Archived: Heatherwood

We carried out an announced inspection of this service on 21 and 22 March 2017 at which breaches of legal requirements were found. We took enforcement action and served warning notices on the registered provider in respect of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Risks to people had not always been identified, assessed adequately, or steps taken to mitigate them. The provider's systems for assessing and monitoring the quality and safety of the services provided, to mitigate risks to the health, safety and welfare of people using the service were not always operating effectively.

We undertook this focused inspection on the 13 June 2017 to check that the provider met our legal requirements. This report only covers our findings in relation to the breaches identified in the warning notices. We will follow up on the other breaches of legal requirements at our next inspection. You can read the report from our last comprehensive inspection, by selecting the link for Heatherwood on our website at www.cqc.org.uk.

At this inspection we found that the provider had addressed the breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and were compliant with the warning notices we served. Risks to people had been identified, assessed and steps were being taken to mitigate them. The provider's systems for assessing and monitoring the quality and safety of the services provided had improved and were operating effectively.

The home had a registered manager in post; however we were advised at the time of this inspection that they had tendered their resignation. The provider was in the process of recruiting a new manager to run the home. The director of care said they would be managing the home until a new manager was recruited. They also told us that a new deputy manager had been recruited and would start working at the home in July 2017.

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 the ratings for the key questions safe and well led at this inspection remain ‘Requires Improvement’ at this time as systems and processes that have been implemented have not been operational for a sufficient amount of time for us to be sure of consistent and sustained good practice.

The home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. They were also registered with the CQC to manage another care home run by the provider across the road from Heatherwood. 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.

At our first ratings inspection on 20 and 21 August 2015 we found breaches of legal requirements because risks to the health and safety of people had not always properly assessed and the provider’s quality assurance systems did not always correctly identify issues and because action had not always been taken where issues had been identified.

At our last inspection on 16 August 2016 we found that improvements had been made to the provider’s quality assurance systems, although further improvement was required to ensure they identified all appropriate action was taken to address identified issues. We found that whilst improvements had been made to risk assessment processes, the malnutrition risk assessment tool used by staff had not always been completed correctly and therefore did not always identify when people were at risk of malnutrition. We also found that improvement was required to ensure that all staff received regular supervision and an annual appraisal of their performance.

At this inspection 20 and 21 of March 2017 we again found that the home’s systems for assessing, monitoring and improving the quality and safety of care provided to people using the service were not operating effectively. We found that although a Malnutrition Universal Screening Tool (MUST) had been placed in people’s care plans they had not always been completed correctly and therefore did not always identify when people were at risk of malnutrition. We found that no improvements had been made to the frequency of staff supervision and annual appraisals despite the issue being picked up and recorded in visits to the service by the provider in November 2016 and January 2017.

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.

There were safeguarding adult’s procedures in place and staff had a clear understanding of these procedures. There was a whistle-blowing procedure available and staff said they would use it if they needed to. Appropriate recruitment checks were being carried out before staff started working at the home and there were enough staff to meet people’s needs. People’s medicines were managed appropriately and they were receiving their medicines as prescribed by health care professionals. There were arrangements in place to deal with foreseeable emergencies.

We found that staff had completed mandatory training in line with the provider’s policy. The manager and staff understood the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and acted according to this legislation. People were being supported to have a balanced diet and they had access to health care professionals when needed.

People using the service and their relatives, where appropriate, had been consulted about their care and support needs. People using the service and their relatives were provided with appropriate information about the home in the form of a service user guide and people’s privacy and dignity were respected. Staff had a good understanding of peoples care and support needs. People were provided with a range of appropriate social activities. The home had a complaints procedure in place.

The provider took into account the views of people using the service and their relatives through residents meetings and surveys. Staff said they enjoyed working at the home and they received good support from the registered manager. There was an out of hours on call system in operation that ensured that management support and advice was always available to staff when they needed it.

There was no registered manager in place at the time of this inspection although the current manager was in the process of applying to become the registered manager. The previous registered manager had left their role in November 2015. 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 comprehensive inspection on 20 and 21 August 2015 we found breaches of legal requirements because medicines were not safely managed, and risks to the health and safety of people had not always properly assessed. We also found a further breach because the provider’s quality assurance systems did not always correctly identify issues and because action had not always been taken where issues had been identified. The provider wrote to us following that inspection and told us the action they would take to address the breaches.

At this inspection we found that the provider had taken action to ensure people’s medicines were safely managed. Improvements had also been made to the provider’s quality assurance systems, although further improvement was required to ensure they identified all appropriate action was taken to address identified issues.

We also found that whilst improvements had been made to risk assessment processes, the malnutrition risk assessment tool used by staff had not always been completed correctly and therefore did not always identify when people were at risk of malnutrition. This was an issue we had identified at our previous inspection and was a continued breach of regulations. However, whilst there was a risk to people because of the incorrect use of the tool, we found that there had been no negative impact on people at the service at the time of our inspection, and action had been taken by staff in response to people's weight loss. Following our inspection we wrote formally to the provider and they provided us with details of the system they had put in place to ensure staff were aware of how to correctly use the malnutrition risk assessment tool, to prevent any further errors being made. This assured us that action had been taken to address our concerns and we will check on this at the next inspection

Additionally, we found a breach of regulations because one person had not consented to the use of bed rails following a fall from bed, despite having been assessed as having the capacity to make the decision about the use of bed rails for themselves. You can see the action we have told the provider to take in respect of both of these breaches at the back of the full version of this report.

People were protected from the risk of abuse because staff were aware of the action to take if they suspected abuse had occurred. There were sufficient staff deployed within the service to safely meet people’s needs and the provider undertook appropriate checks on new staff before they started work to ensure they were suitable for the roles they were applying for.

Staff had received training in areas considered mandatory by the provider and people told us they thought staff had the skills to support them effectively. Staff also received supervision although improvement was required to ensure all staff were supervised on a regular basis in line with the provider’s policy.

People were supported to maintain a balanced diet and were involved in choosing meal options for the menus. People had access to a range of healthcare services when needed. Staff were aware to seek consent from people when offering them support and told us people had capacity to make decisions about their care and treatment for themselves. Staff confirmed that none of the people living at the service were subject to a Deprivation of Liberty Safeguards (DoLS) authorisation, although improvement was required to ensure the manager understood the conditions under which a person may be considered to be deprived of their liberty.

People told us that staff were caring and considerate. Staff treated people with dignity and respected their privacy. People were involved in making day to day decisions about their care and treatment.

People had care plans in place which were regularly reviewed and which reflected their individual preferences. The service offered people a range of activities to encourage social interaction. The provider had a complaints policy and procedure in place and people told us they were aware of how to raise concerns if they needed to.

People and relatives spoke positively about the management of the service, although they told us the manager was not always a visible presence. Staff had mixed views about the leadership of the service but told us they worked well as a team. The provider sought feedback from people through residents meetings and an annual survey and we noted that people had fed back positively about their experience of living at the service. The provider also undertook checks and audits covering a range of areas, and took action to address any issues that were identified in audit findings, findings although some improvement was required to ensure that this was consistent.

We saw that maintenance certification for the home, including the maintenance for a bath-chair was now up to date.

People told us they were always treated in a respectful manner, and the staff knew them well and understood how to attend to their needs. Everyone we spoke with said that the staff explained what they were doing and involved them in decisions about their care. People said they were given choices about meals and activities and they felt safe and well cared for. A number of people said that the food was excellent and was always freshly cooked.

The home was generally well maintained and decorated but one bathroom was in a poor state of decoration. The provider ensured that safe recruitment practices were adhered to in order to keep people safe. There was a system for people to make complaints and people told us they knew how to use this, but said they hadn't needed to as they were happy with service provided.

We reviewed information about three people's care and found that their care needs were being planned for with their involvement and care plans were signed by people or by their families. We found that the staff understood people's care needs and how to protect them from risk and harm. We found that staff had adequate training and supervision and were supported by the agency's management to do their job.

Appropriate checks were being done by the provider to ensure that the quality of people's care was maintained.