Heston Care Services Ltd, a supported living service for people with learning disabilities and/or autism, was rated Requires Improvement overall with Safe rated Inadequate, reflecting multiple regulatory breaches including unsafe medicines management, absent risk and PEEP documentation, unanalysed incidents and safeguarding outcomes, and ineffective infection control. Warning Notices were issued for breaches of Regulations 12 and 17, with a further requirement to act on Regulation 9 regarding person-centred care planning.
Concerns (17)
criticalMedication management — “People were being given homely remedies...no record of the use of these over-the-counter medicines had been checked with a GP to ensure there were no risks of interaction.”
criticalMedication management — “Training records showed that not all staff had completed training on administration of medicines.”
criticalIncident learning — “There was no analysis of the reasons for the incident and accident and what could be done to limit the risk of reoccurrence.”
criticalSafeguarding — “There were no records of improvements being identified and learning put in place following the outcome of the safeguarding.”
criticalIncident learning — “The register manager confirmed that not all incidents were recorded...if an incident occurred between people they were supporting, it was not always recorded.”
criticalCare planning — “Risk management plans...did not always identify guidance for all risks related to people's care or provide enough information for staff on how to mitigate the risks.”
criticalCare planning — “The provider had not developed personal emergency evacuation plans (PEEPS) for people who were being supported.”
criticalInfection control — “2 other staff members could not explain how they managed infection control...the provider did not have processes in place to ensure that infection control procedures were always followed.”
criticalStaff competency — “The registered manager confirmed that medicines competency assessments to monitor staff member's understanding and skills in administering medicines [were not completed].”
moderatePerson-centred care — “Care plans were not accessible for people...the format was more designed for providing staff with information and not the person receiving the support.”
moderateCare planning — “The care plan for 1 person whose support needs had increased did not reflect their new care needs...food intake was not recorded or monitored.”
moderateComplaints handling — “The provider had information about complaints...but had not undertaken an investigation which identified any actions which could be implemented to reduce further risk.”
moderateGovernance — “An audit was carried out on care plans every 3 months to check if the documents were in place but not if the information in the documents was accurate or person centred.”
moderateGovernance — “The registered manager did not always inform the Care Quality Commission when a notifiable incident occurred.”
moderateRecord keeping — “Records completed by staff were not always contemporaneous...limited information on any activities carried out with staff or what the person had done during the day.”
moderateConsent / capacity — “There was no explanation as to how the information was shared with the person based upon their communication needs...unclear how the care was explained to enable the person to understand and consent.”
minorStaffing levels — “There was no procedure to explain what would happen if more than 1 person required a staff member to accompany them.”
Strengths
· Provider had a recruitment process enabling identification of new staff with required skills, including right-to-work checks, two references and DBS checks.
· People were supported to access their religious community, visit friends and family, and go shopping with staff support when requested.
· People's cultural and religious preferences were identified and respected, including diet reflecting religious preferences.
· The provider worked closely with the local authority and healthcare professionals to provide care packages.
· Staff felt supported by the provider, with monthly supervision and staff meetings in place.
Quality-Statement breakdown (12)
safe: Systems and processes to safeguard people from the risk of abuse; Learning lessons when things go wrongInadequate
safe: Assessing risk, safety monitoring and managementInadequate
safe: Using medicines safelyInadequate
safe: Preventing and controlling infectionInadequate
safe: Staffing and recruitmentRequires improvement
responsive: Planning personalised care to ensure people have choice and control; Meeting people's communication needsRequires improvement
responsive: Improving care quality in response to complaints or concernsRequires improvement
responsive: Supporting people to develop and maintain relationships; support to follow interests and culturally relevant activitiesGood
well-led: Continuous learning and improving care; quality performance, risks and regulatory requirementsRequires improvement
well-led: Engaging and involving people using the service, the public and staffRequires improvement
well-led: How the provider understands and acts on the duty of candourRequires improvement