We inspected the service on 11 and 13 December 2018. The inspection was unannounced and was the provider’s first inspection since it was registered.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 View is a care home and accommodates up to seven people with a learning disability and or autism and complex mental health needs. The service consisted of one bungalow for four people and three individual flats in another building. Within the same grounds the provider had a second registered location Heathcotes Enright Lodge that provided the same service for six 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, four people were living at Heathcotes Enright View.
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.