Archived: Heath House

Heath House Care Home is a service that provides accommodation, personal care for up to 25 people. The home consists of a ground floor and first floor in a converted Victorian building. There were some people living with dementia. During the inspection visit, there were 17 people living in the home.

There was a registered manager employed at 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 and associated Regulations about how the home is run.

At the last inspection on 12 October 2015, we asked the provider to take action to make improvements in respect of the quality of care that was provided to people. At this inspection, we found that the necessary improvements had not all been made. People's medicines were still not being managed safely and staff had not assessed and managed risks to people's safety effectively. The systems in place to assess, monitor and reduce the risk of people receiving poor care were not always effective. You can see what action we have told the provider to take at the back of our report.

Risks to people’s individual health and safety had not always been assessed, and there was no guidance for staff to mitigate these risks. This included risks to people of not eating enough, and risks of developing a pressure area. Risks associated with people’s personal activities where necessary, had not always been assessed and mitigated.

You can see what action we have told the provider to take on the back of this report. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Risks associated with people’s living environment had not been effectively assessed and lessened. There were also aspects of people’s living environment that were unclean, presenting a risk of infection spread. There were problems with people’s living environment which compromised their privacy and dignity.

Staff members did not have guidance about people who were at risk of not eating and drinking enough. The home did not always provide staff with adequate guidance in respect of thickening people’s drinks, and storing thickener safely.

Medicines were stored and administered safely, however there were risks associated with ‘as required’ (PRN) medicines not having clear protocols in place for staff to follow. Staff did not always follow recommendations given by health professionals, and they did not always ensure that people were referred to them when they needed.

There were not always staff available to support people when they needed it and this resulted in falls and delays to people receiving assistance with personal care.

People did not receive a daily choice of meals. They were provided with enough to eat and they had drinks available throughout the day to them.

People did not always receive individualised care based on their own needs and preferences. Care plans did not contain adequate current guidance for staff.

People were supported to engage in activities with staff although these were not always available for people in their rooms or for whom group activities were not suitable.

Most staff were kind and caring. However, some staff demonstrated poor practice, which resulted in some people not being treated with dignity and respect.

The systems in place for monitoring and assessing the quality of the service did not always pick up problems and therefore had not acted to improve the quality of the care provided.

The overall rating for this service is ‘Inadequate’ and the service is therefore 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. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

During our previous inspection on 21 August 2014, we found that the provider was not meeting the required standards of cleanliness and infection control as people's mattresses, bed linen and some equipment they used were unclean. Following this inspection, we warned the provider and the registered manager and told them that they had to make improvements by 1 October 2014. On 27 October 2014, we returned to see if the required improvements had been made.

Below is a summary of what we found. The summary describes what people who used the service, and 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 found that some improvements had been made. People's bed linen, commodes and equipment they used such as hoists and wheelchairs were clean. The communal toilets and bathrooms were clean. However, some areas of the service remained unclean and were not suitably designed to reduce the risk of the spread of infection. Therefore the service was not safe as people were at risk of the spread of infection. The provider is currently working with an infection control specialist regarding this matter.

Is the service well-led?

Although the provider and registered manager had put in place effective systems to monitor the cleanliness of some areas of the service, they had not applied this learning to other areas of the service to make sure that they fully complied with Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. Relevant guidance had not being followed and therefore people were at risk of receiving unsafe or inappropriate care.

During our previous inspection on 29 April 2014, we found that the provider was not meeting the standard of cleanliness and infection control as people's mattresses, bed linen and some equipment they used was unclean. Following this inspection, the provider wrote to us and told us what action they were going to take to make improvements. They advised that the standard would be met by 27 May 2014. On 21 August 2014, we returned to the service to see if improvements had been made.

Below is a summary of what we found. The summary describes what people who used the service, and 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 it safe?

The service was not safe because the provider had not taken sufficient steps to protect people from the risk of the spread of infection. Some people's bed linen and equipment they used was unclean. The communal toilets and bathrooms were unclean. The processes that were in place to monitor the cleanliness of the service and equipment were not effective.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people who used the service, the staff supporting them and looking at records.

Is the service caring?

People were supported by kind and supportive staff. Staff were patient and understanding when supporting people. We saw staff treating people with respect and compassion. The staff asked people for their consent before performing any tasks to support them.

People told us that the staff were caring. 'One person said, 'The staff are very good, they are very caring.' Another person said, 'They (the staff) are sometimes very busy but they are always very helpful.'

Is the service responsive?

Staff responded quickly to people's requests for assistance. Changes to people's individual needs were assessed regularly.

People told us that they enjoyed the activities and entertainment that were offered to them.

People were encouraged to raise any complaints they had. Complaints were investigated and responded to in a timely way.

Is the service safe?

People told us that they felt safe. Risks to people's personal safety had been completed and actions had been taken to keep people safe where required.

The service understood the requirements of the Mental Capacity Act (2005), its principles and the Deprivation of Liberty safeguards to protect people from harm.

The provider had checked that their staff were of good character and were safe to work with vulnerable people.

The majority of the service looked clean and hygienic. However, three of the five people's bedding that we checked was unclean. Some equipment was also unclean. This was putting people at risk of harm of the spread of infection. There was an offensive odour in some parts of the building.

Some parts of the premises were poorly maintained. The provider was aware of this and was taking steps to ensure that the premises were safe.

Is the service effective?

People told us that they were happy with their care and that their needs had been met. One person told us, 'I am happy living here, the staff are very good.' Another person said, 'There is plenty of food, I am very happy here.'

People's care needs had been assessed and we saw that these were being met. People's health needs were monitored and expert advice from healthcare professionals was requested when needed.

The staff told us that they felt supported by the management team and that the morale of the staff in general was good.

Is the service well led?

The service had a registered manager in place.

The provider conducted regular quality assurance checks. Any identified areas of concern were acted upon to ensure that the care provided was safe.

Regular staff meetings were held that enabled staff to discuss topics relating to people's care and welfare. People were regularly asked for their feedback on the care they received.

We received an action plan from the provider on the actions they had taken by the end of September 2013 and visited the home on 23 October 2013 to check the improvements we were advised about had been implemented.

We found that improvements had been made on the safe storage of medication with further improvements to be implemented that would make the safe storage of medication more robust.

We also found that all staff were now receiving supervision and that records of these sessions, written by the supervisor and supervisee, were now held on file. This ensured that staff were suitably supported to carry out the work expected to an appropriate standard.

We received comments such as, "....she a good girl" and ".....they are my friends in here and not just staff." "This is a great home with a fabulous manager and I would not want to be anywhere else." A person recently admitted said, "I am happy enough. I like being near my family and my room is nice and beginning to look like mine with some of my own pictures." This told us people were supported as they wished and encouraged to make their bedroom their own.

The home was clean and tidy. We found evidence of suitable procedures being followed to monitor the cleaning and that staff were clear about what practices should be followed. Audits to check cleanliness were in place that ensured infection control and good hygiene procedures were followed.

The medication procedures for administering medication and the management of controlled medication was carried out safely. However, the medication management was not found to be following safe guidelines in regards to safe keeping of medicines. Cabinets that were not suitable for medication were found unlocked. The temperature on the day of the inspection and over the previous four weeks had been above the recommended and safe level of 25 degrees.

The premises had been correctly maintained and records seen showed that servicing and maintenance checks were in place making the building a safe place to live in.

The support for staff was carried out by the home management but limited information was formally recorded. Staff told us they felt supported and that training was regularly provided. However it was not evident that all staff were given the formal supervision to monitor their practice or discuss any development needs they may have.

During this January 2013 follow up inspection visit we found that many improvements had been made to offer a suitable quality of care. We noted that records were more appropriately worded with no derogatory language found. Staff were conversing with people in a suitable manner by offering choices with each question asked. Nutritional care plans had been improved upon. We found risk assessments regarding nutritional needs were clearer; recordings such as the amount of food and drink consumed were more accurate and people's weights were being recorded and monitored regularly.

The home had tried to include families and friends to gather their views and contribute to the construction of individual care plans. A number of methods used to include these people were shared with us, with further efforts still in progress at the time of this visit.

Within the care plans we found assessments completed that stated whether a person had the capacity to understand and consent to their planned support and care. These were not in place at the August inspection. The manager told us that staff were now trained in Mental Capacity Act and Deprivation of Liberty Safeguards which was confirmed by staff spoken with.