The Heathers Residential Care Home

The Heathers Residential Care Home provides personal care and support to older people, some of whom were living with dementia. At the time of the inspection, there were 13 people using the service.

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

Medicines were mostly managed safely. We have made recommendations about best practice with regards to the monitoring of ‘when required medicine’ protocols and the monitoring of the application of patches. Prompt actions were taken during the inspection to address these issues.

People told us they felt safe. Staff knew what action to take if they had any concerns. Risks to people were assessed and safely managed. Accidents and incidents were managed and acted on in a timely manner. There were enough staff to support people safely. Safe recruitment practices were in place. People were protected from the risk of infection.

Staff were supported through training and supervision. People's needs were assessed, to ensure they could be safely met. Staff understood the requirements of the Mental Capacity Act 2005 (MCA). 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 were supported to maintain a healthy diet and had access to health care professionals when required.

People told us staff were caring and kind and they respected their dignity and independence. Care records were reflective of individuals needs and preferences. People were aware of the complaints procedures and knew how to raise a complaint. The provider had effective quality assurance systems in place to monitor the quality and safety of the service on a regular basis. The provider worked in partnership with health and social care professionals to ensure people's needs were planned and met.

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

Rating at last inspection

The last rating for this service was Good (published 15 May 2018)

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

¿ The provider had procedures in place to manage visitors whilst minimising the risk of the spread of infection. These included screening visitors on arrival, providing them with appropriate PPE and hand washing facilities, and maximising the use of the service’s garden house, to reduce footfall within the home.

¿ Staff had access to the PPE they required to support people safely, in line with national guidelines.

¿ People were supported to maintain social distancing within the home.

¿ The home was clean. Domestic staff were aware to clean ‘high touch’ areas frequently and had access to suitable cleaning products.

Further information is in the detailed findings below.

The home did not have a 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. The current manager had applied to become the registered manager of the service.

At our last comprehensive inspection of the service in March 2017 we found improvement was required because staff were not always up to date with refresher training in areas considered mandatory by the provider and because people’s care plans had not always been reviewed on a regular basis to ensure they remained up to date. At this inspection we found that the provider had acted to address these issues. However, we found further improvement was required because the provider’s systems for monitoring the safety and quality of the service failed to identify to consistently identify issues or drive service improvements in areas including the use of risk assessment tools and monitoring people’s Deprivation of Liberty Safeguards (DoLS) authorisations.

People were protected from the risk of abuse because staff were aware of the types of abuse that could occur and the action to take if they suspected abuse. Risks to people had been assessed and action taken to manage identified risks safely. There were sufficient staff deployed to safely meet people’s needs and the provider followed safe recruitment practices.

Staff were aware of the action to take to reduce the risk of infection. People’s medicines were received, stored, administered and disposed of safely and accurate records were maintained relating to medicines administration. Staff were aware of report and record any accidents and incidents and the manager reviewed accident and incident records to ensure sufficient action had been taken to reduce the risk of repeat occurrence.

People’s needs were assessed and their care was planned in line with nationally recognised guidance. 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. Staff received an induction when they started work at the service and were supported in their roles through regular training and supervision.

People told us staff sought their consent when offering them support and involved them in making decisions about their care and treatment. People also told us they enjoyed the meals on offer at the service and were supported to maintain a balanced diet. Staff treated people with dignity and respected their privacy. People confirmed that staff were kind and caring in their approach when offering them support.

People had access to a range of healthcare services when required and the service worked in partnership with other agencies to help ensure people received co-ordinated care and support. People were supported to maintain the relationships that were important to them and spoke positively about the range of activities on offer at the service. The provider had a complaints procedure in place and people confirmed they knew how to raise a complaint.

The provider had systems in place for seeking feedback from people about the service they received through one to one discussion, residents meetings and an annual survey. People spoke positively about the manager and the management of the service. Staff were aware of the responsibilities of their roles and told us they worked well as a team and received good support from the manager. The manager held regular staff meetings to discuss service developments.

We took this action because risks to people had not always been adequately assessed and staff had not always followed risk management guidance to keep people safe. Where people had been prescribed eye drops, these had not always been safely managed placing people at risk. The provider’s systems for monitoring the quality and safety of the service were not always effective and there were limited opportunities for people to provide feedback in order to help drive improvements. We also found a further breach of regulations because recruitment checks on new staff were not always comprehensive. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Heathers Residential Care Home' on our website at www.cqc.org.uk

We conducted this unannounced focused inspection of the service on 26 June 2017 to check action had been taken to meet regulatory requirements. At the inspection we looked at aspects of the key questions 'Is the service safe?', ‘Is the service effective?’ and ‘Is the service well-led?’ This is because these were the areas in which we had found breaches of regulations at the last comprehensive inspection in March 2017.

The Heathers Residential Care Home provides accommodation, care and support for up to 14 people who are primarily elderly and physically frail. There were 13 people living at the home at the time of our inspection. During the inspection we spoke with two people but they were not able to comment directly on the areas we inspected at this inspection.

There was no registered manager in post at the time of our inspection. The previous registered manager had left the service at the beginning of 2017. The manager of the service was in the process of applying to become registered manager. 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 this inspection we found the provider had acted to address the breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Risks to people had been assessed and action taken to manage risks safely. Medicines were securely stored and administered as prescribed to people by trained and competent staff. The provider had put new systems in place to assess areas of risk to people which had been effectively used by staff. Appropriate recruitment checks had been made on staff to ensure they were suitable for their roles.

The manager had systems in place to monitor Deprivation of Liberty Safeguards authorisation expiry dates. The provider also had systems in place to monitor the quality and safety of the service and to seek people’s feedback in order to help drive service improvements.

We found that the provider had addressed the breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and were compliant with the warning notices we served. However, although improvements had been made the ratings for the key questions 'Is the service safe?', ‘Is the service effective?’ and ‘Is the service well-led?’ remain 'Requires Improvement'. This is because the systems and processes that have been implemented had not been operational for a sufficient amount of time for us to see evidence of consistent and sustained good practice, and because other areas identified at our last inspection as requiring improvement were not followed up at this inspection. We will follow up on these issues at our next inspection and will check to ensure the improvements identified at this inspection have been maintained.

There was no registered manager in post at the time of our inspection. The previous registered manager had left the service at the beginning of 2017. The new manager was in the process of applying to become registered manager. 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 on 01 June 2016 we found a breach of regulations because medicines had not always been safely managed at the service. Following the inspection the provider sent us an action plan telling us how they would address the concerns we had identified. However, during this inspection we found further concerns regarding the management of people’s medicines amounting to a continuing breach of regulations because one person’s prescribed eye drops had not been disposed of correctly in line with the manufacturer’s guidance and were still being administered by staff at the time of our inspection, placing them at risk of infection.

We found further breaches of regulations because areas of risk to people were not always adequately assessed or safely managed. The provider’s systems for monitoring and mitigating risks to people were not always effective in identifying or addressing areas of risk. Systems for ensuring people were lawfully deprived of their liberty under the Deprivation of Liberty Safeguards (DoLS) failed to ensure DoLS authorisation requests were submitted to the relevant local authority in a timely manner. There were deficiencies in the systems used to seek and act on people’s feedback, in order to drive improvements at the service. The provider had not always followed safe recruitment practices because there were gaps in the information held by the service relating to staff which should have been considered as part of the recruitment process.

You can see what action we told the provider to take at the back of the full version of the 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.

People were protected from the risk of abuse because staff were aware of the different types of abuse and the action to take if they suspected abuse had occurred. There were sufficient staff deployed at the service to safely meet people’s needs although improvement was required to ensure all staff were up to date with their refresher training in areas considered mandatory by the provider.

The manager had rolled out a new supervision programme for staff since starting work at the service and staff told us they received the support they needed to carry out their roles. Staff were aware of the importance of seeking consent from the people they supported and told us people were involved in making day to day decisions about their care and treatment.

People were supported to access a range of healthcare services when they needed them and staff supported people to maintain a balanced diet. People told us staff treated them with kindness and consideration, and that their privacy and dignity were respected. Staff provided people with person centred care which met their individual needs, although improvement was required to the frequency at which people’s care plans were reviewed to ensure they remained up to date and reflective of their current needs.

The provider had a complaints policy in place and people told us they knew how to make a complaint. People spoke positively about the new manager at the service and expressed confidence that any issues they raised would be addressed promptly.

At this inspection we found that improvements had been made in this area and that the provider was compliant with the relevant regulation. However, we found a further breach of regulations because people had not always received their medicines as prescribed and records relating to the administration of people's medicines had not always been accurately maintained. You can see the action we have told the provider to take in respect of this breach at the back of our report.

The Heathers Residential Care Home provides accommodation, care and support for up to 14 people who are primarily elderly and physically frail. At the time of our inspection there were eleven people using the service. The home had a 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.

We found that improvements had been made regarding the arrangements in place to deal with emergencies and that risks to people had been assessed and monitored. Staff had taken action to reduce the level of risk to people where risks had been identified. There were sufficient staff deployed within the service to meet people's needs and the provider followed safe recruitment practices, although improvement was required to ensure the service maintained records which included copies of staff identification including a recent photograph.

People were protected from the risk of abuse because staff had received relevant safeguarding training and knew the action to take if they suspected abuse had occurred. Staff underwent an induction when starting work at the service and received training and supervision in support of their roles. People told us they enjoyed the food on offer at the service and that they had sufficient amounts to eat and drink. Staff were aware of the importance of seeking consent when offering support to people and worked within the requirements of the Mental Capacity Act 2005 (MCA) where people lacked capacity to make specific decisions. The registered manager had made appropriate applications to ensure people were only lawfully deprived of their liberty in the interests of their wellbeing under the Deprivation of Liberty Safeguards (DoLS).

People told us that the staff were compassionate and caring. Staff worked in ways which promoted people's dignity and independence, and respected their privacy. People were involved in day to day decisions about their care and treatment. They had care plans in place which had been developed based on an assessment of their needs and included information about their views and preferences. People were aware of how to raise a complaint and told us they had confidence that any concerns they raised would be addressed to their satisfaction. They also had access to a range of healthcare professionals in support of their health and wellbeing when required.

The provider had quality assurance systems in place to help identify issues and drive improvements. However improvements were required to ensure these checks were consistently undertaken on a regular basis. People's views on the running of the service were sought through regular service user meetings and an annual survey and the provider took action to make changes to the service in line with people's feedback. People also told us that the service was well managed and staff expressed confidence in the registered manager and the support they received in carrying out their roles.

Below is a summary of what we found. The summary is based on our observations during the inspections, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see evidence supporting our summary please read our full report.

Is the service safe?

Safeguarding procedures were in place and staff understood how to identify abuse and report concerns to safeguard people using the service. Risk assessments were completed for each person using the service to identify potential risks such as falls or poor nutrition. There were systems in place to ensure the environment was well maintained and staff knew how to respond if a person using the service became unwell. Accidents and incidents were reported and recorded.

Is the service effective?

People's health and care needs were assessed with their involvement where possible. Care plans were developed which reflected the level and type of support each person required to be safe and appropriate for their needs and preferences. People's mental capacity to make informed choices had been assessed and we saw relatives had been involved to ensure their best interests were considered. Relatives we spoke with felt people were safe and care was provided in accordance with people's wishes.

Is the service caring?

We observed people using the service had their privacy and dignity respected and staff sought people's agreement before providing care. We spoke with people and their relatives. Relatives said, 'I know they are happy, they always have nice food and nibbles when they want and staff are kind.'

People had been involved in the planning of their care and supported by their relatives to identify their preferences and what was important to them. Staff demonstrated a good understanding of each person's needs and how to effectively communicate with them. This ensured people were supported and involved in decisions about their day to day care.

Is the service responsive?

There was a system in place to respond to and handle complaints. A relative we spoke with was pleased with the way their concerns were responded to. They said, 'a meeting was called and everything was quickly sorted out.' People were invited to be involved and make decisions about their group activities but their wishes were respected when they did not wish to participate. We observed peoples wishes about aspects of their care and daily activities were respected and responded to appropriately.

Is the service well led?

The registered manager had completed audits of adverse events to identify possible trends and solutions to minimise the risk of incidents reoccurring. This meant the service was proactive to ensure the safety of people using the service. People using the service had been supported by their families to participate in meetings to obtain their opinion of the service and there was evidence to show the registered manager had responded to people's feedback to improve the service.

We found that people's ability to consent to their care was being assessed, and care plans were agreed by people who used the service or their representatives. One family told us: 'We were involved in the planning of care from the start and they always ring us with any questions or concerns, we feel the home is excellent'. We found that the staff understood people's care needs and how to protect them from risk and harm, for example when helping people to move safely around the home. People were provided with adequate food and drinks and special dietary needs had been considered. Five people told us that they were asked about the food they liked, and said the food provided was good. Equipment used such as wheelchairs and hoists were safe and regularly maintained. The care staff were supported by the home's management to provide safe an appropriate care.