Northern Healthcare Head Office

Northern Healthcare is a 'supported living' service that provides support for people with a recognised diagnosis relating to mental health, learning disabilities, autism or acquired a brain injury, which includes support and recovery programmes. Each person has their own individual lease agreement with the housing association and a separate contractual agreement for their care.

The provider has 13 'supported living' locations nationwide and other locations currently under development. Each location contains a number of individual bedrooms or flats and shared or communal gardens, lounges, kitchens and dining areas. The service provides 24-hour support from mental health professionals, including registered mental health nurses, occupational therapists, and a cognitive behavioural therapist.

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

Support plans were detailed and included risk assessments in relation to people’s specific support needs. Accidents and incidents were monitored and documented. We saw the service had systems in place to keep medicines secure and oversee people administer their own medicines safely. Appropriate staffing levels were in place during our visits to the provider's locations. Good infection prevention and control practises were in place.

The provider had changed their management structure to ensure further oversight of the service and each site. Audit systems were in place to monitor the standard of support people received. Staff felt supported by the wider management team. The service worked in partnership with other health and social care organisations to achieve better outcomes for people using the service. There was a good working relationship with commissioners and health staff.

Although, statutory notifications were being submitted to the CQC when required, they were not always submitted timely. We have made a recommendation about the provider reviewing their notification systems.

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.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. This was a targeted inspection that considered safe management of medicines, management of risks, staffing levels and good governance. Based on our inspection of these areas the service was maximising people’s choice, control and independence through their support planning and delivery. The support people received was person-centred and the provider’s ethos involved empowering people to live independent lives.

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 08 June 2021) and there was a breach in regulations. 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.

Why we inspected

We undertook this targeted inspection to look at specific concerns we had about staffing levels, safe use of medicines, whether the risks to people were safely managed, and governance systems. The overall rating for the service has not changed following this targeted inspection and remains as requires improvement.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home or supported living 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.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

Northern Healthcare is a 'supported living' service that provides care and support for people with a recognised diagnosis relating to mental health, learning disabilities, autism or acquired a brain injury, which includes support and recovery programmes. Each person has their own individual lease agreement with the housing association and a separate contractual agreement for their care.

The provider has 13 'supported living' locations nationwide and other locations currently under development. Each location contains a number of individual bedrooms or flats and shared or communal gardens, lounges, kitchens and dining areas. The service provides 24-hour support from mental health professionals, including registered mental health nurses, occupational therapists, and a cognitive behavioural therapist.

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

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 able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. People’s privacy was not always maintained. In some of the locations microphone recording was used in communal areas without consent from people. Some people told us this had a negative impact on their privacy as they could not have a private conversation with their families and friends in the communal areas. The provider deactivated the microphones across locations during the inspection process.

We received mixed feedback from staff and people regarding staffing levels. We have made a recommendation about the provider reviewing their staffing levels across locations.

There was a lack of training for specific conditions. We have made a recommendation about the provider reviewing their training programmes for specific conditions.

Staff had administered prescribed creams for one person without the appropriate training or competency checks. We have made a recommendation about the provider using a reputable source to review their medicine training, policies and processes.

Medicine audits were not robust. We have made a recommendation about the provider using a reputable source to review their medicine auditing systems.

After the inspection we received concerns in relation to staffing levels, training, medicine management, oversight of the service and meeting people’s care needs in one of the provider’s locations that was not visited as part of the inspection. This is being investigated outside the inspection process in partnership with the local systems, including contract monitoring and safeguarding teams.

People and staff members were involved with the service through regular team meetings and surveys. We received mixed feedback from staff in relation to the management of the service.

People's care needs were risk assessed and care plans provided staff with the information they needed to manage the identified risk. People’s ongoing risk assessments were reviewed on a regular basis and when needs changed. People’s views and decisions about care were incorporated in their care plans. This helped staff to support people in a way that allowed people to have control over their lives.

Staff received training in infection control and told us personal protective equipment (PPE) was readily available to them.

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 good (published 16 September 2019).

Why we inspected

We received concerns in relation to staff training and management of the service. As a result, we undertook a focused inspection to review the key questions of 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 the service has changed from good to requires improvement. This is based on the findings at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

The provider has taken some action to mitigate the risks. Staff have been provided further training to meet the needs of the people they support. Microphone recording has been deactivated across locations.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Northern Healthcare Head Office 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 maintain people’s privacy at this inspection.

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 for 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.

Northern Healthcare is a ‘supported living’ service that provides care packages for people with a recognised diagnosis relating to mental health, learning disabilities, autism or acquired a brain injury, with included support and recovery programmes. Each person has their own individual lease agreement with the housing association and a separate contractual agreement for their care.

The service has nine ‘supported living’ settings nationwide and other settings currently under development. Each setting contains a number of individual bedrooms or flats and shared or communal gardens, lounges, kitchens and dining areas. The service provides 24-hour support from mental health professionals, including registered mental health nurses, occupational therapists, a cognitive behavioural therapist and support workers.

Not everyone being supported by Northern Healthcare received a regulated activity. The Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’ (help with tasks related to personal hygiene and eating) and ‘treatment of disease, disorder or injury’. Where they do we also consider any wider social care provided. At the time of inspection 83 people being supported by Northern Healthcare were receiving a regulated activity.

Services for people with learning disabilities and or autism are supported

The service predominantly supports people with a mental health diagnosis, and some of the people they support also have a learning disability and / or autism.

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 and what we found

People’s outcomes were consistently good, and people’s feedback confirmed this. One person told us, “The support here is amazing and I would recommend this service to anyone.”

People told us they felt safe. Staff had a good understanding of how to safeguard people from abuse.

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 used positive behaviour support principles to support people in the least restrictive way. No restrictive intervention practices were used.

People told us staff were kind, courteous and sensitive. One person said, “All the staff are nice, my link worker is like a friend."

The service worked in partnership with other health and social care organisations to achieve better outcomes for people using the service. The service had developed strong links with the local community and this supported people’s independent living.

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. The outcomes for people using the service 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.

The service was well led. Person-centred care was promoted and people told us the staff knew them well and responded to their needs in a person-centred way.

Governance and quality assurance systems used provided effective oversight and monitoring of the service.

Staff spoke positively about how the service was managed and one staff member told us, “The management are very good and approachable. They support us very much. I am happy here and love working here. All the staff are nice and we are a good team. I would recommend this service.”

The service met the characteristics of Good in all areas.

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

Rating at last inspection

This service was registered with us on 24 July 2018 and this is the first inspection.

Why we inspected

This was a planned inspection since the service was newly registered.

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.