Archived: Heatherdene Residential Care Home

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.

Heatherdene Residential Care Home is a residential care home registered to provide personal care for 20 people aged 65 and over. At the time of the inspection 16 people lived at the home. The care home accommodates 20 people in one adapted building.

Although the home was registered for older people, we found people with learning disabilities were also living at the home. The service has not been registered and 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 did not always 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 service was not well-led. The registered manager did not have appropriate oversight on the management of the service to ensure safe and effective care was provided. Systems and processes for managing risk were lacking and ineffective. Legal requirements were not always understood. We identified multiple breaches of Regulations.

Although people and relatives told us people were safe, we found the service was not safe. Safety checks to ensure the premises were suitably maintained had not been carried out in a timely manner. We could not be assured people received their medicines safely, in line with good practice and legislation. We found infection control processes in the home were inconsistent and did not always reflect good practice.

The service was not always effective. Consent to care and treatment was not always considered and achieved. The registered provider did not always understand and apply the principles of the Mental Capacity Act 2005. Signage was used around the home to promote independence, but this was not always accurate and could contribute to people’s confusion. Whilst there was some work taking place within the home to improve living standards, communal areas were cluttered and in a poor state of repair.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People and relatives told us staff were kind and caring. One person said, “This is a very kind place.” Although we received positive feedback about the kind and caring nature of staff, we found privacy and dignity were not always considered. Care was not always person-centred for people who lived at the home. Language used was not always respectful and in line with key concepts set out in Registering the Right Support. The outcomes for people with learning disabilities did not fully reflect the principles and values of Registering the Right Support for the following reasons; People were not encouraged to live ordinary lives and were not always encouraged to participate in meaningful activities to promote independence.

The service was sometimes responsive. The registered manager told us links had been developed with the local community to combat isolation. We saw evidence activities sometimes took part, although we observed no group activities taking part whilst we visited. The registered manager had a complaints process for people to follow should they wished to complain. No one wished to raise any formal complaints as part of the inspection.

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 18 March 2017.)

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to person centred care, consent, safe care and treatment, good governance, recruitment of staff and failure to notify the commission of significant incidents at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore 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 rating, 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.

Heatherdene Residential Care Home is registered to provide accommodation with personal care for up to a maximum of 20 people. There were 20 people living at the home on the day of our inspection. Some people were living with dementia.

At the last inspection on 19 April 2016 we identified that improvements were needed regarding all five of the key questions. We identified breaches of Regulations 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider sent us an action plan telling us what they would do to make improvements and meet legal requirements in relation to the law. We found at this inspection the provider had taken most of the necessary measures to ensure the quality of care people experienced had improved.

A registered manager was in post and present throughout this inspection. 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 received support with their medicines from staff who were trained to safely administer them. Medicines were locked away safely and in accordance with their individual risk assessments.

People were safe as staff had been trained and understood how to support people in a way that protected them from harm and abuse. People’s records had individual assessments of risk associated with their care. Staff knew what to do in order to minimise the potential for harm.

People were supported by enough staff to safely meet their needs. The provider now followed safe recruitment practices and completed checks on staff before they were allowed to start work. The provider had systems in place to address any unsafe staff practice including retraining and disciplinary processes if needed.

People received care from staff that had the skills and knowledge to meet their needs. New staff received an introduction to their role and were equipped with the skills they needed to work with people. Staff attended training that was relevant to the people they supported and any additional training needed to meet people’s requirements was provided.

People’s rights were protected by staff who were aware of current guidance and legislation directing their work. People were involved in decisions about their care and had information they needed in a way they understood.

Staff received support and guidance from a registered manager who they found approachable. People and staff felt able to express their views and felt their opinions mattered. People had good relationships with the staff who supported them. People’s likes and dislikes were known by staff who assisted them in a way which was personal to them.

People had their privacy and dignity respected by those supporting them. People had access to healthcare when needed and staff responded to any changes in needs promptly. People were supported to eat and drink sufficient amounts to maintain optimum health.

The registered manager had started to do more regular quality checks of the service. The provider engaged more with people and their families at their visits to the service. The provider encouraged feedback from people in order to improve the service. People felt confident they were listened to and their views were valued. The registered manager acknowledged the need to sustain improvement of the record keeping and imbed management practice consistently.

Heatherdene residential care home is registered to provide accommodation with personal care for up to a maximum of 20 people. There were 18 people living at the home on the day of our inspection. Some people were living with dementia.

There was a registered manager in post who was present during the inspection. 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.

The home was last inspected on 15 June 2015 where we gave it an overall rating of requires improvement. We had identified that the provider was in breach of Regulation 11, 12, 17 and 18 of the Health and Social Care Act 2008(Regulated Activities) Regulations 2014. The breaches related to a failure by the provider to ensure people’s ability to make decisions had been properly assessed. The premises were unsafe for their intended purpose and were not used in a safe way. The quality assurance monitoring systems in place were not robust enough to ensure people received a safe and effective service. The provider had failed to ensure that all staff were competent and skilled or that staff received suitable training, supervision and induction. We asked the provider to make improvements to the environment and staff practice. The provider sent us an action plan detailing what action they had and proposed to take to address the concerns raised.

At this inspection we found that some improvements had been made. The restrictors on the windows had been repaired and electrical improvement work had been completed. Staff had received training on the Mental Capacity Act and the provider was no longer in breach of Regulation 11 of the Health and Social Care Act 2008(Regulated Activities) Regulation 2014. However we found further improvement were still needed.

The leadership was not effective, while people and staff felt that they could approach the registered manager for support, areas of concerns were not always acted upon in a prompt or appropriate manner. People were not always protected from harm because not all staff had received training to help people move around the home safely. While there was secure storage for cleaning products, staff did not always lock hazardous products away after use. People were placed at risk because safe recruitment procedures were not followed. Checks of the environment were not regularly completed and concerns were not always reported or rectified.

People were not always kept warm and comfortable. People were not always involved in decisions about their care or support and their preferences were not known or respected. People told us they were not always given choice about what they wanted to eat. They did not know they could ask for alternatives if they did not like what was being served.

People told us there was a lack of stimulation. People were not always consulted about their interests and hobbies or about changes that were made in the home.

People received their medicine when they needed it. Staff made sure medicine was given to people safely and maintained accurate records. People were able to see health care professionals as and when needed.

People told us that staff asked their consent before supporting them and respected their wishes when they declined support. Where people were unable to make decisions for themselves we saw that decisions had been made in their best interest. People were supported by staff who were respectful and kind. People were supported by staff who knew them well and who had access to up to date information about their needs.

There was a complaints process in place and people and their relatives felt comfortable to raise complaints with staff or the registered manager. The registered manager sought the views of people, relatives and staff on the quality and development of the service.

You can see what action we told the provider to take at the back of the full version of the report.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

We spoke with two people who used the service who told us that they felt comfortable and safe within their home. However, we found that the environment was unsafe and could place people at risk of harm. For example, we saw that a bedroom that was occupied, the door handle was missing which could lead to entrapment. The registered manager told us that the handle had been removed three days ago because it had broken. We saw that cords from sash windows were missing and the registered manager was aware of this. We saw fire doors wedged open throughout the home. Cleaning chemicals were not securely stored and for people who lacked capacity due to their mental health, this could place them at risk of harm.

At our previous inspection on 13 June 2013, the provider was found to be non-compliant with the regulation relating to cleanliness and infection control. At this inspection we found that the cleanliness of the home remained unsatisfactory. The registered manager said that they were the nominated infection prevention and control (IPC) lead. An (IPC) lead is responsible for processes in place to reduce the risk of cross infection and the cleanliness of the home. The registered manager confirmed that there were insufficient staff hours to maintain the cleanliness of the home. This meant that people were placed at risk of cross infection.

Is the service effective?

The registered manager said that a needs assessment was carried out before people were admitted to the home and this was confirmed by a visiting relative. This meant that people could be confident that their assessed care needs would be met when they moved into the home.

We spoke with two people who used the service who confirmed that they were satisfied with the care provided to them. We found that staff had access to detailed care plans that told them about people's needs and how to meet them.

We found that people were provided with support to take their prescribed medicines. However, medication systems and practices needed to be reviewed to ensure that they were entirely robust. For example, one medication administration record (MAR) showed that medicines had been administered but we found that they had not. This meant that the person did not receive their prescribed treatment.

We observed a number of shortfalls during this inspection that could have a negative impact on people's safety. The registered manager was aware of these shortfalls. For example, we saw that a number of single pane windows were cracked and these were accessible to people who used the service. However, no action had been taken to reduce the risk to people.

Is the service caring?

We spoke with two people who used the service who told us that they were happy living at the home. One person said, 'It's alright living here, it's nice here.' We found that staff had access to detailed care plans that told them about people's assessed needs and how to meet them. The registered manager told us that where possible, people or their family were involved in their care planning and this was confirmed by a visiting relative. This meant that people would receive care and treatment the way they preferred.

We observed that staff were attentive to people's needs. For example, we saw that one person was distressed and saw a care staff reassure them. We saw that risk assessments were in place to promote people's health and wellbeing. For example, one risk assessment provided staff with information about how to prevent pressure sores and the appropriate equipment needed. We observed that this equipment was in use. This meant that people could be confident that efforts would be made to ensure their skin integrity.

Discussions with the registered manager and the care records we looked at confirmed that people had access to relevant health care services when needed. Access to these services ensured that people's mental and physical healthcare needs would be met.

Is the service responsive?

We saw that one person used a household device to assist with their mobility. Discussions with the registered manager and the care records we looked at confirmed that this person had not been referred to an occupational therapist. Access to an occupational therapist would ensure that the person was equipped with an appropriate walking aid to safely promote their independence.

We found that the registered manager was aware of shortfalls identified at this inspection but had not taken action to address these and ensure people's safety.

Is the service well led?

We spoke with two people who used the service and two visiting relatives who confirmed their satisfaction with the care and treatment they had received. We found that the registered manager had a good understanding of people's assessed needs and had an auditing system in place to ensure people received appropriate care and treatment.

The registered manager told us that staff meetings were carried out and this was confirmed by one care staff. Access to these meetings ensured that staff were aware of changes to policies and procedures that could affect the service provided to people.

The registered manager informed us that quality assurance questionnaires were given to people who used the service to obtain their views and comments about their experience of using the service. One person who used the service confirmed that they had completed this questionnaire. This meant that people were encouraged to be involved in the running of the home.

People we spoke with were happy with the service they received. Their comments included, 'It's very good', 'I like it here' and, 'I'm happy here'.

The staff we spoke with were happy in their work and told us that they were well supported by the management.

We found that the staff gained consent from people in relation to the care and support provided to them.

We found that care plans were comprehensive and up to date. Staff told us that they gave them all the information they needed to provide consistently good care. We saw care being delivered with kindness and sensitivity.

However, we saw several instances of poor practice in relation to cleanliness and infection control that needed to be addressed to ensure people were protected from the risk of infection.