Background to this inspection
Updated
10 November 2021
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.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection was carried out by one inspector.
Service and service type
Heathcotes Enright Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Our records showed 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. However, the registered manager had left the service several weeks previously and the provider had not formally notified CQC, something which they are required to do by law.
The care home was being managed by the provider’s regional manager as an interim measure.
Notice of inspection
This inspection took place on 29 and 30 September 2021 and was unannounced on both days.
What we did before the inspection
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. 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 two people, who used the service, about their experience of the care provided. We spoke with six members of staff including the regional managers, senior care workers and care workers. We observed staff interactions with people who used the service.
We reviewed a range of records. This included two people’s care records and multiple medication records. We looked at three 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 looked at training data and quality assurance records. We received feedback from two relatives of people who use the service. We also received feedback from seven staff members who worked at the service.
Updated
10 November 2021
About the service
Heathcotes Enright Lodge is a residential care home service that can accommodate up to six people. The service can support four people in one shared bungalow and two other people in self-contained apartments. The service specialised in caring for people with learning disabilities, autistic people and people with complex mental health needs. At the time of the inspection three people were living at the service.
People’s experience of using this service and what we found
People were not supported in a consistent way and since the last inspection there had been an escalation in incidents and injuries. People had care plans and risk assessments in place, but it was not clear that staff always had the opportunity, or time, to read people’s updated care plans.
People were not always supported by staff who had the right training and experience. Staff retention continued to be a problem and the provider had drafted in staff from other services, and also used agency staff to maintain safe staffing levels. This did not help with the problem of consistent support.
People’s living environment was generally clean and tidy. However, we notified the local council environmental health team about overflowing external waste bins which posed a potential health hazard.
Staff told us they did not feel supported by their managers and felt stressed and over worked at times. Not all staff had received the specialist training they required to support people safely; although most staff had received the provider’s basic training.
People were supported to have enough to eat and drink. The food was seen to be appetising, although we found one person was not supported to have access to the snacks they preferred.
Staffing issues sometimes affected the ability to support people to attend community activities which they enjoyed. Staff received guidance from external specialist agencies on how to provide support to people; although some staff told us they did not agree with aspects of the advice and guidance received.
Some people’s relatives told us it was difficult to obtain information from the care home about their loved one, and they wanted more information to be shared with them regularly.
People were protected from the risk of abuse by the provider’s policies and procedure and staff knew how to raise concerns appropriately. People’s prescribed medicines were managed and administered safely. We found that general COVID-19 precautions and procedures were in place and in line with current guidance.
The provider had engaged with other agencies and had an open approach to explaining about the problems they had been encountering at the service.
People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests.
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.
Based on our review of the key questions; Safe, Effective and Well-led
The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, Right care, Right culture.
The care provided to some people did not always promote people’s choice, control and independence. Care was not always person centred. The behaviours of leaders and care staff did not always ensure the people using the service led confident, inclusive and empowered lives. Inconsistencies in the support provided had a negative impact on some people which affected their wellbeing.
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 requires improvement (published 9 August 2021) 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 not enough improvement had been made and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement, or inadequate, for the last three consecutive inspections.
Why we inspected
We received concerns in relation to the management of incidents and staffing levels. As a result, we undertook a focused inspection to review the key questions of Safe, Effective and Well-led only.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has remained Requires Improvement. This is based on the findings at this inspection.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
We have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.
The provider continues to work closely with the local authority and specialist health teams to identify ways in which consistent and appropriate support can be provided. The provider is also working with local authority service commissioners to support a person to move into a more appropriate placement which may better meet their needs.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Heathcotes Enright Lodge on our website at www.cqc.org.uk.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to people’s safety, the care and treatment they receive, and the management of the service. Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.