Archived: Heanton

In October 2014 we carried out an unannounced comprehensive inspection, where we judged the service to be overall good, but required improvement in the responsive domain. . After that inspection we received concerns in relation to risks not always being managed effectively. These included concerns there were not enough care staff to meet the needs of the people living at the home and that essential safety works had not been completed. Initially we sought assurances from the registered manager and provider. However during September 2015, we received a number of concerns about lack of staff. As a result we undertook a focused inspection to look at those concerns on 15 October 2015. We also looked to see that some essential safety work at the home had been undertaken. We found the two domains we inspected, safe and effective care required improvement. In particular, we found there was a shortage of staff to meet people’s needs. The provider was addressing this with recruitment and was supporting staff to enhance their skills through training to meet people’s needs. Essential works had been undertaken or had set timescales to be completed.

On 22 December 2015, we carried out another focused inspection. This was in response to some safeguarding information, which included two people developing pressure sores, whilst living at the home. There were also concerns about medical assistance not being sought for people in a timely way. We also received concerns from two relatives about low staffing levels and poor care being delivered. At the time of the inspection there were 50 people living at the service, although two people were in hospital.

Since our last inspection the registered manager had resigned and left. A new manager was in post who was undergoing the process to register with Care Quality Commission (CQC). 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 2014 and associated Regulations about how the service is run.

This report only covers our findings in relation to these topics. You can read the report from the last comprehensive inspection by selecting the ‘all reports’ link for Heanton on our website at www.cqc.org.uk

People were not always safe because there were not enough staff on duty at all times to meet the needs of people in a timely way. This was because of staff sickness, staff resigning and some newly recruited staff deciding not to follow up on employment. On the day of the inspection there were six care staff plus one nurse working on one of the units and five care staff plus one nurse on the other unit. Staff said this was unusual and they had been operating in the recent weeks with only three or four care staff and one nurse per unit. This was supported by relatives we spoke with during this inspection. One said ‘‘The staff are very good, there is just not enough of them.’’ One family reported their relative had been found still in bed in their night attire at 11.30 am in the previous few weeks and only just having their breakfast. When the relative asked why this had occurred, the staff said they were short staffed and could not get everyone up at a reasonable time. Another relative said their relative had got outside at night where a door had been left open by staff. They said their relative was ‘‘At risk of harm to themselves as there was not enough staff to support and supervise people.’’ We saw there was an incident form in relation to this event, but no signage had been put on the fire door.

The manager said the service had been working with four care staff and a nurse on each unit but ideally needed five staff and a nurse to meet the needs of people. Staff staffing rotas from the previous two weeks showed there was a nurse and four care staff on each unit during the day. However, on three occasions there were only three care staff on duty in a unit. Staff said low staffing levels meant people did not receive their care in a timely way and there were more accidents and episodes of physical and verbal aggression towards people and staff, when staff couldn’t supervise or spend time with people. This increased risks for people and staff.

When we fed this back to the managers and provider, they agreed staffing retention had been an issue and they were looking at ways they could ensure there was sufficient staff to cover the next two weeks, whilst new staff were being recruited and inducted. This included asking current staff if they wished to do overtime shifts, checking with other homes owned by the same company whether there were staff who could provide cover and using agency staff. They had already sent requests to local agencies for shifts that needed to be covered.

There were risks to people’s health in relation to the adequacy of the management of skin care . Two people had developed serious pressure sores at the service (known as grade 3 or 4). One person’s pressure ulcer had required hospital admission for treatment. We also found one person who was high risk of developing pressure sores did not have a risk assessment in place to show how their risks had been assessed. Where people had been assessed as at risk of developing pressure ulcers, we found pressure relieving equipment was in place such as airwave mattresses, although care plans did not always indicate what setting these should be set on for the person’s weight. Where people needed regular changes of position to reduce the risks of them developing pressure sores, records of changes of position was not recorded in a timely way and there were some gaps in these records. These meant risks of developing skin damage were increased for people.

There were a number of new staff at the service who were undergoing training and induction. New staff said they felt well supported by existing staff and were receiving training appropriate for their role. Several staff who had worked at the service for longer said they would like more practical training particularly on meeting the needs of people living with dementia and on managing behaviours that challenged the service. Staff also said they needed more equipment, particular hoists, slings and stand aids, which are used for moving and handling people. When we discussed this with the provider, they explained some equipment was awaiting repair parts and that a new hoist had been ordered and would arrive soon.

There were two breaches of regulation found at this inspection. You can see what action we told the provider to take at the back of the full version of this report.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found.

At the time of our inspection there were 49 people living at Heanton. The home consists of two units known as the Williamson unit on the ground floor and the Chichester unit on the first floor. Both units provide nursing care for older people with dementia with the Williamson unit supporting people with higher physical nursing needs. On the day of our inspection there were 25 people living in the Williamson unit and 24 people living in the Chichester unit.

Our inspection was carried out by two inspectors on one day which lasted ten hours.

During our inspection, we spoke with three people who lived at the home and four visitors. Most people living at Heanton were unable to comment directly on the care they received and therefore we spent time in both units in the communal areas observing people's experiences and how staff interacted with them.

We also spoke with the registered manager, two people from the provider's higher management team and 19 staff.

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

Is the service safe?

The service was not safe. Staffing levels and skills on the Chichester unit during our inspection were insufficient to ensure people's needs were met in a timely manner. The registered manager had not ensured there were enough staff on duty with the appropriate skills and experience required at all times.

The service was not safe because of the standard of record keeping. There were gaps in some records which could affect the care or treatment people required. For example fluid charts and personal care charts had not been completed accurately. Some information was not transferred between documents, which could lead to mistakes.

The service was not safe because the home's equipment quality monitoring did not always identify areas of risk. These included wheelchairs which were unclean and with missing footplates and health monitoring equipment which had not worked when needed.

The home was clean and had processes in place to maintain a clean environment. However the service was not safe with regard to infection control procedures.

The registered manager understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS), which applies to care homes. The registered manager told us they were aware of the judgement made by the supreme court in March 2014 regarding depriving people of their liberties. They had submitted applications for everybody living at the home to the DoLS team in line with Deprivation of Liberty Safeguards legislation.

Is the service effective?

With regard to people's health care needs the service was effective. Generally health and care assessment and planning was detailed and informative with risk monitoring regularly reviewed. However we saw some care plans had not been reviewed in a timely way which could put people at risk of not receiving care relevant to their needs.

Activities were effective because there were opportunities for people to be engaged in activities. We saw people engaged and enjoying activities during our visit.

Is the service caring?

The service was caring; visitors to the home told us they were happy with the care their relative received. Comments included 'The staff show a caring nature towards the residents they are lovely girls' and 'My mum is very content here the staff have been really friendly' and 'We are really happy with the care provided by Heanton it could not be better.

We were also told by visitors they were kept informed of any changes in their relative's care and were regularly asked their opinions. Visitors told us 'I am quite happy with my Mum's care they couldn't do any more' and 'We have no concerns, my sister is always contacted if there are any changes'.

We observed staff to be friendly and polite when interacting with people and they were able to offer reassurance to people who appeared anxious or restless. We saw on the Williamson unit at mealtimes, people were assisted in a dignified and safe manner. When assisting people with their meals staff were discreet and respectful, promoting people's privacy and dignity.

Is the service responsive?

The service was responsive to people's health care needs. Where advice was needed from external health care professionals this was sought in a timely manner.

The registered manager had been responsive to people's needs. They had increased the provision of a designated activities person at the home to 12 hours a day for six days a week. This was because they felt it was important people had the opportunity to be engaged in social activities.

Is the service well-led?

The unit was not well led because the registered manager had been undertaking two roles at the unit and had not ensured systems were monitored to ensure people were receiving safe care.

We were told by visitors to the home they had confidence in the registered manager and were able to approach them if they had any concerns. Comments included 'We can always pop in and speak with X (registered manager) at any time' and 'She is always around and we can speak with her if we need to, she is brilliant'.

Staff also told us they had confidence in the registered manager and said she was very hands on and would always help if requested. Comments included "she is always here and is very supportive" and 'if I have a problem I know she will listen".

At this inspection we spent the majority of our time in the upstairs unit observing how care and support was being delivered and talking to people who use the service. We also spent some of the lunchtime period in the ground floor unit and spoke with staff. We checked some of the records, including two care plans, staff rotas, accident and incident reports.

We saw the home had changed the working patterns of the two activities coordinators so they provided cover from 8 am to 8pm Monday to Friday. This enabled them to provide some calming activities to people in the upstairs lounge during the busy evening period. This meant people were not left for long periods unsupervised during the evening.

We observed the period up to lunchtime on the top floor and saw there were only two staff available for a half hour period whilst staff were taking their breaks. The manager said she would change this with immediate effect to ensure only one staff member took their break.

We concluded the home were now fully compliant in the staffing outcome.

There was a marked improvement since our previous inspection in December 2012 when

we had highlighted shortfalls in the way the quality of the care was monitored and how infection control was managed.

During this visit, we inspected six outcome areas. Five were compliant, including infection control, which had previously been non-compliant. We saw that staff ensured that people's consent to care was gained, and where appropriate other measures were put in place. Their health and well-being was assessed, and care was provided in a way that suited people's individual needs. The management of infection control had improved, as had the supply and quality of equipment. Quality assurance processes were more robust and effective. Staffing levels were appropriate for the majority of the day but we observed that this was not the case on one unit during the evening.

We spend time on units, observing care and support being delivered. We looked in detail at six care plans, medication records, staff training information and some quality audits. We had asked the provider to send us some additional information following the inspection, to help us make our judgements.

We heard from visiting two professionals, four relatives and from eight staff working at the home, that there had been some clear improvements since the new manager had started at the home in October 2012. For example we heard that new placements for people had been fully assessed and responded quickly to an emergency situation. Care was being planned, although it lacked detail about individual's preferred routines to be able to demonstrate person centred care.

One relative told us 'I have been very impressed with the level of professional approach from staff. I have watched them with people when I visit. They are very kind and patient.'

We saw that improvements had been made to make the environment safe and more pleasant for people.

We found that some improvements were needed to fully protect people from the risk of infection. We also found that audit processes lacked detail to be able to ensure robust infection control and safe use of equipment.