Hucknall and Watnall

Although the service was very clean, we signposted the registered manager to guidance around specific cleaning products to use during an outbreak.

Staff who may be disproportionately at risk of COVID-19 did not all have risk assessments in place.

We found the following examples of good practice.

The provider worked with people using the service to help them understand the pandemic and the extra measures in place. They gave reassurance where needed. The provider found ways to ensure people still managed to get out into the community safely.

The provider had arrangements in place to ensure people and staff were tested for COVID-19 in accordance with current government guidance.

The provider had an enhanced cleaning schedule in place which prompted staff to regularly clean touchpoints at least three times a day.

There were restrictions on visiting the service. There was a clear system for visitors in place to ensure they followed the current guidance on the use of personal protective equipment (PPE) and social distancing. All visitors were screened for symptoms of respiratory or other infections before being allowed to enter the home.

Further information is in the detailed findings below.

Heathcotes (Hucknall and Watnall) is a residential care home for people with learning disabilities, and or autism and complex mental health needs. The care was provided across two homes; Hucknall and Watnall. There were 14 people living at the service at the time of our inspection, seven people in each home.

The service was purpose built and in a gated community on a residential street. The service was registered for the support of up to 16 people. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the service being across two homes. There were deliberately no identifying signs and staff did not wear anything that suggested they were care staff when coming and going with people, in line with the principles of Registering the Right Support.

Peoples experience of using this service and what we found

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.

People were kept safe in the service by staff who were appropriately recruited and trained. Peoples risks were assessed and managed well. People were living in a home that was kept clean and free from infection. People were supported to have their medicines in a safe way.

Peoples needs were assessed and they were supported to live the healthiest lives they could. People were supported to eat and drink well. People could choose how to decorate their room and had access to communal areas and outdoor spaces.

People were cared for by kind and respectful staff. People were supported to express their views. Peoples privacy and dignity was upheld. People were encouraged to be as independent as they could.

Peoples care was planned in a personalised way. People were supported to continue to do things that were important to them. Peoples individual beliefs were respected. People were helped to maintain important relationships.

The service was well-led by the management team, they understood their duties and responsibilities. The provider had oversight of the running of the service to ensure quality care continued to be delivered.

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 (published 7 June 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 7 June 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.

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.

People’s experience of using this service:

The overall rating for the service is inadequate and the service will be placed in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The outcomes for people using the service did not always reflect the principles and values of Registering the Right Support. People’s capacity to make decisions was not always clearly understood. This meant people were not always supported to have maximum choice and control of their lives and staff didn’t always support them in the least restrictive way possible. They did not always have the restrictions used to support them to manage behaviour that challenges reviewed in line with the provider’s procedures to ensure it was the least restrictive practice to keep people safe. Some incidents were not referred to safeguarding authorities as required to ensure a thorough investigation was completed. The provider’s systems for assessing and reviewing the quality of the service were not always effective in highlighting these issues.

Staff did not always have the training required to safely support people. They did not always receive the support needed through supervision and regular team meetings to review their work and ensure they were effective in their roles. People’s care plans were not always followed to protect people from harm and this impacted on their dignity. Referrals were not always made in a timely manner to ensure people received professional support to manage their health.

People were included in making choices around their care, with the support of advocates when required. They planned activities throughout the week and some of these had a clear goal; for example, increasing independence. People were involved in planning their meals and these were provided in line with specific requirements. People had caring relationships with staff and felt they could trust them. Any concerns or complaints were managed in line with the provider’s procedures.

The environment was adapted to meet people’s needs and was clean and hygienic. The previous inspection rating was displayed in line with CQC requirements.

Rating at last inspection: The home was last inspected on 8 June 2017 and was rated good in all areas.

Why we inspected: We brought this inspection brought forward due to information of risk and concern.

Enforcement: We found the provider was in breach of four of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one of Registration regulations (2009). You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up: Immediately after our inspection, we wrote to the provider and asked them to take urgent action to address the most serious risks outlined in this report. In response, the provider developed an action plan detailing actions taken and planned, to make improvements and reduce risk. Additional resources were also immediately deployed to the service. We also had a meeting with the provider to discuss our concerns and establish lines of communication to report ongoing improvements.

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

Heathcotes Hucknall and Watnall is part of a purpose built campus situated in Hucknall in Nottinghamshire. The service comprises of two separate new buildings called Hucknall and Watnall and provides care and support for up to 16 people with a learning disability or autism. At the time of our inspection 16 people lived at the service.

The service had a registered manager in place at the time of our visit. 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.

People told us they felt safe at Heathcotes Hucknall and Watnall and did not have any concerns about the care they received. Staff knew how to protect people from harm and referrals were made to the appropriate authority when concerns were raised.

Risks to people’s safety were identified and managed and assessments carried out to minimise the risk of harm. The building was well maintained and regular safety checks were carried out.

People received care and support in a timely way and there were sufficient numbers of suitably qualified and experienced staff employed. Appropriate pre-employment checks were carried out before staff began work at Heathcotes Hucknall and Watnall.

People received their prescribed medicines when required and these were stored and administered safely. Procedures were in place to ensure people received their medicines safely when they were away from the service.

People received effective care from staff who received training and support to ensure they could meet people’s needs. Ongoing training and assessment for all staff was scheduled to help maintain their knowledge.

People provided consent to any care and treatment provided. Where they did not have capacity to offer informed consent their best interests and rights were protected under the Mental Capacity Act (2005). People’s wishes regarding their care and treatment were respected by staff.

People told us they enjoyed the food offered and we saw they had sufficient quantities of food and drink to help them maintain healthy nutrition and hydration. People had access to healthcare professionals when required and staff followed their guidance to ensure people maintained good health.

People were treated with dignity and respect and their privacy was protected. We observed positive, caring relationships between staff and people using the service. Where possible people were involved in making decisions about their care and daily activities.

Staff understood people’s support needs and ensured they received personalised responsive care. People had the opportunity to take part in enjoyable, constructive activities and maintain family and social relationships. When a complaint or concern was raised this was acted on quickly and investigated thoroughly by the service.

There was an open and transparent culture at the service. People, their relatives and staff were encouraged to have their say on their experience of care and their comments were acted on. Robust quality monitoring systems were in place to identify areas for improvement and ensure these were acted on.