Garmsway

We found the following examples of good practice.

Visitors were supported to wear personal protective equipment (PPE) and screened for symptoms before entering the home.

Residents could be isolated in the event of an outbreak with staff supporting people to stay in their rooms for the duration of the isolation period.

Staff were seen to use PPE effectively and had the appropriate training in infection prevention and control, which included putting on and taking off PPE.

All staff and people living at the service received regular COVID-19 testing. Appropriate processes were in place and followed should anyone display symptoms of COVID-19.

The service was clean, and cleaning of frequently touched surfaces was in place and recorded regularly by staff.

There was an up to date IPC policy in place which had contingency plans to follow in the event of any COVID-19 related shortfalls developing in the service.

Heathcotes (Whitley House) is registered to provide care and accommodation for up to 6 people with learning disabilities, autism and associated complex needs. At the time of our inspection 6 people were living there.

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 received planned and co-ordinated person-centred support that was appropriate and inclusive for them.

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

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 some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles. Where interventions were used the registered manager agreed to record where lessons could be learnt to reduce the likelihood an incident would occur again.

Everyone we spoke with was positive about the service. There was a relaxed and homely atmosphere. Staff had developed caring and trusting relationships with people. The service demonstrated exceptional positive outcomes for people which reflected the principles and values of Registering the Right Support. This included; supporting people to make their own decisions and choices to maintain independence and control of their lives. Improving people’s life experiences and accessing the right support at the right time to maintain positive outcomes for people’s health conditions. This had a positive impact on people’s wellbeing and mental health. People were offered opportunities to gain new skills and explore work and other interests.

Care plans contained detailed and relevant information about how to proactively meet people's needs. Staff were immediately informed of changes in people’s needs so that care was tailored and specific to each individual.

People enjoyed a range of activities and followed their hobbies and interests. Staff took time to understand things that were important to people such as, supporting them to build and maintain friendships and family relations.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; policies and systems supported this practice. People were provided with information they needed and were encouraged to be involved in all aspects of their care. Staff always asked for people’s consent before staff delivered care and support for them.

Systems were in place to safeguard people from abuse or harm, which included safe recruitment processes. Detailed risk assessments were in place and overall medicines were managed safely. Accidents and incidents were recorded appropriately.

Staff received regular training to enable them to deliver person centred care. This included additional training specific to people’s health needs and some was sourced from external health professionals.

People were encouraged to eat a balanced and nutritious diet, whilst respecting their own food choices. Staff supported people with their eating and drinking by creating an inclusive environment.

People, their relatives and staff spoke positively about the management team. They were confident about raising concerns and that they would be addressed immediately. Staff felt supported and valued by them.

Checks were in place to maintain safety and drive improvements at the service. The management team had a proactive approach and were keen to make changes that would impact positively on people's lives.

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 Good (published 22 August 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

Heathcotes (Whitley House) is a residential care home for up to six people living with autism, learning disabilities and mental health needs. The service was newly registered in May 2015. People who live at the service have complex needs and associated communication difficulties, which increases their vulnerability. The property is situated in a rural location on the outskirts of the village of Whitley and accommodation is provided across a five bedroom house and a one bedroom independent living flat on the same site.

At the last inspection on 23 May (and 03 June) 2016 the service did not meet all of the regulations we assessed under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service was rated ‘Requires Improvement’, because the provider was in breach of two regulations. These related to ‘safe care and treatment’ and ‘records’. We also recommended that improvements be made with support plans.

At this inspection we found the overall rating for the service to be Good. The rating is based on an aggregation of the ratings awarded for all five key questions. Improvements were made in the provision of safe care and treatment and in maintaining records, so that all requirements made against breaches in regulations were now met. A recommendation made about support plans was also met.

The provider was required to have a registered manager in post and on the day of the inspection we found that the manager had only been registered for ten days, though in post as the manager for the past five weeks. 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.

Systems in place to detect, monitor and report potential or actual safeguarding concerns, protected people from the risk of harm or abuse. Staff were appropriately trained in safeguarding adults from abuse and understood their responsibilities in respect of managing potential and actual safeguarding concerns. Risks were also managed and reduced so that people avoided injury of harm wherever possible. The premises were safely maintained. Staffing numbers were sufficient to meet people’s needs. Recruitment policies, procedures and practices were carefully followed to ensure staff were suitable to support vulnerable people. The management of medicines was safely carried out.

People were supported by qualified and competent staff that were regularly supervised and appraised regarding their personal performance. People’s mental capacity was assessed and their rights were protected. Support workers had knowledge and understanding of their roles and responsibilities in respect of the Mental Capacity Act (MCA) 2005 and enabled people to make decisions for themselves. The registered manager explained how the service worked with other health and social care professionals and family members to ensure decisions were made in people’s best interests where they lacked capacity. People received adequate nutrition and hydration to maintain their levels of health and wellbeing. The premises were suitable for providing support to people with a learning disability or mental health needs.

Support workers were kind and caring and knew about people’s needs and preferences. People were supplied with the information they needed at the right time, involved in all aspects of their care and were asked for their consent before any support was provided to them. People’s wellbeing, privacy, dignity and independence were monitored and respected.

We saw that people were supported according to their person-centred care plans, which reflected their needs and were regularly reviewed. People had the opportunity to engage in pastimes, occupation and activities of their choosing. People had family connections and support networks and were encouraged to maintain relationships. An effective complaint procedure was in place and people had their complaints investigated without bias.

The service was appropriately led by the new registered manager who was supported by an acting area manager. Heathcotes (Whitley House) has had two newly registered managers in the past year and there was an acting area manager present at this inspection, where a longer-standing area manager might have been present. We found that a period of instability had ensued when Heathcotes (Whitley House) was still developing as a service and that these changes in management did not provide consistent direction and management for people that used the service and their support workers. However, this movement in managerial staff at service and area level reflects more on the organisation than the service, as the service was being appropriately managed.

An effective system for checking the quality of the service using audits, satisfaction surveys and meetings was in place, but a part of it was not completed because views were not always acted upon. People had opportunities to make their views known through regular individual question sessions with support workers and people’s answers were recorded on satisfaction questionnaires. We saw that some responses from people were consistently negative and so we asked the registered manager to look at possible alternatives for consulting people and engaging them more effectively by ensuring people’s views were acted upon. People were assured that recording systems used in the service protected their privacy and confidentiality as records were better maintained and held securely on the premises.

The home was first registered in May 2015. We inspected this service on 23 May and 3 June 2016. This was our first inspection of this home. The inspection was unannounced. At the time of our inspection, there were three people using the service; two people living in the main house and one person living in the home’s independent living flat.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager registered with the Care Quality Commission (CQC). However, the registered manager was in the process of de-registering and a new manager was in post and applying to become the home’s registered manager. A registered manager is a person who has registered with the 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.

During the inspection we found that risks were identified and assessed, but care and support provided did not always effectively manage these risks. For example, one person using the service had left the home on several occasions. However, new gates installed to manage this risk and prevent the person running into a busy road at the front of the property, were left open when we visited.

This was a breach of Regulation 12 (2) (b) of the Health and Social Care Act 2008 Regulated Activities) Regulations 2014.

We found that the registered provider had not maintained a complete and contemporaneous record in respect of each person using the service or with regards to the management of the regulated activity.

This was a breach of Regulation 17 (2) (c) (d) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the registered provider to take in relation to these breaches of regulation at the back of the full version of this report.

Health and social care professionals told us the care and support provided was not always person centred and responsive to people’s individual needs. Concerns were raised about inconsistencies in the staff team at Heathcotes (Whitley House). We identified concerns about how recommendations from health and social care professionals were recorded and shared with staff and concerns around the support provided to engage in meaningful activities including access to transport. We have made a recommendation about developing person centred care in our report.

Staff we spoke with understood their role and responsibilities with regards to safeguarding vulnerable adults.

There were sufficient staff on duty to meet people’s needs and medicines were managed safely and in line with guidance on best practice.

Staff received an induction, on-going training, supervision and yearly appraisals to support them to develop in their role.

Due to people’s complex needs, people using the service did not always have a varied and nutritious diet. However, staff encouraged people using the service to eat and drink regularly. People’s food and fluid intake were monitored.

People were visited by health and social care professionals, however, records of their visits and the outcomes or any recommendations made needed to be more clearly recorded to ensure more effective collaborative working.

Staff were described as kind and caring and we observed that people using the service were treated with dignity and respect. People were encouraged to make decisions and be involved in planning their care and support.

There were systems in place to manage and respond to complaints.

We received positive feedback about the new manager of the home. However, a number of health and social care professionals raised concerns about the lack of coordination and management response to issues or concerns.

The registered provider had a system in place to monitor the quality of the service provided.