Background to this inspection
Updated
16 July 2020
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 carried out by three inspectors and one assistant inspector
Service and service type
Heathcotes (Erdington) 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.
Heathcotes (Erdington) can provide accommodation with personal care to children aged 13-18 years, younger adults aged 18-65 years who may have dementia, learning disabilities or autistic spectrum disorder, mental health, physical disability or sensory impairment.
The service did not have a manager registered with the Care Quality Commission. This means the provider is legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced on 25 and 28 October 2019 and announced on 29 October 2019.
What we did before the inspection
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 reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used all of this information to plan our inspection.
During the inspection
We interacted with three people, however they all had limited communication abilities and understanding. We spoke with three relatives about their experience of the care provided. We spoke with 12 members of staff including care staff, manager, regional managers and the director of operations. We spoke with two visiting professionals.
We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.
We reviewed a range of records. This included five people’s care records and multiple medication records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We spoke with the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We spoke with professionals from local authorities to discuss the service and obtain their feedback.
Updated
16 July 2020
About the service
Heathcotes (Erdington) is a residential care home providing personal care to two people at the time of the inspection. The service is able to support up to eight people from the ages of 13 to 65 years old.
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.
The service was a large home, bigger than most domestic style properties. There were no identifying signs to indicate it was a care home. Staff did not wear clothing which suggested they were care staff when going outside the home with people.
People’s experience of using this service and what we found
The provider had not made all the necessary improvements since our previous inspection and people continued to be put at risk of unnecessary harm and abuse.
Although the culture at the home had improved since our previous inspection, there was further improvement needed to ensure people’s safety and wellbeing was kept risk free.
People were not safeguarded against the risk of inappropriate restraint. Although people had clear support plans, risk assessments and guidance in place, these was not always followed. The provider did not monitor people’s liquid medicines to ensure they had received them as required. Staffing levels were improved and people were supported by enough staff. The provider identified lessons to be learnt from incidents but improvement had not been made.
Staff did not always demonstrate respect towards people because some restraint was not necessary and they did not follow their individual guidance. However, during our inspection we did see caring interactions between staff and the two people who lived at the home.
Staff received the training they needed to support people, but this was not always put into practice. People’s care plans were detailed, holistic and showed staff worked with other health professionals. People were supported to eat and drink enough.
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests. The provider had policies and systems in place, but the staff did not always support this practice.
The service did not consistently apply the principles and values of Registering the Right Support and other best practice guidance. These ensure 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 of Registering the Right Support by promoting choice and independence, but not always control. People's support focused on them having opportunities and to become more independent.
People's care was planned around them as an individual. People's communication needs were assessed and staff knew how best to communicate with each person. The provider had a complaints process in place and most were dealt with at a local level.
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 14 January 2020), and there were multiple breaches of regulation and the service was placed in special measures. At this inspection sufficient improvement had not been made and the provider was still in breach of regulations.
Following our last inspection, we imposed a condition on the provider's registration so they could not accept any new admissions to Heathcotes (Erdington).
Why we inspected
This inspection was carried out to follow up on action we told the provider to take at the last inspection.
Enforcement
All representations and appeals have been concluded and we have imposed conditions onto the provider's registration in respect of the regulated activity, accommodation for persons who require nursing or personal care, at Heathcotes (Erdington).
Follow up
The overall rating for this service remains as ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under close review to check for significant improvements.
If the provider does not meet the conditions of their registration we will begin the process of preventing the provider from operating this service.