Archived: Heathcotes (Hollyfield House)

Updated 25 November 2020

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 Care Act 2014.

This was a targeted inspection to check on a specific concern we had about staff adherence to personal protective equipment guidance.

Inspection team

The inspection was completed by an inspection manager.

Service and service type

Heathcotes (Hollyfield House) is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

Before the inspection we reviewed the information we already held about the service including notifications they had submitted to us. Notifications information about events that providers are required to tell us about by law. We reviewed the information the provider had submitted to the NHS Capacity Tracker. We sought feedback from the local authority and local health protection team.

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

During the inspection

We spoke with the registered manager and a team leader. We made general observations of people’s care and support as well as observing the condition of the service. We reviewed risk assessments, cleaning records and various policies and procedures.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records.

Updated 25 November 2020

About the service

Heathcotes (Hollyfield House), is a residential care home providing 24-hour support for adults with a learning disability, autism, epilepsy and associated challenging behaviour. The service has nine en-suite bedrooms over three floors. It has two lounges, two kitchens and a well-maintained garden area. At the time of our inspection eight people were using the service.

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

Risk assessments in place were detailed and person centred. However, some people’s risk had not been identified and some equipment that was used to help manage people's risk was not checked or working as it should do. People received their medicines when they needed them but the room people’s medicines were kept in was too hot and no measures were in place to reduce the temperature. This meant some people’s medicines may not be safe or work very well.

There were enough staff to keep people safe. However, some staff did not always receive their induction training before they started to work at the service and some mandatory training for existing staff had not been completed or had not been refreshed. This meant some staff may not have the skills and knowledge they needed to support people.

The service applied the principles and values of Registering the Right Support. This meant people who used the service were able to live as full a life as possible and achieve good outcomes that include control, choice and independence. However, some best practice and legislation around how people were supported in the least restrictive way possible and in their best interests had not been followed.

Staff knew how to keep people safe and used many different ways to communicate with people to find out how they were feeling and what choices they wanted to make. Care records helped staff know what was important to people and how they wanted to be supported. Information was available for people in a way they could understand.

Staff supported people to follow their interests in the community and at the service. They helped people keep in contact with their family and friends. During our inspection people were very active getting ready with staff to go out or making plans for their day.

The manager had joined the service in the last six months and people and staff liked him. He was working hard to make the improvements needed. The provider was making regular checks on the service to make sure people had the care and support they needed. When issues were identified they were working with the manager to make things better for people.

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 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 (report published 09 January 2018).

Why we inspected

The inspection was prompted in part by risks identified at other Heathcotes services, these included risks around poor restraint practices, risk management, staff training and governance. A decision was made for us to inspect and examine those risks as part of a comprehensive inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led sections of this full report.

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

The provider has acted to reduce the risk to people and has supplied full details of how they are making changes to make things better or people.

Enforcement

We have identified breaches in relation to people’s risk, staff training and support, people being deprived of their liberty unlawfully and how the service is managed.

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 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.