Archived: Heathcotes Enright Lodge

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.

Heathcotes Enright Lodge is a residential service that can accommodate up to six people. The service accommodates four people in one shared bungalow and two other people in self-contained apartments. The service specialises in caring for people with learning disabilities, autism spectrum disorders and complex mental health needs. At the time of the inspection one person was living at the service.

Within the same grounds the provider had a second registered location Heathcotes Enright View that provided the same service and could accommodate seven people.

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

Staff had received training in safeguarding, however, did not always recognise issues that should be identified and reported.

People’s needs were assessed, and support plans were in place, however they were not always up to date and there were inconsistencies in how staff applied support to people.

Staff did not always have the right mix of skills, competence and experience to support people. Staffing levels were still impacted by a high turnover of staff.

Staff recruitment procedures were in place and staff had a probation period with training and shadow opportunities. Staff had mandatory training in place, however, staff did not always have 'service user specific training' in place before they commenced worked under supervision.

Incidents did not always have effective measures in place to avoid reoccurrence.

The service was clean and well maintained. Staff were following current guidelines for infection prevention and control.

Medicines were stored, administered and disposed of safely.

There was a registered manager in post who was responsible for running another service on the same site, with overview of Enright Lodge. The service had a manager who had been in post for six months and improvements within the service had not been fully sustained. Staff reported inconsistencies in team working and support from management.

Systems and processes to monitor the quality of the service were in place and were identifying and addressing concerns to learn and make improvements.

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.

This service was not always able to demonstrate some of the underpinning principles of Right support, right care, right culture. Some practice we identified was restrictive and reduced people’s choice. This was recognised by the service, reported and measures put in place to improve practice.

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

Rating at last inspection

The last rating for this service was requires improvement (published 13 September 2019).

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels, staff training and supervision. A decision was made for us to inspect and examine those risks, and we undertook a focused inspection in Safe 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 service has remained at Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Enright Lodge on our website at www.cqc.org.uk.

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.

We conducted an unannounced inspection at Heathcotes Enright Lodge on 16 and 17 July 2019. The service consisted of one bungalow for four people and two individual apartments in another building. People living at the service had a learning disability and or autism and complex mental health needs. At the time of the inspection, one person was living at the service. Within the same grounds the provider had a second registered location Heathcotes Enright View that provided the same service and could accommodate seven people.

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 receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service:

Improvements had been made and were ongoing, in how the person's safety needs were assessed and managed. Staff skills and competency had improved in managing incidents where the person became highly anxious, and their behaviour became a risk to themselves and others.

Where safeguarding incidents had occurred, the provider had used their safeguarding and staff disciplinary procedures to reduce further risks. The management team had also worked with external agencies, responsible for completing safeguarding investigations.

Improvements had been made to how incidents were managed. This included more robust ways of involving the person and staff, with an emphasis on how lessons could be learnt. Staff had received additional training in positive behavioural support. Least restrictive practice in the care and support the person received had improved. The management team were working more effectively and being supported by external health and social care professionals.

Whilst improvements had been made to staff recruitment procedures and induction, concerns were identified regarding the transfer of staff internally from the provider's other organisations. Staff training, and support had improved and whilst staff were positive about these improvements, staff morale was generally low. Staff expressed concerns about not being fairly treated and valued.

The person using the service received their prescribed medicines safely and when they needed. The service was clean and infection control practice was understood and followed.

The person using the service received sufficient amounts to eat and drink and they were involved in menu planning and independence was promoted. However, food stocks were low and repeated concerns were raised about the availability of food. Following our inspection, the provider took action to make improvements.

The person using the service was supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The person was supported with any health conditions and accessed health services to maintain their health needs.

The person using the service was positive about the staff who supported them and positive engagement was seen between staff and them. Independence and choice were promoted, encouraged and respected. This had resulted in positive outcomes for the person using the service and reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

Support plans that provided staff with guidance of how to meet the person's needs had improved. The person received opportunities to pursue their interests and hobbies, including social activities and inclusion. The person was involved in discussions and decisions about their care as fully as possible.

The provider had an ongoing action plan that confirmed what action had been completed to make improvements with targets for future work. The inspection found improvements and the breaches in legal requirements had been met. However, improvements had been slow in progression and the majority had been completed within a few months prior to this inspection. It was clear more time was required for further improvements to be made and those developed, to fully be embedded and sustained.

Rating at last inspection:

At the last inspection the service was rated Inadequate (published 5 January 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.

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

Why we inspected:

This was a planned inspection based on the rating of the last inspection. This service has been in Special Measures since December 2018. 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.

Follow up:

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.

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 Enright Lodge is a care home and accommodates up to six people with a learning disability and or autism and complex mental health needs. The service consisted of one bungalow for four people and two individual flats in another building. Within the same grounds the provider had a second registered location Heathcotes Enright view that provided the same service for seven people. The management and staff team managed and worked across both services. People received high levels of staff support. On the day of our inspection, two people were living at Heathcotes Enright Lodge.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.” Registering the Right Support CQC policy.

There was no registered manager in post at the present time and an interim manager was managing the service with oversight by senior managers. 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 were not supported by sufficient numbers of staff, and skill mix and competency was a concern. Staff had not all completed an induction on commencement of their employment, due to how the three day induction was delivered. There was high use of agency staff, who did not all have relevant skills and experience in working with people with complex needs. Concerns were also identified in the induction agency staff received. Significant gaps were also identified in the training staff had received, which the provider required staff to complete. Staff did not consistently receive opportunities to discuss their work, training and development needs.

Risks associated with people’s needs were not consistently and effectively managed. Incidents were not sufficiently reviewed and robustly analysed, to consider themes and patterns and how lessons could be learnt and improvements made.

National best practice guidance in the management of medicines was not consistently met. This included how medicines were checked and recorded. Guidance and instruction for staff also lacked detail in places. Whilst some changes had been made to make improvements, these required further time to be fully embedded.

Staff found it difficult to keep the environment clean due to the time available whilst supporting people. Checks associated with legionella was not fully completed. This was in relation to water flushes in unoccupied bedrooms.

The provider recruited staff after completing checks. This ensured, as far as possible, staff were suitable to work with people. Staff could identify the potential signs of abuse and knew who to report any concerns to. Action had been taken to safeguard people when concerns had been identified.

The provider was not consistently working in accordance with the Mental Capacity Act 2005 (MCA). Consent to care was not always sought in accordance with legislation and guidance.

People’s health needs were not consistently met. People had experienced missed health appointments and or, their health needs were not monitored as required and this not been identified by staff. This could have impacted on people’s health and well-being. People had limited access to a choice of foods because food stocks were not managed well.

Staff were kind and caring and respected people’s privacy and dignity. However, the deployment of staff and skill mix, impacted on people receiving consistently good care and support. People were involved as fully as possible in their care and support. Independence was promoted and advocacy information and support was provided to people.

People’s support plans were not easy for staff to follow they were repetitive and lacked guidance in places. People were happy with the activities and opportunities they received and social inclusion was encouraged, people accessed their local community regularly. People had access to the provider’s complaint procedure. At the time of our inspection no person was receiving end of life care, and discussions about end of life was not appropriate given people’s needs and recent transition to the service. However, documents were in place and ready for staff to discuss people’s end of life preferences when deemed appropriate.

The provider’s systems and processes to assess, monitor and improve the service was found to not be fully effective. Staff morale was low with staff concerned about staffing levels and competency, high use of agency staff and poor communication systems. External professional and agencies had significant concerns about how the service was meeting people’s individual needs. However, people who used the service, relatives and advocate we spoke with were overall positive about the care and support provided.

During this inspection we found four breaches of the of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. 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.

The overall rating for this service is ‘Inadequate’ and the service is therefore 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 act 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 act 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.