Heathfield House

About the service

Heathfield House is a care home providing care and support for up to 10 people who have a learning disability and or mental health needs. At the time of our inspection 10 people were living at the service. People received support from staff 24 hours a day. The service is owned by an individual who also owns 2 other adult social care services in North London.

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

The service was able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture.

Right Support:

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. Staff focused on people’s strengths and promoted people’s capabilities, so people had a fulfilling and meaningful everyday life.

People had a choice about their living environment and were able to personalise their rooms.

Staff supported people to make decisions following best practice in decision-making. Staff communicated with people in ways that met their needs. We made a recommendation for the provider to review accessible communication guidance. Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcomes. Staff supported people to play an active role in maintaining their own health and wellbeing.

Right Care:

People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs. Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

The service had enough appropriately skilled staff to meet people’s needs and keep them safe. People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs.

People’s care, treatment and support plans reflected their range of needs, and this promoted their wellbeing and enjoyment of life. Staff and people cooperated to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks. We made a recommendation to the provider to review how they identified lessons learned following incident and accidents.

Right Culture:

People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff. People received good quality care, support and treatment because trained staff and specialists could meet their needs and wishes. Staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing. Staff placed people’s wishes, needs and rights at the heart of everything they did. People and those important to them, including advocates, were involved in planning their care.

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 4 September 2019).

Why we inspected

We undertook this focused inspection to assess that the service is applying the principles of right support, right care, right culture.

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 has remained good. 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 Heathfield House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Heathfield House is a care home providing care and support for up to 10 people who have a learning disability and/or mental health needs. At the time of our inspection 10 people were living at the service. People received support from staff for 24 hours a day. The service is owned by an individual who also owns three other adult social care services in North London.

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.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 10 people. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

Some of the practices at the service presented a risk to the health and safety of people who lived there. Medicines were stored in a room which became very hot during the day and the temperature exceeded the recommended range for safe storage. Some of the risks people were exposed to had not been clearly recorded and there was a lack of guidance for the staff about these.

We spoke about the above concerns with the registered manager, who took immediate action to rectify these issues.

People using the service and their relatives felt the service was good. They liked the staff, who they described as kind and supportive. They felt their needs were being met. People were supported to learn independent living skills and regularly accessed the community.

The staff were well supported. They enjoyed working at the home. They spoke about training they had undertaken which had been useful. They worked closely as a staff team and shared information, so they could work in a consistent way. There were suitable procedures for recruiting the staff.

Care had been planned with people who used the service and was regularly reviewed to make sure this met their needs and preferences. People were involved in household activities such as planning menus, shopping, cooking and cleaning. They had access to a variety of foods and drinks throughout the day. The staff supported people to access other healthcare services and make sure they understood about healthcare appointments and what they needed to do to stay healthy.

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 registered manager had worked at the service for a number of years and knew people's needs well. People using the service and staff liked them and felt they were easy to speak with, and the service was well managed. There were appropriate systems for investigating when thing went wrong, monitoring the quality of the service and making improvements.

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 Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.

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 27 April 2016).

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Heathfield House 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.

The last inspection took place 12 and 13 April 2016 when we found breaches of four Regulations relating to notifying the Care Quality Commission (CQC) of significant events, having a process and system in place to report any safeguarding concerns, ensuring the service was safe and good governance. At this inspection we found improvements had been made in all these areas.

Heathfield House provides support and accommodation for up to ten people who have mental health needs and/or learning disabilities. There were ten people using the service at the time of this inspection.

There was a registered manager in post. 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.

The registered manager had been in post for approximately two years and regularly worked alongside staff on shift so that they could see how the service met people's needs.

There were now more detailed and regular checks and systems in place to check the fire procedures and that equipment protected people in the event of a fire. Fire doors were checked each week to ensure they automatically closed.

Staff received training on safeguarding adults from abuse and there were policies and procedures in place. There had been no safeguarding incidents since the last inspection. We saw evidence in the policies and in people’s care records that staff were reminded to report any concerns to the registered manager and to the local authority and to CQC.

People’s care records included people's needs and preferences and were individualised. We saw information had been reviewed on a regular basis.

There were checks on a range of areas in the service to ensure people received safe good care.

Feedback from people using the service, staff we spoke with and professionals was positive about the service.

Staff continued to receive support through one to one and group meetings. They also received an annual appraisal of their work. Training on various topics and refresher training had been arranged in different topics that were relevant to staff member's roles and responsibilities.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the systems in the service supported this practice.

There were sufficient numbers of staff working to meet people’s needs. Recruitment checks were carried out to make sure staff were suitable to work with people using the service.

People received the medicines they needed safely.

People had access to the health care services they needed and their nutritional needs were being met.

There was a complaints procedure available, which was also in a pictorial version for people who responded to pictures more than words.

The inspection was carried out on 12 and 13 April 2016. The first day was unannounced.

There was a registered manager in post. 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.

There were some systems in place to check the fire procedures and that equipment protected people in the event of a fire. However, several fire doors did not automatically close (and had not done so since March 2016) and therefore placed people at risk of harm.

Staff received training on safeguarding adults from abuse and there were policies and procedures in place. However, there were some potential safeguarding incidents that had not been reported to the local authority or to the Care Quality Commission (CQC).

Care records included people’s needs and preferences but some information had not been reviewed and updated.

There were a number of quality assurance audits in place to monitor the quality of the service. However, the shortfalls identified at this visit were not picked up during the checks that were currently in place.

Staff received support such as having one to one supervision meetings with the registered manager and receiving an annual appraisal of their work. Training and refresher training had been arranged in various subjects relevant to staff member’s roles and responsibilities.

Checks were carried out to make sure staff were suitable to work with people using the service and there were enough staff to meet people’s needs.

People received the medicines they needed safely.

We found the service to be meeting the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). DoLS provide a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them. Staff understood people’s right to make choices for themselves.

People had access to the health care services they needed.

There was an appropriate complaints procedure and this was produced in an accessible format. People told us they knew about the complaints procedure. They were confident the registered manager would respond to any concerns they might have.

Staff supported people in a caring way and with kindness and patience.

There were systems in place to gather the views of people using the service and others.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the (Registration) Regulations 2009 in relation to not ensuring the premises were safe in the event of a fire, information on people’s needs had not always been reviewed and therefore did not fully reflect people’s current needs. In addition, audits were not effective in identifying all the areas that needed to be acted on or improved and the Care Quality Commission had not been always been informed of notifiable incidents and events.

You can see what action we told the provider to take at the back of the full version of the report.

Following our inspection the provider submitted information telling us what action would be taken to ensure these issues were addressed.

During this inspection we found that systems had improved to ensure that only suitable staff were employed. For example, a new application form had been developed and implemented that requested more detailed information about each staff member's employment history. We also saw that references had been verified to ensure they were authentic and there were details of each staff member's right to work in the UK. However, the provider had not always documented discussions with staff about some remaining gaps in their employment history that had not been explained.

People told us that they were asked for their consent before any decisions were made about their care. We observed positive interactions between staff and the people using the service. We saw that people were routinely involved in decision making about daily routines such as meal preparation and offered choices about what they wanted to eat and what they wanted to do.

People's needs were assessed and a suitable plan of care developed. People's care plans had been reviewed at regular intervals and updated to reflect their changing needs. People were supported to access healthcare professionals for routine check-ups and specialist support where required. One person told us, "the dentist comes to visit us here and the chiropodist comes every few weeks."

The home was clean and well maintained. We saw that bedrooms were personalised to reflect people's preferences with pictures and personal effects. We looked at certificates relating to health and safety. We saw that gas, electrical and fire safety certificates were in place and renewed as required to ensure the premises remained safe for staff and people using the service. However, there had not been a fire drill recorded for the home for some time.

Quality assurance systems were in place to monitor the service people received and address any issues identified.

Staff recruitment processes were not effective and did not ensure that staff were suitable to work with vulnerable people.

We observed positive interactions between staff and the people using the service. People told us staff treated them well and respected their privacy. Care records were clearly written and contained sufficient information about people's needs and the action staff should take to meet them. People's likes, dislikes and preferences had been considered throughout. People were supported to attend health appointments and encouraged to take part in leisure activities.

People were protected from the risk of abuse as staff were appropriately trained and aware of their responsibilities. Staff received training in appropriate topics to equip them with the appropriate knowledge and skills to effectively meet people's needs. Staff told us that they received regular formal and informal supervision and support. However, the records did not evidence that formal supervision was taking place at sufficiently regular intervals to ensure staff were supported in their roles.

There was an effective complaints management system in place. The complaints procedure was accessible and clearly displayed in the home and people told us they felt able to raise any concerns that they had.