Archived: Heaton Grange Residential Home

We inspected Heaton Grange on 16 January 2018 and the inspection was unannounced.

Our last inspection took place on 2 June 2017 and at that time we found the service was not meeting four of the regulations we looked at. These related to ‘safe care and treatment’, ‘person centred care’, ‘fit and proper persons employed’ and ‘good governance’. Three of these breaches were continued breaches from the inspection before last. The service was rated ‘Inadequate’ for a second time and continued to be in special measures.

Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. This inspection was therefore carried out to see if any improvements had been made since the last inspection and whether or not the service should be taken out of ‘Special measures.’

During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the five key questions. Therefore, this service is now out of Special Measures. However, while we concluded improvements had been made they needed to be fully embedded and sustained to make sure people consistently received safe, effective and responsive care. This is reflected in the overall rating for the service which is now ‘Requires Improvement.’

At the time of our inspection the service had a manager who was going through the registered manager’s process. The manager was being supported by a registered manager from another service. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

During the inspection people who used the service told us they felt safe. We found staff knew how to recognise and report concerns about people’s safety and welfare. Safeguarding policies and procedures were in place and risk was assessed. We saw guidance in place to ensure risks were minimised with as little impact as possible on people’s independence.

At the last inspection we found risk assessment documents were not always relevant or up-to- date. At this inspection we found that overall improvements had been made although further work was needed to ensure risk assessments were reviewed following incidents such as falls. Incident/accident forms did not reveal any concerns themes or trends with regards to incidents.

We found some improvements were needed to some aspects of care planning. For example some reviews required more meaningful evaluation.

Staff were recruited safely and we found the necessary checks were carried out in line with the provider’s policy. Staff were on duty in sufficient numbers to provide timely care and support; including ensuring people could maintain their independence as much as possible.

Staff told us training was good and we saw evidence that training was regularly updated.

Although the décor was tired the home was clean. Gloves and aprons were readily available and seen to be used by staff when providing personal care.

Overall, we found medicines were safely managed. Medicines administration charts were well completed.

People told us they were happy with the food. People received a nutritionally balanced diet and were offered sufficient fluids to keep them hydrated.

People’s health care needs were supported with access to a range of professionals including GPs, district nurses and physiotherapists. Appropriate equipment was in place to meet people’s health care needs.

The service was working in line with the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) which helped to make sure people’s rights were protected and promoted. People’s rights to choose and make decisions were supported in accordance with good practice and legislation. Staff asked people’s consent before any care or support was given.

People were treated with kindness and compassion. There was a clear emphasis on people’s individuality, dignity and independence. There was a lively and homely atmosphere and we saw people and staff knew each other well.

There was a good approach to planning and supporting activities which people wanted to participate in.

People were provided with information about how to make complaints. Complaints were documented and evidenced actions taken as a result.

Staff told us the manager and support manager were approachable, and we saw people who used the service felt free to approach management at any time.

People, their relatives and staff were consulted on the running and operation of the home. Regular residents’ meetings were held and actions seen to be taken as a result of concerns raised.

We did not find adequately robust governance systems in place. We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the full version of the report.

We inspected Heaton Grange on 2 June 2017 and the inspection was unannounced.

Our last inspection took place on 24 August 2016 and at that time we found the service was not meeting five of the regulations we looked at. These related to safe care and treatment, need for consent, fit and proper person employed, staffing and good governance. The service was rated ‘Inadequate, and was placed in special measures. This inspection was therefore carried out to see if any improvements had been made since the last inspection and whether or not the service should be taken out of ‘Special measures’.

Following the last inspection we met with the registered provider and they informed us they were committed to improving the service and had put an action plan in place.

At the time of this inspection there was a registered manager in post. However, they were not in day to day management of the service and in their absence an interim manager from another service operated by the same provider was managing the home. 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.

During the inspection we found staff recruitment and selection procedures were not always being followed to ensure only people suitable to work in the caring profession were employed.

We found the care plans in place did not always provide accurate and up to date information and in some instances staff had completed monthly care plan evaluations without making sure the care plan was still relevant to the person’s needs.

People told us they liked living at the home and staff were kind and caring. Staff we spoke with knew people well including what they liked to do and their care and support needs.

People’s dietary needs were met. However, there were no effective systems in place to monitor people’s weight.

People told us they felt safe. Safeguarding policies and procedures were in place and staff had received safeguarding training. Staff we spoke with were able to identify types of abuse and what to do if they had safeguarding concerns.

We saw individual risk assessments which identified specific risks to people’s health and general well-being, such as falls, mobility, nutrition and skin integrity. However, we found they did not always provide accurate and up to date information. This might lead to people receiving inappropriate care, treatment and support.

We also found that although medication policies and procedures were in place staff did not always following the correct procedures which meant we could not be confident people received their medicines as prescribed.

We found the service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and acting within the legal framework of the Mental Capacity Act 2005 (MCA).

We saw the complaints policy had been made available to everyone who used the service. The policy detailed the arrangements for raising complaints, responding to complaints and the expected timescales within which a response would be received. However, we were not confident all complaints were being recorded as required.

We found although the interim manager had started to implement an internal quality assurance monitoring system it was not yet fully embedded and the present system had failed to identify the shortfalls in the service we found during the inspection process.

We identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safe care and treatment, person centred care, fit and proper persons employed and good governance. Three of these were continued breaches from the last inspection.

We found the overall rating for the service remained ‘Inadequate’ and therefore the service remains in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.

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.

CQC is now considering the appropriate regulatory response to resolve the problems we found.

Heaton Grange is a single storey detached residence located in the Heaton area of Bradford. The service is registered to provide care and support to a maximum of 20 people in both single and double bedroom accommodation. At the time of inspection there were 17 people using the service and all single occupancy.

The service had a registered manager. 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 overall rating for this service is ‘Inadequate’ and the service is therefore in 'Special measures'. The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. Improvements were needed in many areas where the provider was not meeting the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Improvements were needed in the management of medicine administration and guidance for medicines prescribed as ‘when required’. Staff were signing for medicines they had not administered and one person self-medicated some of their medicines, this was not risk assessed and staff were signing to say they had administered these medicines. Medicines were stored safely, however temperatures were not taken daily to make sure the medicines were stored at a temperature below 25 degrees. We have required that the registered provider makes improvements to ensure the safe management of medicines.

Risks to people arising from their health and support needs were not always assessed and risks to the premises and environment were not in place. Therefore there were no plans in place to minimise risks.

The service kept no record of accidents and incidents taking place.

We asked to see safety checks and certificates that were all within the last twelve months for items that had been serviced and checked such as fire equipment and gas safety. We did see a copy of a electrical installation condition and the last check in October 2013 stated it was unsatisfactory. The registered manager said they would provide this certificate after the inspection. Water temperature checks were taking place every week, however there were just ticks and no temperatures were recorded, therefore we could not evidence that water temperatures were at a safe level. Fire drills were taking place twice a year, however we could not see evidence which staff had completed a fire drill as the records just stated a number.

On arrival to the inspection we were met by a member of staff who was the deputy manager and another person who turned out to be the registered manager. The registered manager quickly went inside to put their uniform on. We found that they were the only two staff on duty. We shared our concerns for the lack of staff and the fact they were both outside and people were left alone inside. The registered manager stated the cook was keeping an eye on the people using the service and a carer had also rang in sick. We asked to see the staff rotas and we were told there were none.

Staff we spoke with understood the principles and processes of safeguarding. Staff knew how to identify abuse and act to report it to the appropriate authority. Staff said they would be confident to whistle blow [raise concerns about the service, staff practices or provider] if the need ever arose.

The registered provider and registered manager did not always follow safe processes to help ensure staff were suitable to work with people living in the service. Gaps in employment were not checked and recorded, files contained no ID, one person had no references and one person had no Disclosure and Baring Service (DBS). Staff did not receive regular supervisions and appraisals to monitor their performance. One member of staff refused to have a supervision meeting.

Staff received regular training in the areas needed to support people effectively.

Policies were in place to ensure people’s rights under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were protected. Where appropriate, the service worked collaboratively with other professionals to act in the best interests of people who could not make decisions for themselves. Evidence of signed consent was not always sought for everyone and there were inconsistencies from one care file to another. Not all staff were clear on what DoLS meant.

People were supported to maintain a healthy diet, and people’s dietary needs and preferences were catered for. People told us they had a choice of food at the service, and that they enjoyed it.

The premises were clean and tidy. The service did not employ cleaning or laundry staff and the care staff completed these tasks. There were people living with dementia using the service, however there were no dementia signage available and people’s room doors had no numbers or anything to distinguish who the room belong to. People had the choice of keeping their own key to their room.

Staff treated people with dignity, respect and kindness. People and their relatives spoke highly of the care they received.

Procedures were in place to support people to access advocacy services should the need arise.

People had their health and social care needs assessed and plans of care were developed to guide staff in how to support people. We found care plans were becoming person centred. Person centred planning [PCP] provides a way of helping a person plan all aspects of their life and support, focusing on what’s important to the person. People who lived at the service received additional care and treatment from health professionals based in the community.

There was no evidence of activities provision. Staff carried out activities such as music and dance or sitting talking and reminiscing. People were happy with what was on offer.

The service had an up to date complaints policy. Complaints were not recorded.

Quality assurance checks were undertaken monthly. However these stopped in April 2016, the registered manager stated this was due to running out of printer ink. The audits we did see were not effective as they had not highlighted any issues we found.

Staff felt supported by the registered manager, who they described as approachable. The registered manager also worked as a carer.

Feedback was sought on an annual basis from people and their relatives on how to improve the service.

Staff and people who used the service had meetings every three months. No meetings took place for relatives..

The registered manager did not understand all their roles and responsibilities.

We identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered provider to take at the back of the full version of the report.

We used the information to answer the five key questions we always ask;

' 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. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

Is the service safe-

People who used the service and they told us they were pleased with the standard of care and facilities provided by the service. One person said '"I am very happy living at Heaton Grange, things could not be any better."

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Effective -

People had an individual care plan which set out their care needs. We saw wherever possible people had been involved in the assessment of their health and care needs and had contributed to developing their care plan. This meant that people were sure that their individual care needs and wishes were known and planned for and that they had the equipment they needed to meet their individual needs.

Caring '

We found the staff we spoke with demonstrated a good knowledge of people's needs and were able to explain how individuals preferred their care and support to be delivered.

We found the atmosphere within the home was warm and friendly and we saw staff approached individual people in a way which showed they knew the person well and knew how best to assist them.

Responsive '

The provider had a complaints procedure in place and we saw a copy of the complaints procedure was on display within the home. We were informed the service had not received any complaints since the last inspection visit.

People told us they knew how to make a complaint if they were unhappy. People told us they had never needed to make a complaint but if they did they thought complaints would be investigated thoroughly and action would be taken to resolve the matter.

Well led '

People told us they had confidence in the manager and they were approachable and listened to what they had to say.

We saw since the last inspection the manager had started to introduce a quality assurance monitoring system which was focused on providing positive outcomes for people who used the service

We considered all the evidence we had gathered under the outcomes we inspected.

We used the information to answer the five key questions we always ask;

' 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. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

Is the service safe-

We inspected the staff rotas which showed there were generally sufficient staff on duty to meet people's needs throughout the day and night. The service has a low staff turnover therefore people received a consistent and safe level of support. However, as the service did not employ cleaning and laundry staff the manager was currently looking at increasing the staffing levels at the weekend when minimum staffing levels were in place so these additional duties did not affect the quality of the service provided.

Each person's care file had risk assessments which covered areas of potential risk such as pressure ulcers, falls and nutrition. When people were identified as being at risk, their plans showed the actions required to manage these risks.

Staff demonstrated good knowledge and awareness of their responsibilities for infection prevention and control and there was evidence staff had received relevant training. We saw the kitchen had been inspected by the local environmental health department in May 2013 and given a rating of 4 (5 being the highest) for their standards of food safety and hygiene.

We spoke with six people who used the service and they told us they were pleased with the standard of care and facilities provided by the service. One person said '"You could not find a better place to live, the staff are kind, the food is good and we are all well cared for."

.

The manager understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Although no DoLS applications had been made, the manager was able to describe the circumstances when an application should be made and knew how to submit one.

Effective -

People had an individual care plan which set out their care needs. We saw wherever possible people had been involved in the assessment of their health and care needs and had contributed to developing their care plan. This meant that people were sure that their individual care needs and wishes were known and planned for and that they had the equipment they needed to meet their individual needs.

The home had a good working relationship with other healthcare professionals and followed their guidance and advice. The input of other healthcare professionals involved in people's care and treatment was clearly recorded in their care plan. We spoke with one healthcare professional who told us they had no concerns about the care people received.

Caring '

People who used the service told us they were very happy with the care and facilities provided at Heaton Grange. One person said, 'I am very pleased with the care I receive, everyone is friendly and kind." Another person told us, 'I have no complaints at all about the care provided we are all well looked after.'

We found the care staff we spoke with demonstrated a good knowledge of people's needs and were able to explain how individuals preferred their care and support to be delivered.

We found the atmosphere within the home was warm and friendly and we saw staff approached individual people in a way which showed they knew the person well and knew how best to assist them.

Responsive '

The provider had a complaints procedure in place and we saw a copy of the complaints procedure was on display within the home. The manager told us all complaints were acknowledged and responded to in a timely manner. We were informed the service had not received any complaints since the last inspection visit.

People told us they knew how to make a complaint if they were unhappy. People told us they had never needed to make a complaint but if they did they thought complaints would be investigated thoroughly and action taken as necessary.

Well led '

People told us they had confidence in the manager and they were approachable and listened to what they had to say.

However, we found the service did not have an effective quality assurance system in place and there was little documentary evidence to show the views and opinions of people who used the service, their relatives and staff were actively sought as part of the quality assurance process.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to quality assurance.

You can see our judgements on the front page of this report.

People were also very complimentary about the meals and said they had more than enough to eat. They told us they were able to make suggestions and requests about changes to the menu and f they didn't like what was on the menu they were able to ask for something different to be prepared.

We spoke with two visitors and they told us they were pleased with the standard of care and facilities provided by the service. One person told us their relatives had lived at the home for a number of years and they had always been satisfied with the care provided and were always made to feel welcome when they visited.

The staff we spoke with demonstrated a good knowledge of people's needs and were able to explain how individuals preferred their care and support to be delivered. We found the atmosphere within the home was warm and friendly and we saw staff approached individual people in a way which showed they knew the person well and knew how best to assist them.

The visitors we spoke with told us that they had no concerns at all about the standard of care provided at the home and always found the staff to be professional in their approach to providing care and support. One person said 'When we initially visited the home we were made to feel very welcome and the manager and staff answered all our questions.' Another person said 'It was very difficult for my friend to accept they needed residential care but the admission procedure was done in a sensitive manner which helped them to accept the situation a little better.'

During the visit we spoke with two visiting healthcare professionals. They told us they had no concerns about the standard of care provided at the home and that staff had a good understanding of people's needs.

However, we found that the registered care provider did not have effective systems in place to ensure that accurate and up to date records and reports were completed and could be produced promptly when requested.