CQC report explained · a residential care home
What the CQC found at Preston
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Staff understood safeguarding and how to manage complex and unpredictable behaviours. Risk assessments, medicines systems, recruitment checks and incident learning had improved, although inspectors identified and saw a potential ligature risk being fixed within three days.
- Effective?
- Good
- People's physical, mental and social needs were assessed, and staff worked with health professionals. Staff training, supervision and handovers had improved, but the new pre-admission process had not yet been tested.
- Caring?
- Good
- Staff treated people with dignity and respect, understood their communication and encouraged independence. People were involved in decisions through house meetings, accessible information and advocacy when needed.
- Responsive?
- Good
- Care plans recorded people's needs, goals, preferences, interests and relationships. Staff supported communication, community activities, relationships, complaints access and sensitive end of life planning.
- Well-led?
- Good
- Leadership, staff morale and governance had improved. Managers used audits and action plans, involved people and staff, and showed that lessons were being learned from incidents.
What inspectors found, December 2019
Heathcotes Preston was rated Good and is no longer in Special Measures, after inspectors found major improvements in safety, care and leadership.
This was an unannounced follow-up inspection on 21 and 24 October 2019. Two inspectors spoke with the three people living there, nine staff members and a commissioning professional. They reviewed care, medicine and staff records, along with management and safety records.
The home supports up to seven adults with learning disabilities, mental illness and complex needs, including behaviours that may challenge. Inspectors found people were safe, treated with kindness and supported in a person-centred way. Staff helped people make choices, build independence, access the community and receive healthcare.
All five areas were rated Good: Safe, Effective, Caring, Responsive and Well-led. The report says there had been significant improvements since the previous inspection, including better safeguarding, risk management, staff training, incident learning and governance.
The previous inspection had rated the home Inadequate and found multiple breaches of regulations. At this inspection, the provider was no longer in breach. The home had been in Special Measures since 12 July 2019, but was no longer in Special Measures after this inspection.
Improved safety
Safeguarding, risk management and learning from incidents were much stronger than at the previous inspection. Staff had more confidence supporting people with complex and distressed behaviours.
“Since the last inspection there had been significant improvements.” from the report
Kind and respectful support
Staff built trusting relationships, respected people's privacy and understood their verbal and non-verbal communication. People were involved in decisions about their care.
“People told us staff were kind and respectful.” from the report
Choice and independence
People were supported to make choices, develop life skills, access the community and work towards greater independence. The home used the least restrictive approach and no restrictive interventions were used.
“The service used positive behaviour support principles to support people in the least restrictive way.” from the report
Stronger management
Managers used audits and action plans to identify and complete improvements. Staff were encouraged to share views and learn from incidents.
“The registered manager and regional manager undertook comprehensive audits, clear action plans had been implemented and updated to show when the action was complete.” from the report
Communal space if numbers increase
needs fixingThe home had three residents during the inspection, but it could support up to seven. Inspectors warned that having more people in the house could reduce personal space and increase distress, so admissions should be considered carefully.
“Should the service facilitate seven people it is likely to impose on people's personal space and could cause heightened behaviours.” from the report
Admission process not yet tested
minorThe provider had improved its pre-admission process, including safeguards for people returning from hospital. However, no admissions had taken place since the previous inspection, so inspectors could not assess whether the new process worked in practice.
“There had not been any admissions since the last inspection so we could not check how effective the new admission procedure was.” from the report
Potential ligature risk found
needs fixingInspectors identified a potential ligature risk during the visit. Senior management dealt with it and said it was rectified within three days.
“During the inspection we highlighted a potential ligature risk, this was dealt with by senior management and rectified within three days.” from the report
- 01How have you kept safeguarding, risk management and incident learning at the improved standard found at this inspection?
- 02How do you decide whether the home has enough space and the right mix of residents, particularly if occupancy increases towards seven people?
- 03How has the improved pre-admission process worked for people admitted or returning from hospital since the inspection?
- 04What checks are now in place to prevent potential ligature risks and how quickly are any problems fixed?
- 05How do staff receive ongoing training, supervision and support when people show distressed or challenging behaviours?
This was an unannounced planned follow-up inspection covering all five CQC key questions, after the previous Inadequate rating and breaches. This explanation was written from the published report of 14 December 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, July 2019
Heathcotes Preston was rated Inadequate and placed in special measures because inspectors found serious risks around safety, staffing, care and management.
Inspectors visited on 7, 9 and 15 May 2019. The inspection was unannounced. They spoke with everyone living at the home, staff and outside health professionals. They checked care records, incident reports, recruitment files, training records, medicines and management systems.
Inspectors found that people were at risk of avoidable harm. Assessments before admission were not always thorough, safeguarding concerns were not always reported promptly, and new staff supported people before completing induction training. Staff did not always understand how to support people with complex mental health needs and behaviours.
There were also concerns about people's dignity, choice and control. The home could be chaotic, and some people felt unsafe because of another person's behaviour. There were some positive relationships, community activities, clean surroundings and safe medicines systems, but these did not outweigh the serious shortfalls.
The home was rated Inadequate overall. It was rated Inadequate for Safe, Effective, Responsive and Well-led, and Requires Improvement for Caring. It was placed in special measures, meaning CQC said it would keep the home under review and normally reinspect within six months.
Some trusting relationships
People told inspectors that staff were kind and that they had built trusting relationships. Some positive support was observed.
“We saw people had built trusting relationships with staff and were keen to spend time with them outside of the service.” from the report
Community activities
People were supported to follow individual interests and take part in activities in the local community.
“People were supported to follow their interests and take part in activities that were socially and culturally relevant and appropriate to them.” from the report
Medicines systems
Medicines were stored and administered using safe systems. Records included clear instructions and personal preferences.
“Staff followed safe systems for the storage and administration of medicines.” from the report
Clean home
The home was clean, and people were encouraged to take part in cleaning as part of daily living.
“The house was clean and people were encouraged to maintain cleaning skills as part of their daily living routine.” from the report
Unsafe admissions and risk assessments
seriousPeople were admitted without sufficiently detailed assessments of their needs and compatibility. This contributed to placement breakdown and avoidable risks.
“People were placed at significant risk of harm because the service failed to carryout comprehensive assessments before admission, on admission and as people's needs changed.” from the report
Untrained staff
seriousNew staff supported people with unpredictable and complex needs before completing induction. Inspectors observed unsafe and restrictive practice.
“Staff were deployed to support people with complex and unpredictable needs before they had received induction training.” from the report
Safeguarding failures
seriousSome incidents involving possible abuse or harm were not referred to the local authority promptly. People were not always supported in the least restrictive way.
“Safeguarding incidents were not always referred to the local authority.” from the report
Poor dignity and respect
seriousInspectors saw staff stand over people during one-to-one support and fail to engage with them in a person-centred way.
“Across both days of the inspection we observed staff stand over people on one-to-one support and not engage with them in a person-centred way.” from the report
Unsafe environment
seriousThe open first-floor balcony did not protect people from the risk of jumping. The home was also described as chaotic and disruptive.
“The open balcony did not protect people from the risk of jumping from a height.” from the report
Weak management checks
seriousThe provider's checks had not identified the problems found by inspectors. Incidents were not always escalated or investigated properly.
“Shortfalls found at this inspection had not been identified by the provider's quality assurance systems.” from the report
- 01What has changed in the way you assess people's needs and compatibility before admitting them?
- 02How do you make sure new staff complete induction and have the right training before supporting people with complex needs?
- 03How are safeguarding incidents reported, investigated and reviewed now?
- 04What has been done to make the balcony and other parts of the environment safe for people at risk of self-injury?
- 05How do your quality checks now identify and act on risks, incidents and poor care?
This was a planned, unannounced inspection covering all five key questions and the overall quality and safety of the home; it was the first inspection since registration in May 2018. This explanation was written from the published report of 12 July 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Preston
2 rated inspections over a year: the service has improved, from Inadequate to Good.
- December 2019Goodcurrent ratingup from InadequateSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- July 2019InadequateSafe: InadequateEffective: InadequateCaring: Requires improvementResponsive: InadequateWell-led: Inadequate
- May 2018
Registered with the Care Quality Commission on 4 May 2018.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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85 live-in carers within about an hour of Lancashire
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £980 to £1,260 a week. 78 can care for a couple. 11 years' experience on average.
“She understands the needs of an elderly person in the early stages of dementia and has treated my mother with great kindness and skill.”
“Thanks to Tracy, Dad was always immaculately dressed and clean, his meals were all home cooked and nutritionally well balanced and his home was always kept really clean and tidy.”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.