Archived: Heather House care home with nursing

Heather House is registered to provide personal and nursing care for up to 36 people. At the time of our inspection there were 20 people living in the service. On the day of the inspection we were informed by the operations manager that the provider intended to close the service. On the following day we were sent a copy of a letter sent to people advising them of the impending closure date. In the letter the provider has stated that they propose to close the service no later than 30 April.

There was a registered manager in place on the day 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.

Staffing levels were not sufficient to support people. Unexpected staff absences such as sickness were not adequately covered and this position was confirmed by the registered manager.

Staff were not consistently supported through a regular training and supervision programme.

In some areas of the building the premises were not suitable for the purpose for which they were meant to be used. Some bathrooms were not fully operational and there was a lack of adequate storage facilities throughout the service.

Systems were not being operated effectively to assess and monitor the quality and safety of the service provided.

In January 2015 people were not protected from the risk of infection because appropriate guidance had not been followed. During this inspection sufficient improvements had been made, although further work was required.

In January 2015 we found that the provider had failed to notify the Commission or local authority of safeguarding incidents. We found sufficient improvements had been made.

In January 2015 there were inadequate processes in place to support people to make best interests decisions in accordance with the Mental Capacity Act 2005 (MCA). During this inspection sufficient improvements had been made.

Medicines were generally managed safely. The administration of topical medicines requires improvement.

Records showed a range of checks had been carried out on staff to determine their suitability for the work. For example, references had been obtained and information received from the Disclosure and Barring Service (DBS).

People’s nutrition and hydration needs were met.

People were treated with kindness and compassion. Staff knew people well, understood their support needs and were familiar with people’s personal preferences.

Relatives were welcomed to the service and could visit people at times that were convenient to them. People maintained contact with their family and were therefore not isolated from those people closest to them.

We found three 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 this report.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the care staff gave and from looking at records. If you would like to see the evidence supporting our summary please read the full report.

Is the service caring?

Staff spoke to people in a friendly, caring and respectful manner. Those people requiring assistance to eat were sensitively helped. People's privacy and dignity was maintained.

Is the service safe?

Systems were in place to monitor the safety of the environment. This included regular servicing of equipment and checks to minimise potential hazards.

People's medicines were stored and administered in a safe manner.

Safeguarding concerns were addressed without delay in accordance with local protocols.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. No applications have needed to be submitted from this home. Staff had undertaken training in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

Is the service responsive?

People benefitted from a weekly visit from a GP so health concerns were responded to and monitored efficiently.

There were many negative comments about the time it took staff to answer people's call bells. There was a limited staff presence in certain areas of the home. The limited staff presence and the high level of call bells ringing impacted upon the service some people received.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in terms of sufficient qualified, skilled and experienced staff to meet people's needs.

Is the service effective?

People looked well cared for. Each person had a lengthy care plan yet plans were not effective in informing staff about particular treatments or the management of certain health care conditions. Some people were not adequately supported to change their position to minimise their risk of pressure ulceration.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring the appropriate assessment, planning and delivery of people's care.

Is the service well led?

The service had an acting manager. The previous registered manager had recently submitted an application, to cancel their registration with us.

There were detailed auditing processes to monitor the quality of the service provided. Any shortfalls formed part of a clear action plan and were addressed in a timely manner.

The provider sent us an action plan which confirmed they had taken action in relation to the areas we identified.

During this inspection, we saw improvements had been made.

People were happy with the way in which their bedrooms were cleaned.

The home had been 'deep cleaned.' Wheelchairs and hoists were free of debris. Attention had been given to more intricate areas, such as the beading on over-bed tables.

Bathrooms, toilets and sluice rooms had been 'de-cluttered' so were ordered and tidy.

Not all communal toilets were clean. Adjustments to the frequency and timings of cleaning arrangements were discussed and were to be implemented straight after our visit.

Alternative arrangements had been made to store wheelchairs, personal toiletries and disposable protective clothing more appropriately.

Monthly infection control audits were being completed. Any issues were addressed with staff through informal discussions or one to one formal supervision sessions and staff meetings.

The manager was monitoring the standard of the environment and staff practice more frequently to ensure the improvements made, were being sustained.

People said they enjoyed the food and had regular drinks. There had been changes to the catering arrangements and pre-prepared, nutritionally balanced meals were now delivered to the home. People had a choice of food and drink and their risks of malnutrition were monitored.

People were not being cared for in a clean and hygienic environment. Specialist advice was being gained in order to make improvements. Infection control audits were being increased in order to identify, rectify and monitor practice.

People had the equipment they required to meet their needs. Equipment was satisfactorily maintained and records were in place to demonstrate this.

People told us they liked the staff. They said staff usually responded to their call bell without delay. There had been difficulties with staff recruitment and agency staff were being used to fully maintain staffing levels. Staffing levels were flexible according to people's dependency needs.

Staff had a range of opportunities and support to develop their knowledge and skills. They said they were well supported by management and other members of the team. Systems were in place for staff to be regularly supervised both on a formal and informal basis.