Archived: Heywood Court Care Home

People’s experience of using this service:

The service met the characteristics of good in all areas and was rated good overall.

People told us the service was well run, staff were kind and independence was promoted which had a positive effect on their lives.

Staff continued to be robustly recruited to ensure they were safe to look after vulnerable people and there were enough well trained staff to meet the care needs of people who used the service.

Medicines continued to be safely administered.

People had their known risks assessed and action was taken to protect their health and welfare. This included the provision of any specialist equipment such as pressure relieving devices.

We saw that gas and electrical equipment had been maintained.

The principles of the Mental Capacity Act (2005) were followed to help protect people’s rights. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

Food served at the home was nutritious and people had a choice in what they ate.

Staff received the training, support and supervision they needed to carry out their roles effectively.

People were able to personalise their rooms to their own tastes. The home was clean and there was a relaxed and homely atmosphere.

People's independence was promoted, they could make choices about their care and were treated with dignity and respect by staff.

People who used the service said staff were kind and caring. We observed staff and saw they helped preserve people’s dignity when delivering care.

Activities were available for people to access within the home and individual interests were encouraged. People were supported to engage in these activities.

There were systems to record and act upon complaints, accidents and incidents to help improve the service.

Managers conducted audits to ensure the quality of service provision was maintained.

Rating at last inspection: At the last inspection (report published 11 November 2016) the service was rated as good.

Why we inspected: This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up: We will continue to monitor information and intelligence we receive about the home to ensure care remains safe and of good quality. We will return to re-inspect in line with our inspection timescales for good services, however if any information of concern is received, we may inspect sooner. For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The warning notices stated that the provider and registered manager must be compliant with these regulations by 13 August 2016. The registered manager sent us regular action plans in regards to the requirement actions.

We undertook a comprehensive inspection on the 5 and 6 October 2016 to re-rate the service and to check that they had met the legal requirements of the warning notice.

Heywood Court Care Home is a purpose built detached home close to the centre of Heywood. Accommodation is provided over three floors. The home is registered to provide accommodation and personal care for up to 45 people. On the day of our inspection 41 people were living at the home.

The service had a registered manager in place at the time of our 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.

During this inspection we found that they had met the warning notices and all requirement actions had been complied with and improvements had been made.

Issues that were raised at the inspection of 29 June 2016 by the health and safety officer (local authority) had been addressed. The registered manager showed us a letter from the health and safety officer to confirm that adequate improvements had been made in relation to the safety of moving and handling equipment. We found there was more detailed information available to staff members in relation to the use of slings and hoists.

Improvements had been made in relation to risk assessments. Those people identified as being at risk in regards to their health and well-being had all the necessary risk assessments in place. Information from these had been transferred into care plans to guide and support staff.

At our focussed inspection of 29 June 2016 we found risks in relation to fire safety. During this inspection we found improvements had been made. We found all fire exits were clear of items and were safe for people to use in an emergency. All the people who used the service had a personal emergency evacuation plan in place which was person centred and identified the required amount of support based on health conditions.

We checked the management of medicines within the service. We have made a recommendation that the service considers current best practice and reviews the way creams are administered and who is signing for them.

All the staff members we spoke with told us they had received an induction when they commenced employment with the service. Records confirmed what we had been told.

Prior to our inspection of 29 June 2016 we had received concerns that DoLS that were in place for people who used the service were not being followed by staff members. We did not find any concerns when we checked these on the 29 June 2016. We checked these again during this inspection and found DoLS in place were detailed and contained relevant information. Staff had been trained in this area and the registered manager had notified us in a timely manner when an application had been made and/or authorised.

Records we looked at showed capacity assessments had been undertaken with those people who the service deemed lacked capacity. Best interest meetings had also been undertaken for those people who lacked capacity to consent.

People who used the service and relatives told us the food within the service was good. We saw people were given choices of what they wanted to eat either verbally or by showing people the two choices. Tables were nicely laid and there was a relaxed atmosphere.

The service had recently been awarded the Four Seasons Dementia Care Framework Accreditation. This was in recognition of the work the service had undertaken to meet the four components of this framework.

Prior to our inspection of 29 June 2016 we had received concerns that people who used the service were being wakened and dressed very early in a morning. At our inspection of 29 June 2016 we found a significant number of people were up and dressed at 05:50am. This was addressed by the regional manager, registered manager and deputy manager and no concerns were identified during this inspection.

We observed interactions from care staff that were kind and sensitive. We spoke with the registered manager to inform them of the kindness and empathetic nature that two particular staff members showed throughout our inspection.

We observed the atmosphere in the service was both relaxed and happy. We observed a number of occasions when staff members were singing and dancing with people in the main reception area.

The religious needs and wishes of people who used the service were not always sufficiently assessed or addressed. We have made a recommendation that the service considers current best practice in relation to meeting the spiritual and religious needs of people who use the service.

We asked people who used the service and staff members what the culture of the service was like. We received a number of positive comments and all the staff we spoke with told us they would be happy for one of their family members to use the service.

The registered manager ensured that surveys were completed by people who used the service, relatives and staff members. We saw the results of surveys were analysed and action taken to address any issues or concerns.

Other methods used by the registered manager to gain feedback were resident and relative meetings and staff meetings. All of which were documented and showed any action taken.

This report only covers our findings in relation to the concerns raised. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Heywood Court Care Home on our website at www.cqc.org.uk

Heywood Court Care Home is a purpose built detached home close to the centre of Heywood. Accommodation is provided over three floors. The home is registered to provide accommodation and personal care for up to 45 people. On the day of our inspection 33 people were living at the home.

The service had a registered manager in place at the time of our 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.

During this inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We found a number of items were being stored in two fire escapes that should be kept clear for use in an emergency situation. We also found a number of door guards (specially designed equipment to keep doors open that close when the fire alarm sounds) were not safe as the batteries were buzzing to suggest they required replacement. This meant some doors may not close in a fire situation.

One person’s records we looked at showed they were assessed as a high risk of choking, however an oral assessment, level of need and care plan had not been completed placing the person at risk of choking.

Records for one person showed they were at risk of weight loss, however they had not been weighed on admission and there was no evidence of further weights being undertaken.

Food and fluids charts that were in place did not adequately provide information relating to the intake of diet for people, for example if they had eaten a full portion or half a portion. This meant it would not be possible to monitor if people were taking adequate diet to maintain a healthy weight.

The service could not demonstrate that people who were at risk of developing pressure ulcers were receiving the required amount of positional changes to protect their skin from breaking down.

People were at risk of incorrect moving and handling procedures as they were not adequately assessed in relation to the type of equipment to be used and how to use this.

At the commencement of our inspection at 6am we found 13 people were up and dressed. Some people were sleeping in chairs and one person was dressed and asleep on their bed. Care plans and daily notes did not always provide evidence why people were up early. One staff member told us there was an expectation that night staff got people up early in the morning.

Care plans we looked at did not always reflect people’s choices about the amount of baths/showers they had a week. Records we looked at showed people were receiving one shower or bath a week, some of whom were incontinent and would benefit from more regular bathing.

One person who had been discharged from hospital on end of life care did not have an end of life care plan in place. This meant their wishes in the event of their death would not be met as these were not known to the staff.

Terminology used in some care plans was negative and disrespectful of people who used the service, for example ‘wandering’ or ‘wander some’. One staff member we spoke with described a person as ‘a wanderer’.

All the staff we spoke with knew their responsibilities in relation to safeguarding people who used the service.

Toiletries contained people’s names so that they remained personal to them. We found people had adequate supplies of toiletries in their rooms.

People who were able to talk to us were complimentary about the staff members and meals provided within the service.

Bedrooms we looked at were clean, tidy and had been personalised with people’s own belongings.

Heywood Court Care Home is a purpose built detached home close to the centre of Heywood. Accommodation is provided over three floors. The home is registered to provide accommodation and personal care for up to 45 people. On the day of our inspection 36 people were living at the home.

The service had a registered manager in place at the time of our 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.

During this inspection we found that the service had a whistleblowing policy in place. This was accessible to staff and gave clear steps for them to follow should they need to report poor practise.

We looked at the staffing levels within the service. We found that whilst sufficient numbers of staff were employed, the deployment of these throughout the service was not always safe.

Medicines, including controlled drugs, were stored securely and only authorised and trained staff members had access to them.

There were robust recruitment processes in place within the service. Records we looked at showed that all necessary checks had been undertaken prior to a new staff member commencing employment.

We looked at records relating to the evacuation of people in an emergency situation. We saw people had Personal Emergency Evacuation Plans (PEEP) in place but found these were not person centred. We have made a recommendation in relation to the personal emergency evacuation plans (PEEPs) in place for people who use the service.

We saw equipment was available throughout the service to support people with limited or no mobility. Records we looked at showed that staff members had received training in moving and handling.

Staff told us and records we looked at showed that staff members had to undertake an induction when commencing employment at Heywood Court Care Home. Mandatory training and shadowing experienced staff members were also part of the induction process.

Records we looked at showed that where the service considered someone lacked capacity, capacity assessments were undertaken and the relevant people were involved. Best interest meetings were also held for those people who lacked capacity to make certain decisions.

The service did not always follow the principles of the Mental Capacity Act (2005). We have made a recommendation that the service considers the MCA in relation to Lasting Powers of Attorney and ensures that people’s rights are protected.

We found that people who were susceptible to urinary tract infections were not being encouraged to drink extra fluids. We spoke with the registered manager regarding this and the matter was addressed during our inspection.

People who used the service had access to a range of healthcare professionals in order for their health needs to be met. This included GP’s, district nurses and tissue viability nurses.

We saw communal areas were thoughtfully decorated and bedrooms had been personalised with items that people had brought with them.

We observed interactions from staff members that were calm, respectful and valued people who used the service. People who used the service told us that staff were kind and nice to them.

Staff had completed training in understanding end of life care in dementia and person centred approaches in end of life. We saw that people who used the service and their relatives were involved in the development of end of life care plans.

The service had an activities coordinator in place. We saw activities on offer included memory games, movies, loom knitting, days out, trips to the local shops, dancing and Blackpool illuminations.

We checked our records before the inspection and saw that accidents or incidents that CQC needed to be informed of had been notified to us by the registered manager.

There were robust quality assurance systems in place which looked at areas such as health and safety, maintenance, laundry, kitchen and infection control. Night visits were also completed by the registered manager.

The service had improvement plans in place which covered refurbishment throughout the service. During our inspection we saw that some of the work had been completed.

' Is the service safe?

' Is the service caring?

' Is the service effective?

' Is the service responsive to people's needs?

' Is the service well led?

Below is a summary of what we found. The summary is based on an out of hours visit that took place at 6 am, spending time with people who used the service, talking with a relative, speaking with four managers and six care staff as well as looking at records.

All the people living at the home at the time of this visit had a diagnosis of a dementia and were not able to give the views or opinions about the service they received.

Is the service safe?

We saw that wheelchair footplates were being used when they were moving people around the home. Using wheelchair footplates helps to prevent injury to people's feet.

We saw that were there spillages the housekeeping staff addressed them quickly to help prevent falls.

We were told that all the staff team had recently undertaken refresher training in safeguarding vulnerable adults. We saw copies of some of the completed work books. The workbooks make reference to policy and procedures such as 'whistleblowing' procedures and a range of different situations that staff might become involved in during day to day practice. This helps staff to know what action they should take to protect people from harm.

Is the service caring?

A relative told us they had chosen the home because the staff appeared 'kind, helpful and friendly'. They said they were kept informed of any changes in their relative's health. We noted that a staff member had come in on their day off to go clothes shopping for a person living at the home.

The atmosphere was calm and relaxed for the majority of our visit. We saw that there were frequent and friendly interactions between people who lived at the home and all members of the staff team. Where people started to become distressed they were quickly reassured and gently distracted until they became content again.

Is the service effective?

We were told that there had been a period of time since our last visit when a number of longstanding staff had left and this had been unsettling time. At the time of our visit the home was fully staffed again with an additional 10% of staff to cover, vacancies, annual leave and sickness. To help ensure continuity of care for people outside agency staffing was not used by the home. The home had access to bank staff who knew the people who lived at the home.

Is the service responsive to people's needs?

We saw that where a person had significant needs in relation to pressure area care a special chair had been acquired to support them.

Where a person was experiencing intermittent periods of behaviour that was challenging to others we saw that the relevant healthcare professionals were involved in supporting the person and the staff team.

Is the service well led?

The home has recently had a change in manager. The manager had submitted their application form to register with us.

Both the manager and the deputy manager told us that they received very good support from the regional manager and the senior home manager. Both told us that they worked flexibly to support the home's day to day support needs and this was confirmed by some of the staff we spoke with.

The regional manager carried out a monthly quality monitoring visit at the home. The visit checked that audits had been carried out by the manager for example, medication, nutrition, and care documentation as well as staffing levels, staff training and health and safety.

All incidents happening at the home were recorded onto a computerised system that enabled the regional manager to externally monitor any adverse events that happened at the home.

The home was clean and there were no unpleasant odours. We saw regular checks were carried out to make sure the home was clean and the risk of infection was minimised. The manager and the provider also completed regular checks on the quality of the service.

We looked at the care records of seven people. Risk assessments and easy to understand care plans were in place, and these had been updated at least every month. Daily records provided evidence that staff followed the care plans.

We saw that a varied menu was available and people were given a choice of food at all mealtimes. Snacks were available during the night if requested. If there was a concern about a person's weight a dietician was consulted.

We observed that people appeared happy and content. Support was given when required and we saw a care worker spending one to one time with a person who received services.

We found that people's needs were regularly assessed to make sure they received appropriate care. Records provided evidence that people's preferences were taken into account during the planning of their care.

Robust recruitment procedures were in place and staff did not start work until all the appropriate checks were completed.

Staff told us they were well supported at work by the manager and the provider. They gave us examples of the choices people had around how they spent their days, and they told us that they felt able to maintain people's dignity at all times.

A lot of the people living at the home had complex needs and although we spoke to people, most responses did not relate to the standards we were inspecting. However, we spent approximately two hours in a communal lounge and were able to see people appearing at ease with staff and each other. People seemed to be content and they spoke freely with staff during our observations.