribute and review their care. However, we found that evidence of people’s involvement to manage their risk was inconsistently recorded.

Staff told us that people were involved in their care and risk assessments as much as they were able to be. Staff and leaders feedback was inconsistent around the communication tools used to support people to be involved in their care and in meetings. We saw how some people had been supported with easy read and accessible information whilst others who also needed this support had not. Staff knew the people they supported well; however, some medicines care plans did not always contain the most up to date information.

We saw that care plans were detailed and most included all the relevant information to keep people safe. The environment that people lived in was safe and clean. We observed how staff interacted well with the people they supported.

We could see people's representatives were included in the details of some of the care plans, but this was not consistent across both services. The service needed to review how they captured consent and ongoing involvement from people and their representatives in their care plans.

People’s environments were safe, personalised and met their individual needs.

Most staff felt that issues with the environment when raised were responded to promptly now the new managers were in position.

We saw that the services were clean and personalised and overall well maintained. One of the services needed to replace some of the furniture due to wear and tear.

Environmental risk assessments had been completed and we saw that action plans were in place with the required actions taken. Staff were aware of how to evacuate in the event of a fire and documentation to support this was in place and readily available.

Family members told us that there were always staff allocated to support their family member. They felt people were usually supported by regular and consistent staff, and although agency staff were sometimes needed, this was minimal.

Staff reported feeling stressed at times and had mixed opinions on whether there was enough staff to meet the needs of people. Staff told us when there was not enough staff, this impacted on how often people could access the community. During the inspection we did not see evidence that current staffing levels had negativley impacted on care provided.

We observed sufficient staff supporting people as part of our visit to the service. Staff seemed relaxed with the people they were supporting, spending time to chat with people while completing their care tasks.

Rotas were in place but varied in how well they identified the staff on shift, which person staff were allocated to support and the training the staff had received. We raised this with leaders who told us they were working to improve this. Staff had completed the relevant training required of them, overall compliance with training was 97% across both supported living services. Evidence was not always available on the electronic staffing records to evidence that all staff had been safely recruited. The provider assured us these checks were completed and this was an administration error due to implementing a new system and would be rectified. This had not been identified as part of the audit of the HR files.

People were encouraged to take part in cleaning and household tasks as part of their independent living skills. Staff had a good awareness of what tasks people could and couldn’t do. Family members told us the environment was kept clean, tidy and free from clutter.

Staff told us that they were responsible for maintaining good standards of infection, prevention and control and had received training to do so.

We observed that peoples living environments were clean and free from clutter.

Cleaning schedules were in place to support staff in the cleaning of the environments.

Family members told us they were happy with how their relatives were supported with the managment of mediciation. However, during the inspection shortfalls were found with the recording and order process of medication which meant people were at risk of going without the medication they needed. Due to this the inspector could not be fully assured that peoples experience of medication was consistently good overall.

Staff told us that they were trained and competent in the management and administration of medication. However, one staff member told us that at times people ran out of medication as there was a lack of an accountable person to re-order medication. This meant people may have been at risk of not having their medication when needed. Staff had a good understanding of STOMP and could tell us how they had implemented this and worked with GPs around this.

People’s medicines were stored securely with staff completing appropriate checks to ensure storage temperatures were within the recommended range. People’s allergies were recorded accurately on their medicine records and staff knew people’s preferences around how they liked their medicines administered.

Staff had received training and had their competencies assessed for the management of medicines. A policy was in place around the safe management and administration of medication. However, we found that care plans and medication charts did not always match, protocols for the administration of “as and when required” medicines were not always in place and the outcomes following administration of these medicines were not always recorded. We also found that risk assessments required for the use of flammable creams were not always in place. The provider had failed to ensure a robust system was in place for the ordering of medication which mean people were at risk of not receiving their medication when needed or as prescribed.