Magna

People living at Heathcotes (Magna) have their own bedrooms with en-suite bathrooms, and shared communal facilities including a living room, dining room, kitchen, downstairs bathroom and garden.

We found the following examples of good practice.

¿ There was a clear process for visitors to follow to reduce the risk of infection. This included symptom checks, temperature checks, and the wearing of personal protective equipment (PPE).

¿ People using the service were supported to maintain contact with family members and friends via phone, video calling, and socially-distanced out door visits when appropriate. The service updated its visitors policy in line with changes to government guidance.

¿ Staff were observed to wear the correct PPE in line with government guidance. PPE was accessible throughout the service.

¿ Cleaning schedules had been updated and improved to ensure high-touch surfaces were cleaned regularly.

¿ The service had adequate space to enable people to socially distance within the service.

¿ The service had considered the individual support people would need if there was a Covid-19 outbreak at the service.

¿ The provider sent government infection prevention and control information to registered managers to ensure they knew how to keep people and staff safe.

¿The service had an up to date infection control policy.

Further information is in the detailed findings below.

Heathcotes Magna is a residential care home for people living with Learning Disabilities and Autism. Heathcotes Magna was providing personal care to six people at the time of inspection. The service can support up to six people in one adapted building.

People living at Heathcotes Magna have their own bedrooms with en-suite bathroom, and a shared living room, dining room, kitchen, downstairs bathroom and garden.

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

The registered manager and provider had worked to improve oversight of the service and had acted to address concerns and issues identified during our last inspection.

People were safeguarded from harm and abuse. Staff supported people to be as independent as possible and took steps to minimise risk.

People were supported by staff who had been trained and had relevant experience and knowledge to meet their needs.

People were supported to make decisions and have control over their lives. Staff worked alongside health and social care professionals to ensure that people received good quality care.

The service was well-led, and staff felt supported by seniors and the registered manager.

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 24 August 2019) and there were multiple breaches of regulation.

Following our last inspection, we issued requirement notices on the provider. We required the service to be compliant with Regulation 12 (Safe Care and Treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 13 (Safeguarding service users from abuse and improper treatment) of the Health and Social Care Act 2008, Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and Regulation 18 (Staffing) of the Health and Social Care Act 2008 by 20 September 2019 .

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

This was a planned inspection based on the previous rating.

We carried out an unannounced inspection of this service on 8 July 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, good governance, staffing and to safeguard service users from abuse and improper treatment.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service is Requires Improvement and has remained the same. 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 Heathcotes Magna 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.

Heathcotes (Magna) is a residential care home providing personal care to four people at the time of the inspection. The service specialised in supporting people who have learning disabilities, autism, Asperger’s syndrome and challenging behaviour.

The care home was registered to support up to six people in one adapted building.

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 should 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

There were not always enough care staff to safely meet people’s needs. This also limited the opportunities for people to go out and engage in activities in the local community.

People’s medication was not managed effectively and the information available to care staff in care plans was not always accurate.

Care staff had not all received safeguarding children training. This meant some staff did not know how to keep young people safe from abuse or how to report incidents to the relevant authorities.

Notifiable incidents, involving people, were not always reported to CQC. This meant the relevant authorities were not always able to ensure people were receiving appropriate care and support.

Lessons were not always learned when things went wrong. Reviews took place after incidents but were not effective and did not always lead to improvements in the care people received.

People were supported by some care staff who had not received the necessary training. This was especially the case at night time. This meant people were not always supported appropriately.

People had been restrained by some care staff who were not up to date with their training and who carried out unauthorised restraint techniques.

People had personalised their bedrooms. However, the communal areas needed refurbishment following damage caused by a person. This meant the house did not feel ‘homely’ or relaxing.

People were able to make use of the garden area, and enclosed carpark, for outdoor activities.

People had enough to eat and were offered a range of different foods, as well as being supported to go out into the community for meals occasionally.

Care staff treated people with kindness, but people’s dignity was not always maintained by the way care staff supported them to dress.

Some people had found it difficult to cope with the frequent changes in managers and care staff at the care home. That negatively affected the support people received.

Some people were supported to maintain contact with their families, but other people were not.

The registered manager had a quality assurance system in place to monitor the safety and quality of the service. However, this was not being fully, or effectively, used to assess, monitor and improve the quality and safety of the service provided to people.

People were supported to access community healthcare support, and had health action plans in place.

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 5 July 2017).

Why we inspected

The inspection was prompted in part due to concerns received about the improper use of restraint on people who can present behaviours that are challenging. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the five key question sections of this full report.

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

Since the inspection took place the provider notified CQC about a change of registered manager.

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 (Magna) is a registered care service providing personal care and support for up to six people with a learning disability or autism. There were six people using the service when we visited.

There was a registered manager in place. It is a requirement that the service has a registered manager. 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.

Staff knew how to support people to remain safe. Where there were risks associated with people’s care, staff knew how to follow the guidance made available to them within people’s support plans. The registered manager took action following accidents and incidents to prevent a reoccurrence wherever possible. There were safe systems in place to protect people from risks within the home. Emergency plans were in place to help people to remain safe during unforeseen events.

There was a sufficient number of staff available to provide people with the support they required. The provider was recruiting staff to fill vacant positions. They were following their safe systems to make sure people were only supported by those suitable to work with them.

Some areas of the home were unclean and the practice of staff when handling food did not always meet food safety guidelines. The registered manager was taking action to make improvements.

People received their medicines from staff who had received guidance and training to do this safely. Where people refused their medicines, staff sought guidance to help people to remain well.

People were supported by staff who received support and guidance on their work and who had the necessary skills and knowledge. Staff received training that was relevant to their role. This included medicines and specific health condition training.

People were asked for their consent before support was undertaken. Staff worked in ways that protected people’s freedom and liberties. Where there were concerns about people’s mental capacity to make decisions, the registered manager undertook assessments and decisions were made in people’s best interest. There were restrictions on some people’s liberties. Where this occurred, this was undertaken safely by staff who knew their responsibilities.

People had access to the food and drink they preferred. Staff knew people’s preferences and where necessary, they were recording what people had eaten and drank. This was so that they could be sure people were having enough to eat and drink.

People received good support to remain healthy. They had access to a range of healthcare services such as to their doctor and dentist.

Staff supported people in a kind and caring manner. They made sure that people’s privacy and dignity was protected. Staff had built good relationships with people and knew them well. They helped people to be involved in decisions about their support. They also supported people to do tasks for themselves wherever possible.

People received support that was based on things that mattered to them including important routines. Staff had guidance in people’s support plans about each person’s specific needs which they followed when supporting people. Where possible, people contributed to the planning and review of their support. Where this was not possible, people’s relatives were consulted.

People undertook activities that they enjoyed. There were many opportunities to access their local area.

The provider had a complaints procedure that was displayed for people and their relatives. Where a complaint was received, the provider used this as an opportunity to learn and to develop their practice.

The registered manager and provider sought to drive improvement through carrying out checks on the service. The service learnt from mistakes and took action where improvements were required. The registered manager was aware of their registration responsibilities with us.

There were opportunities for people, their loved ones and staff to offer suggestions for how the service could improve. The provider was considering ways to share the feedback that they had received as well as any actions they had taken as a result of it.

Heathcotes Magna provides accommodation for up to six adults who require personal care and support. People who use the service live with autistic spectrum disorder and/or a learning disability.

The service had a registered manager. 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 felt safe at Heathcotes Magna. This was because staff understood and applied the provider’s policies and procedures to guide them on their responsibilities to keep people safe and how to report any concerns on people’s safety.

People had the appropriate level of staff support to meet their assessed needs. The provider completed relevant pre-employment checks which assured them that staff were safe to work with people.

People’s care plans included risk assessments of tasks associated with their support and care. This meant that staff were able to support people in a safe and enabling manner.

People’s medicines were stored safely. Staff made accurate records of medicines that had been administered. However they did not always follow the provider’s protocols or guidance in the support plan to record when a person who used the service refused their medicines. They did not always record any actions they may have taken on such occasions.

Staff received training in the Mental Capacity Act (MCA) 2005 and how they would practice it in their role. However they did not always ensure that when decisions were made on behalf of people using the service that they involved other people who were actively involved in their care and support.

People were supported to have a healthy and balanced diet. People had access to a choice of meals.

People who used the service had prompt access to healthcare services when they needed them.

People were complimentary of the caring attitudes of the staff that supported them. Staff treated people with respect and promoted their dignity and human rights. They also promoted people’s right to privacy.

People were supported to maintain links with the wider community. They had access to a range of activities.

People and their relatives had various opportunities to raise any concerns about the service they received. We saw that staff actively encouraged people to do so.

People who used the service, their relatives and the staff all had confidence in the manager and how the service was run. Staff had a shared commitment to provide a caring service to people.

The provider had quality assurance systems to monitor the quality of the service.