Arnold

Updated 29 November 2022

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 Health and Social Care Act 2008.

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 (Arnold) is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Heathcotes (Arnold) is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

We visited the care home on 3, 4 and 10 October 2022. All inspection site visits were unannounced.

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.

We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We observed staff interactions with the five people who used the service. People were able to communicate verbally, but we also observed their body language during their interactions with care staff to further help us understand their experience of the care they received.

We used the Quality of Life Tool which is designed to support the corroboration of all sources of evidence gathered during inspection. We spoke with 11 members of staff including care staff, senior carers, the registered manager, and regional manager. We reviewed a range of records. This included three people's care records and a sample of medication records. We looked at three staff files in relation to recruitment and staff supervision.

We obtained clarification from the provider to validate evidence found. A variety of records relating to the management of the service, including policies and procedures, were reviewed. We looked at training data and quality assurance records. We received feedback from the relatives of one of the people who lives at the care home. We also received feedback, by phone or email, from eight staff.

Updated 29 November 2022

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

About the service

Heathcotes (Arnold) is a residential care home registered to provide personal and nursing care to up to ten people. The service provides support to people who have mental health support needs, learning disabilities and/or autistic people. At the time of our inspection there were five people using the service.

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

Right Support

People lived in a property in which some fire doors were defective. This created a potentially increased risk of harm in the event of a fire. The provider told us they would rectify those issues. Waste management was not safe. External waste bins were overflowing and had attracted rodents. Parts of a person’s individual living area required repair and refurbishment and floor coverings in some communal parts of the building required replacement. Staff did not always wear protective face masks and, when they did wear them, did not always wear them appropriately. Some relatives told us they felt the service could involve families more than they currently did. The service worked with people to plan for when they experienced periods of distress so that their freedoms were restricted only if there was no alternative. Staff did everything they could to avoid restraining people. The service recorded when staff restrained people, and staff learned from those incidents and how they might be avoided or reduced. People had a choice about their living environment and were able to personalise their rooms.

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.

Right Care

People had appropriate care plans and risk assessments in place and staff understood how to support people. The inside of the care home was generally hygienic and homely. People were supported by enough staff to meet their care needs. People’s prescribed medicines were managed appropriately. Staff understood how to protect people from the risk of abuse and how to report any concerns. People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs. People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs. Staff and people cooperated to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks.

Right Culture

People were supported to maintain contact with their relatives and were encouraged to engage in community-based activities. People told us they knew how to complain if they were unhappy about anything at the care home. Staff told us they felt supported by the registered manager and told us they believed improvements in the service were being made. Staff placed people’s wishes, needs and rights at the heart of everything they did. Staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing.

We have made a recommendation about the management of premises checks and maintenance works at the premises.

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 18 December 2019) and there was a breach of regulation. At this inspection we found improvements had been made and the provider was no longer in breach of regulation 9 (Person-centred care). However, the provider was found to be in breach of regulation 15 (Premises).

Why we inspected

The inspection was prompted in part due to concerns received about the support provided for people who were expressing distress or agitation; and to check the staffing levels at the care home. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of Safe, Responsive, and Well-led only.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains Requires Improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe section of this full report.

The provider has subsequently told us they intend to take action to mitigate the risks we identified during the inspection, by carrying out identified maintenance and refurbishment works to the property.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Heathcotes (Arnold) 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 monitor the service and will take further action if needed.

We have identified breaches of regulation in relation to the fire safety arrangements, maintenance processes, and the management of household waste 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 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 continue to monitor information we receive about the service, which will help inform when we next inspect.