Archived: Headlands

We found the following examples of good practice:

• The service allowed people to meet visitors in a designated visitors room. This was accessible from outside the building without visitors moving around the rest of the service. Rigorous procedures were in place to minimise the risk of infection, including requiring visitors to wear and use protective clothing and masks to minimise the risk of infection to people and staff. People and their visitors were provided with a cream tea during the visit.

• Staff had also helped people to stay in touch with family and friends through phone calls, and through the internet. Regular newsletters were sent out to people’s family and friends to keep them updated about life at the service. Staff had assisted people to learn to use IT and social media applications so they could keep in touch with family and friends, subsequently without people being dependent on others to help them. Electronic tablets had been donated from members of the local community to help people to stay in touch with friends and family.

• The service had identified an area of the building which could be used for people should they need to isolate, and /or who were admitted to the service. This ensured there was minimal risk from infection to other people at the service. Robust admission procedures were in place, for example, the service requiring documentary evidence of Covid-19 test results before people move in, followed by a period of self-isolation.

• The service was providing a range of social activities for people to help to keep them entertained and occupied. The service had a dedicated activities organiser who provided one to one, and group activities. The service used the grounds of the building well.

• Staff had received suitable training and guidance regarding infection control, and how to respond to the Covid 19 pandemic. Throughout the inspection we observed staff demonstrating suitable knowledge of good infection control practice.

• The service was very clean and had effective cleaning routines to ensure risks were minimised and people were kept safe. Additional ancillary staff had been employed, since the start of the pandemic, to help keep hygiene standards to a high standard.

• The registered manager said staff sickness throughout the period of the pandemic had been minimal. Where necessary the service used dedicated bank staff who did not work in other care settings.

Headlands is a residential home providing personal and nursing care for up to 34 predominantly older people. At the time of this inspection there were 29 people living at the service. Some of these people were living with dementia.

The home is situated on the outskirts of St Ives. There is a range of equipment to support people with limited mobility. There are accessible gardens to the front, rear and side of the service.

People’s experience of using this service and what we found

Some people were not able to tell us verbally about their experience of living at Headlands. Therefore, we observed the interactions between people and the staff supporting them.

Staff understood their role in protecting people from harm and assessing avoidable risks. There were enough staff to provide care to people and they were available when people needed support.

The provider had an effective recruitment and selection procedure and carried out relevant vetting checks when they employed staff.

People told us they received a good service and felt safe. Accidents and incidents were recorded, and risk assessments were in place. Arrangements were in place for the safe administration of medicines.

Staff received training to enhance their skills and knowledge to provide the support and care people wanted.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were supported by a staff team that were both caring and compassionate and treated them with dignity and respect. People received person centred care and support based on their individual needs and preferences. Staff knew about people's life history, and their communication needs.

People could choose what to eat and drink and were supported to eat in a pleasant sociable environment.

People’s health needs were being met. The service worked in partnership with a range of healthcare professionals and followed their advice.

People were happy with the way the home was managed. There was a positive and inclusive culture within the service and the registered manager supported the staff and sought to improve the quality of care. The registered manager regularly sought and acted upon people's views of the care.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: At the last inspection the service was rated as Good (report published 8 March 2017)

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service is required to have a registered manager and at the time of our inspection a registered manager was in post although they were not working at the service. 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 service is run. The service was being overseen by an interim manager from another Cornwall Care home.

People told us they were happy with the care they received and believed it was a safe environment. There was a relaxed and friendly atmosphere and we observed people sitting in small groups chatting together and laughing and singing with staff. Some people were unable to tell us verbally about their experiences and we observed they were at ease with staff. Staff sat with people when they had the time and spoke with them kindly.

There were sufficient numbers of suitably qualified staff on duty to meet people’s needs in a timely manner. Staff completed a thorough recruitment process to ensure they had the appropriate skills and knowledge for their role. Staff had received safeguarding training and knew how to recognise and report the signs of abuse. They were confident any concerns would be dealt with. The interim manager had taken action to ensure staff had access to contact information for the local authorities safeguarding team.

People received their medicines on time. Medicines administration records were accurate and consistently completed. Staff supported people to access to healthcare services such as occupational therapists, GPs, chiropodists and dieticians.

People were assessed in line with the Mental Capacity Act (2005) where relevant and the management team followed the legislation to help ensure people’s human rights were protected. Best interest meetings were held when people had been assessed as not having capacity to make specific decisions. These involved other professional and family members to help make sure people’s voices were heard.

Care plans were up to date and relevant and staff told us they were a useful and accurate tool. Any risks in relation to people’s care and support were identified and integrated into the care plans. Risks specific to people’s individual health and social needs were identified. Staff described to us how they would support people in particular circumstances, for example, if they became unwell. Their descriptions were in line with the guidance in care plans.

People were supported to follow their own daily routines and make day to day decisions about where they spent their time and when they got up and went to bed. Activities were arranged on a daily basis by staff. An activity co-ordinator was employed part time to organise planned sessions, events and trips out. There were plans for them to have additional training to enable them to develop the activities programme and help ensure all people were supported to take part in meaningful pastimes.

There was a management structure in the service which provided clear lines of responsibility and accountability. Although the management arrangements were temporary, staff told us they felt well supported and had confidence in the management team and the higher organisation. Staff morale was good and staff frequently referred to the importance of working as a team.

Below 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.

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

Is the service safe?

No, overall, on the day of the inspection we judged the service was unsafe. This was primarily because the home had not followed infection control guidance as published in the 'Prevention and control of infection in care homes, published by the Health Protection Agency. The premises appeared generally clean and odour free. The exception to this was the kitchen, where we did find areas not well maintained or clean. Infection control procedures at the home were not consistently followed and this posed a risk to peoples' safety.

Records were generally to a satisfactory standard.

Is the service effective?

No overall, on the day of the inspection we judged the service was ineffective.

People said staff did not always meet their needs and staff did not respond promptly when people needed assistance.

People all had an individual care plan which set out their care needs. Care plans contained satisfactory information and were accessible to staff.

Is the service caring?

No, overall, on the day of the inspection we judged the service was not caring.

Our observations of the care provided, discussions with people and records we assessed, enabled us to conclude individual wishes and needs were not consistently taken into account and respected. People did not always experience care, treatment and support that met their needs. The dignity of people at the home was not always respected by staff. There were very little meaningful activities for people living at the home. A significant number of people told us there were a lack of consistent stimulating activities offered at Headlands and this led to feelings of 'frustration and boredom'. We saw people mainly spent time either in their rooms or in the lounge area watching the television or talking to other people. Some of the staff we spoke with did not understand the care needs of the people they supported. This was primarily because of a high dependence on a relief bank of staff who were less familiar with the home.

Most people who used the service said staff were caring. One relative of a person who lived at Headlands told us, 'They are a committed staff group'.

We saw people chatted with each other and with staff and people's views and experiences were taken into account in the way the service was provided and delivered in relation to their care. Care records showed people were at liberty to decline care or activities.

People experienced care, treatment and support that met their needs and protected their rights, people were protected by the home's management of medicines and people were protected by the home's robust recruitment procedures.

Records were largely accurate, up to date and stored securely.

We spoke to four people who lived at Headlands, two visitors, and the staff and manager. All the comments we received from people who lived at Headlands were positive. Comments from people included 'When our relative asks when she is coming home, we say no dear we are moving in with you', 'there's always someone there if you need help' and 'they cook me whatever I ask for'.

We saw people's privacy and dignity being respected and staff being helpful. We saw that residents were spoken with in an adult, attentive, respectful, and caring way. We saw and heard staff greeting people in passing, 'hello Mr *' or 'hello sir'.

Staff confirmed the training they had done and also confirmed that they were supervised. Staff said that they enjoyed working at Headlands.