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Reports


Inspection carried out on 13 July 2017

During a routine inspection

This inspection took place on 13 July 2017 and was unannounced.

Headroomgate is registered to provide 24 hour care for up to 19 people. The home is situated close to St Annes town centre and is a large corner property with garden and paved areas around the building. There are three floors, two of which have lift access, two lounges and dining areas.

Some bedrooms have en-suite facilities. At the time of our inspection, 18 people lived at the home.

The service had a 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 the last inspection in May 2016, we found the provider was not meeting the requirements of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches related to dignity and respect, and safe care and treatment. Following that inspection, the provider sent us an action plan which told us how they planned to make improvements for people who used the service. During this inspection, we checked to see what improvements had been made. We found the provider had made positive changes and the service was now meeting legal requirements.

Environmental risks and risks to individuals were assessed and measures put in place to reduce or remove them, in order for care and support to be provided safely. Sufficient information was available to guide staff on how to support people safely.

We saw staff used safe systems when administering medicines. Medicines were safely and appropriately stored and secured safely when not in use. We checked how staff stored and stock checked controlled drugs. We noted this followed current National Institute for Health and Care Excellence (NICE) guidelines.

We found staffing levels were regularly reviewed to ensure people were safe. There was an appropriate skill mix of staff to ensure the needs of people who lived at the home were met.

Staff received training related to their role and were knowledgeable about their responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

Staff had received safeguarding vulnerable adults training and understood their responsibilities to report any unsafe care or abusive practices related to the safeguarding of vulnerable adults. Staff we spoke with told us they were aware of the safeguarding procedure.

People told us they were involved in planning their care and had discussed and consented to their care. We found staff had an understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

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 within the home supported this practice.

People told us they were happy with the variety and choice of meals available to them. We saw regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration.

We found people had access to healthcare professionals and their healthcare needs were met. We saw staff responded promptly when people had experienced health problems.

Comments we received demonstrated people were satisfied with their care. The management and staff were clear about their roles and responsibilities. They were committed to providing a good standard of care and support to people who lived at the home.

Care plans were organised and had identified the care and support people needed. We found they were informative about care people had received. They had been kept under review and updated when necessary to reflect people’s changing needs.

People told us they were happy with the activities organised at the home. Activities were arranged for individuals and for groups. The registered manager explained this was an area they had identified for improvement to ensure people were able to participate in activities that were meaningful to them.

A complaints procedure was available and people we spoke with said they knew how to complain. People and staff spoken with felt the registered manager was accessible, supportive and approachable.

The registered manager had sought feedback from people who lived at the home and staff. They had consulted with people for input on how they could continually improve the service people received. The provider had regularly completed a range of audits to maintain people’s safety and welfare.

Inspection carried out on 11 May 2016

During a routine inspection

The inspection took place on 11 & 16 May 2016 and was unannounced.

Headroomgate Nursing Home provides accommodation for up to 19 people who have nursing needs. The home is situated close to St Annes town centre and is a large corner property with garden and paved areas around the building. There are three floors, two of which have lift access, two lounges and dining areas. Some bedrooms have an en-suite facilities.

This was the first inspection of the service since it was registered with the Commission on 31/07/2015.

At the time of the inspection there were 18 people who used 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 2008 and associated Regulations about how the service is run.

At the time of the inspection the manager’s registration with the Commission had been cancelled. We were advised that the provider was planning to appoint a new manager who would be put forward for registration following their appointment. In the interim, the previously registered manager was continuing to oversee the day to day running of the service.

Risks to the health, safety and wellbeing of people who used the service were assessed and care plans were developed to provide staff with guidance about how to support people safely. These included moving and handling care plans. We found that all staff had received training in safe moving and handling. However, we observed two staff members, on two separate occasions, use moving and handling techniques which were not in accordance with the person’s care plan guidance or general good practice.

People we talked with spoke highly of care workers who they described as ‘kind’ and ‘caring’. People felt they were cared for in a manner that promoted their privacy and dignity. However, we observed that not all care workers were mindful of respecting people’s privacy and dignity at all times.

Personal Emergency Evacuation Plans (PEEPs) were in place for each person who used the service. However, not all those viewed contained person centred information. We made a recommendation that all PEEPs be reviewed to ensure they provide individualised guidance about the support each person would require to evacuate the home in an emergency.

There were generally safe systems in place to manage people’s medicines. This helped to protect their health and wellbeing. However, we made a recommendation that information included in records relating to medicines administration be improved to help ensure people get their medicines at the correct times.

Some good examples of person centred care planning were seen. However, other examples were found where more detailed information in care plans would have been beneficial. We made a recommendation about this.

There was a training programme in place to help equip staff with the skills to carry out their roles effectively. However, in light of some of our observations, we made a recommendation that competence assessments, particularly in relation to moving and handling, be reviewed.

There were clear recruitment procedures in place, which were generally followed to help protect the safety and wellbeing of people who used the service. However, we made a recommendation that the recording of recruitment procedures be reviewed to ensure a clear audit trail was in place.

The feedback received about the standard and variety of food provided was variable. Some people did not feel that current menus offered a nutritionally balanced diet and not all care staff were able to confirm that people were provided with choices about what they ate. We made a recommendation that the provision of meals and menu planning be reviewed to ensure people’s individual needs and preferences are met.

There were processes in place to enable the manager to monitor safety and quality across the service. However, some of the areas we identified for improvement had not been previously identified through these processes. We made a recommendation that the area of quality and safety monitoring be reviewed to help ensure any areas for improvement are quickly identified.

We saw some very good examples of person centred activities being provided. The activities programme was being reviewed to look at how people who lived with dementia may be better supported in this area.

People we spoke with expressed satisfaction with the way their care was provided. People told us they felt safe and said they were treated with kindness and compassion.

People were satisfied with the support they received to access health care. People felt confident in the ability of care workers to meet their needs.

There were procedures in place to protect people who used the service from abuse or improper treatment. Care staff were aware of their responsibility to report any concerns about the safety or wellbeing of a person who used the service.

The manager cooperated with other professionals and made the appropriate notifications to the relevant agencies within the correct timescales.

People felt their choices were respected and that they could make decisions about their care and daily routines. The rights of people who needed support to make decisions about their care were respected because the manager worked in accordance with the Mental Capacity Act and associated legislation.

We found two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 relating to safe care and treatment and dignity and respect. You can see what action we have told the provider to take at the end of the full version of this report.