Background to this inspection
Updated
4 April 2018
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
Our inspection took place on 16 January 2018. The inspection was unannounced. The inspection team consisted of two inspectors and an expert-by-experience with a background in supporting people to use this type of service.
Before the inspection we reviewed all the information we held about the service, including past inspection reports and notifications sent by the provider about key incidents and events, which they are required to tell us about by law. We contacted people who commission services from the provider, safeguarding teams and other bodies such as Healthwatch to ask if they had any significant information to share. Healthwatch is an independent consumer champion that represents the views of people who use health and social care services in England. We did not receive any information of concern.
We did not ask provider to send us a provider information return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.
During the inspection, we used a variety of methods to find out about the experiences of people who used the service. We spoke with the manager, support manager, one senior care worker and two care staff. We also spoke with five people who used the service and three relatives. As it was evident people were able to speak with us and share their experiences, we observed care and support but on this occasion did not carry out a Short Observational Framework (SOFI). We looked at records relating to care and support including five people’s care plans, medicines records and a sample of information about the running of the home including audits, maintenance records and three staff files.
Updated
4 April 2018
Heaton Grange is a single storey detached residence located in the Heaton area of Bradford. The service is registered to provide care and support to a maximum of 20 people, some living with dementia in both single and double bedroom accommodation. At the time of inspection there were 15 people using the service.
We inspected Heaton Grange on 16 January 2018 and the inspection was unannounced.
Our last inspection took place on 2 June 2017 and at that time we found the service was not meeting four of the regulations we looked at. These related to ‘safe care and treatment’, ‘person centred care’, ‘fit and proper persons employed’ and ‘good governance’. Three of these breaches were continued breaches from the inspection before last. The service was rated ‘Inadequate’ for a second time and continued to be in special measures.
Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. This inspection was therefore carried out to see if any improvements had been made since the last inspection and whether or not the service should be taken out of ‘Special measures.’
During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the five key questions. Therefore, this service is now out of Special Measures. However, while we concluded improvements had been made they needed to be fully embedded and sustained to make sure people consistently received safe, effective and responsive care. This is reflected in the overall rating for the service which is now ‘Requires Improvement.’
At the time of our inspection the service had a manager who was going through the registered manager’s process. The manager was being supported by a registered manager from another service. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.
During the inspection people who used the service told us they felt safe. We found staff knew how to recognise and report concerns about people’s safety and welfare. Safeguarding policies and procedures were in place and risk was assessed. We saw guidance in place to ensure risks were minimised with as little impact as possible on people’s independence.
At the last inspection we found risk assessment documents were not always relevant or up-to- date. At this inspection we found that overall improvements had been made although further work was needed to ensure risk assessments were reviewed following incidents such as falls. Incident/accident forms did not reveal any concerns themes or trends with regards to incidents.
We found some improvements were needed to some aspects of care planning. For example some reviews required more meaningful evaluation.
Staff were recruited safely and we found the necessary checks were carried out in line with the provider’s policy. Staff were on duty in sufficient numbers to provide timely care and support; including ensuring people could maintain their independence as much as possible.
Staff told us training was good and we saw evidence that training was regularly updated.
Although the décor was tired the home was clean. Gloves and aprons were readily available and seen to be used by staff when providing personal care.
Overall, we found medicines were safely managed. Medicines administration charts were well completed.
People told us they were happy with the food. People received a nutritionally balanced diet and were offered sufficient fluids to keep them hydrated.
People’s health care needs were supported with access to a range of professionals including GPs, district nurses and physiotherapists. Appropriate equipment was in place to meet people’s health care needs.
The service was working in line with the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) which helped to make sure people’s rights were protected and promoted. People’s rights to choose and make decisions were supported in accordance with good practice and legislation. Staff asked people’s consent before any care or support was given.
People were treated with kindness and compassion. There was a clear emphasis on people’s individuality, dignity and independence. There was a lively and homely atmosphere and we saw people and staff knew each other well.
There was a good approach to planning and supporting activities which people wanted to participate in.
People were provided with information about how to make complaints. Complaints were documented and evidenced actions taken as a result.
Staff told us the manager and support manager were approachable, and we saw people who used the service felt free to approach management at any time.
People, their relatives and staff were consulted on the running and operation of the home. Regular residents’ meetings were held and actions seen to be taken as a result of concerns raised.
We did not find adequately robust governance systems in place. We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the full version of the report.