Background to this inspection
Updated
10 April 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.
Inspection team
This inspection was carried out by an inspector, an inspection manager, a medicines inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
Heatherdene Residential Care Home 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 who had applied to register 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
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service and Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. 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. We used all of this information to plan our inspection.
During the inspection
We spoke with six people who lived at the home and two visitors about their experience of the care provided. We spoke with four members of staff which included the manager, care staff and housekeeping staff. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.
We reviewed a range of records. This included two people’s care records and multiple medication records. We looked at a staff file in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
Updated
10 April 2020
About the service
Heatherdene Residential Care Home provides support with personal care to 11 older people. The service can support up to 20 people in one adapted building.
People’s experience of using this service and what we found
People were not always protected from environmental risks. The provider’s procedures for staff recruitment did not fully protect people. The procedures for the management and administration of people’s medicines were not always safe.
People told us there were sufficient staff to meet their needs. People said they felt safe living at the home and with the staff who supported them. Staff knew how to recognise signs of abuse and how to report any concerns. There was a culture of learning from any incidents and ensuring they did not reoccur. The home was clean, and staff followed good infection control procedures.
The manager had reviewed staff training and had arranged the necessary refresher training to ensure staff had up to date skills and knowledge. However, at this inspection staff did not always have the necessary skills to meet people’s needs. This will be followed up at the next inspection.
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. People lived in a comfortable environment where on-going improvements were being made. People were able to personalise their bedrooms.
People were provided with meals and drinks which took into account their needs and preferences. People saw healthcare professionals when they needed. Before moving to the home people were assessed to ensure their needs and preferences could be met.
People were supported by staff who were kind, caring and considerate. People were treated with respect and their right to privacy was upheld. People could choose how and where to spend their day. Staff understood and respected people’s right to confidentiality. However, more time is needed to ensure any improvements can be sustained or are fully embedded.
People did not always receive support in accordance with their needs and preferences. Care plans informed staff on what was important to the person and what they liked to do. Information could be produced in accessible formats where required. People’s visitors could visit whenever they wanted. There were some activities which people could join in with if they chose. People felt confident to discuss any concerns they may have. Complaints were investigated and responded to. People’s wishes during the end of their lives and following death were considered.
The home was managed by a manager who had applied to become registered with the Care Quality Commission. The manager had been pro-active in addressing the issues raised at our last inspection however, more time is needed to ensure any improvements can be sustained or are fully embedded. Internal audits had not always identified the shortfalls we found at this inspection. People, staff and visitors were positive about the manager. The manager had a good understanding of their responsibilities and regulatory requirements and promoted an ethos of openness and transparency.
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 inadequate (published 12 October 2019) and there were multiple breaches of regulation. The service was placed in special measures. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations.
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified breaches in relation to safe care and treatment, the management and administration of people’s medicines, staffing and quality assurance at this inspection.
You can see what action we have asked the provider to take at the end of this full 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 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.
The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.