Heatherley - Care Home with Nursing Physical Disabilities

About the service

Heatherley - Care Home with Nursing Physical Disabilities is a residential care home that provide personal and nursing care for a maximum of 42 people. At the time of our inspection there were 33 people living there. People live either in the main building or in one of eight self-contained bungalows located within the grounds. People who lived in the bungalows used the facilities in the main building at any time of day or night. People living at Heatherley had physical disabilities and some people also had a learning disability or acquired brain injury.

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

Based on our review of safe, effective and well-led the service was not able to demonstrate how they were meeting some of the underpinning principles of Right Support, Right Care, Right Culture. However, the provider was working toward meeting the principles, and embedding the positive changes made into the running of the service.

Right Support

People were able to access meaningful activities more regularly than they had been able to previously. Changes were being made so people were supported to identify goals and outcomes and plan the support they needed to achieve these. These improvements were just beginning at the time of inspection and time was needed for this to be embedded and for everyone with a learning disability to benefit from the changes.

Right Care

Care was becoming more person centred and flexible to meet people’s needs. People were supported by a kind and caring staff team who treated them with respect. People's rights were promoted, and they were protected from discrimination. Staff understood their responsibilities to protect people from abuse and knew how to report concerns should they need to.

Right Culture

There was a positive ethos at the service and people were involved in planning their own care and were encouraged to give their views about the support they received. People were supported to develop their skills and to be as independent as possible. People's relatives were able to give their feedback about the support their family members received and their views were listened to.

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.

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

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. For those key questions not inspected, we used the ratings awarded at the last inspection of these to calculate the overall rating.

Rating at last inspection and update

The last rating for this service was inadequate (published 18 February 2022) and there were breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

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.

Heatherley - Care Home with Nursing Physical Disabilities is a residential care home that provide personal and nursing care for a maximum of 42 people. At the time of our inspection the service was providing care to 39 people and another person was in hospital. People live either in the main building or in one of eight self-contained bungalows located within the grounds. People who live in the bungalows use the facilities in the main building at any time of day or night. People living at Heatherley may have a learning disability, acquired brain injury, stroke, cerebral palsy or multiple sclerosis.

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

There were not sufficient staff deployed at the service which left people at risk. Risks associated with people’s care was not always being managed in a safe way including people’s nutrition and hydration.

Staff had not received appropriate training and supervision in relation to their role. Advice from health care professionals was not always being following by staff. Staff were not always communicating accurate information about people’s care.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests. People had access to health care professionals to support them with their care. People and relatives told us that staff were kind and caring and we did see examples of this.

Quality assurance was not always effective. Where shortfalls in care had been identified with staff this had not been addressed robustly. The leadership needed to be more effective in ensuring staff were delivering appropriate care. The provider had failed to maintain robust oversight of the service. As a result, the level of care had deteriorated since the last inspection.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• Model of care and setting did not maximise people’s choice, control and independence. People did not have direct links to the community and choices around meaningful activities were limited.

Right care:

• Care was not person-centred and did not always promote people’s dignity, privacy and human rights. People were left alone for extended periods of time in their room and not all staff had an understanding people’s preferences around care.

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff did not ensure people using services led confident, inclusive and empowered lives. People were admitted to the service without consideration from the provider about whether it was an appropriate setting for them.

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

Rating at last inspection (and update)

The last rating for this service was Good (published 12 February 2019).

Why we inspected

The inspection was prompted in part due to concerns raised to us from health care professionals about the safe care and treatment for people and the staff levels. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well Led sections of this full report.

As result of the visit the provider has provided us with assurances they will not be admitting people to the service until improvements have been made.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to low staffing levels and lack of training and supervision of staff, safe care was not always being provided to people and people were not being appropriately supported with adequate nutrition and hydration. The provider was not able to demonstrate how the provider was meeting some of the underpinning principles of Right support, Right care, Right culture, and guidance from health care professional not always being followed. The provider was not applying the principles of the Mental Capacity Act and there was a lack of robust provider and management quality assurance at this inspection.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

We found the following examples of good practice.

Staff supported people to remain in contact with their families in line with government guidance. There was a variety of ways in which relatives could visit their family member in a COVID safe way. These included garden visits; visits in a room with a plastic frame separating the visitor from the service user and for those ‘named visitors’, visits were facilitated in a designated visiting room. One person told us, “I get such support from staff to arrange family visits, this means everything to me.”

The premises were clean and well maintained by a team of cleaners throughout the day. Additional cleaning schedules had been introduced since the beginning of the coronavirus pandemic. High touch areas such as door handles, and light switches were cleaned throughout the day. Hand sanitiser was readily available throughout the premises.

Those who tested positive for COVID-19 were supported to isolate in their rooms. In order to minimise cross-contamination, their clothes and bed linen were washed separately and after all other linen was washed. One person told us, “They are very quick to act here; as soon as there is a positive test, we are given the rules of what to do. We get plenty of explanations for why we have to do this. I understand it is to keep us all safe.”

There were trollies stocked with personal protective equipment (PPE) stationed around the home and we observed staff wearing PPE appropriately throughout the inspection day. People told us that staff wore PPE at all times when they were being supported with their personal care. One said, “Staff are very particular about hygiene and they wear PPE at all times.”

Staff temperatures were recorded daily and they took one PCR and two lateral flow tests per week. People who used the service were supported to access monthly testing. All staff had received recent training in infection prevention and control (IPC) and were seen to be following correct IPC practices at all times.

The registered manager shared government COVID-19 policy updates with staff and family members. The clinical lead was the designated IPC lead . responsible for auditing IPC practice. They did monthly audits of hand hygiene and the environment including high infection risk areas such as sluice rooms.

The registered manager sought support and advice from external agencies including the local health team, Surrey County Council and CQC and was open to all advice and guidance offered.

Heatherley - Care Home with Nursing Physical Disabilities is a care home that provides a range of services including nursing care and in-house physiotherapy treatment. The home is registered to provide support for up to 41 adults with physical disabilities. People live either in the main building or in one of six self-contained bungalows located within the grounds. People who live in the bungalows use the facilities in the main building any time of day or night. People living at Heatherley may have an acquired brain injury, stroke, cerebral palsy or multiple sclerosis.

At the time of our inspection there was an experienced registered manager in post. 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.

At our last inspection of the service on 10 January 2017 we rated the service overall as ‘Good’ and 'Requires Improvement' in Well-led. This was because repairs to the home environment had not always been addressed promptly and some had the potential to impact on people's safety or wellbeing. Following the inspection, the provider submitted an action plan detailing the action they had taken to address the breach of Regulation 15 of the Health and Social Care Act (Regulated Activities) 2014. At this inspection we found improvements had been made and the breach of regulation had been met.

Risks to people were assessed and managed safely. Medicines were managed, administered and stored safely. People were protected from the risk of abuse and staff knew what action to take to ensure people’s safety. There were systems in place to ensure people were protected from the risk of infection and the home environment was clean and well maintained. Accidents and incidents were recorded, monitored and acted on appropriately. There were safe staff recruitment practices in place and appropriate numbers of staff to meet people’s needs in a timely manner.

There were systems in place to ensure staff were inducted into the service appropriately. Staff received training, supervision and appraisals. There were systems in place which ensured the service complied with the Mental Capacity Act 2005 (MCA 2005). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People’s nutritional needs and preferences were met. People had access to health and social care professionals when required and staff worked well with health and social care professionals to meet their needs.

People were treated respectfully and staff ensured their privacy and dignity was maintained. People’s diverse needs were met and staff were committed to supporting people to meet their needs with regard to their disability, race, religion, sexual orientation and gender. People were involved in making decisions about their care. There was a range of activities available to meet people’s interests and needs. The service provided care and support to people at the end of their lives. People’s needs were reviewed and monitored on a regular basis.

There were systems in place to monitor the quality of the service provided. People’s views about the service were sought and considered. The provider worked in partnership with the local community and other professionals to ensure people received appropriate levels of care and support to meet their needs.

Heatherley is a home providing a range of services (including nursing care). The home is registered for up to 40 adults with physical disabilities. People live in either the main building or one of six self-contained bungalows within the grounds. People who live in the bungalows use the facilities in the main building during the day. At the time of the inspection 37 people lived at the service. People living at Heatherley may an acquired brain injury, stroke, cerebral palsy or multiple sclerosis. All people living at the service are wheelchair users and the majority require a hoist to assist in moving them.

During our inspection the registered manager was present. 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.

Heatherley was last inspected on 22 December 2014 and 3 February 2015 when it was given an overall rating of ‘Requires Improvement.’ Three breaches of Regulations were identified and requirement notices were issued. These related to infection control, staffing and records. At this inspection we found that the requirement notices were met and improvements had been made in all areas. Systems for the management of infection control had been reviewed and staff followed safe procedures. Many aspects of the environment had been altered to promote good infection control. These included changes to equipment and facilities. Audits had been completed to monitor safe systems of work were being followed. Staff levels had increased and additional staff allocated of a breakfast time in order that sufficient staff were available to support people. We did observe a period of time when there was no staff presence in the lounge. We have made a recommendation about this in the main body of our report. There had been a complete review of the record keeping procedures at the service. Peoples care records were very organised, easy to follow and accurate.

Everyone that we spoke with said that the registered manager was a good role model. Quality assurance systems were in place to monitor the quality of service provided. However, the registered provider had not ensured action was always taken promptly when shortfalls were identified. Many fire doors and surrounds were badly damaged and could impact on their effectiveness in the event of a fire. Other doors were also damaged and had not been repaired or replaced despite these issues being identified over three months ago. This was a breach of Regulation 15 of the Health and Social Care Act (Regulated Activities) 2014.

Information of what to do in the event of needing to make a complaint was displayed in the home. During our visit we observed staff assessing if people were happy as part of everyday routines that were taking place. Some people felt that concerns were not always responded to in a way they would like. We have made a recommendation about this in the main body of our report.

People said that they felt safe. Staff had received safeguarding training and were able to explain the reporting procedures they would follow if they thought people were at risk of harm. Potential risks to people were assessed and information was available for staff which helped keep people safe.

Staff had received training relevant to the needs of people who lived at the service. Staff said they were fully supported by the registered manager. They received group and one to one supervision. Recruitment checks were completed to ensure staff were safe to support people.

People said that they consented to the care they received. Mental capacity assessments were completed for people and their capacity to make decisions had been assumed by staff unless there was a professional assessment to show otherwise.

People said that they were happy with the medical care and attention they received. People’s health needs and medicines were managed effectively. People’s needs were assessed and care and treatment was planned and delivered to reflect their individual care plan.

People’s dietary needs were met. There were a variety of choices available to people at all mealtimes.

Equipment was available in sufficient quantities and used where needed to ensure that people were moved safely and staff were able to describe safe moving and handling techniques. Servicing and checks of equipment and facilities had taken place that included hoists, wheelchair weighing scales, gas appliances and water.

People said that they were treated with kindness and respect. In the main, we observed interactions by staff to people that were warm, positive, respectful and friendly whilst remaining professional. Staff understood the importance of respecting people’s privacy and dignity.

People said that they were happy with the choice of activities on offer and that they were supported to maintain links with people who were important to them. They also said that they were consulted and involved in making decisions about their care and support.

At the time of our inspection, the service provided care and support to 37 people, and one person was living at the service for respite care. Some were not able to tell us about their experiences of living at Heatherley because of their communication difficulties; however, we did receive feedback from seven people who used the service. We also spoke with six members of staff, as well as the registered manager as part of this inspection.

We reviewed records that related to the management of the service which included support plans, policies and daily records.

Below is a summary of what we found. The summary describes what people who used the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

We saw that risk assessments were in place to provide information to staff to help minimise the risk of any harm to people. For example, in relation to mobility.

The provider had ensured that staff were provided with information that related to safeguarding vulnerable adults. Staff were able to tell us what they would do if they had any concerns. One member of staff told us, 'We have a flowchart to show us how we would report any concerns we had.'

Is the service effective?

Our observations told us that staff had a good understanding of people's needs. The people we spoke with who used the service confirmed this. We heard how one person may be able to go home and another whose mobility had improved during the time they had been at Heatherley.

The service had in-house physiotherapy and occupational therapy sessions available for people. This helped people maintain or improve physically.

Is the service caring?

People were encouraged to be independent but were helped when they needed any support. The staffing rotas showed us that the staff number each day matched what we had been told. We did not specifically witness people waiting to be assisted, but some people that we spoke with told us they would like to see more staff on duty.

We heard how people were treated with respect and dignity. One person told us, 'All over the staff are very caring.'

Is the service responsive?

The service worked with other healthcare professionals or agencies. We saw, for example, in a care plan, and also heard from the manager how the service had worked with external and internal health professionals in relation to one person.

Is the service well-led?

There were meetings for the people who lived at the home as well as staff. Staff told us the manager encouraged them to make suggestions on how to improve the service. We saw that the results of the latest satisfactions were used to create an action plan to help improve the service.

People who lived there told us the staff were 'very helpful' and 'kind.' One person said 'it's good here, I like living here.' One person told us the physiotherapy was "excellent."

We saw the records with regard to the specific abilities and needs of the people who lived there did not contain all the information necessary to ensure staff knew how to deliver care and support. There were no records of these documents having been reviewed to ensure this information was up to date.

People described the food as 'very good' and said they had enough choice. We saw the support and assistance people required was given respectfully.

There were safe systems in place for the management of medicines. Some of the records required were not completed fully.

The necessary information to ensure staff were fit to carry out their work was present. Staff were supported and trained.

People told us they knew how to complain should they wish to do so and issues they had raised had been quickly resolved.

We observed people receiving safe and effective care that was based on detailed care plans and risk assessments. People who used the service told us they were aware of which medications they took, how much and why, and that they discussed medication and treatment with their key worker. People told us they had no complaints about the service they received but that they had been made aware of the provider's complaints procedure. We spoke with care staff who demonstrated a good understanding of the support needs of people who used the service and were clear about their responsibilities with regards to keeping people safe and the processes in place for reporting suspected abuse. The registered manager told us staff received ongoing training and supervision to meet the needs of the people they were supporting.