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Inspection Summary


Overall summary & rating

Good

Updated 18 May 2018

The inspection took place on the 17 and 20 April 2018 and was unannounced. This meant that the provider and staff did not know we would be visiting.

Heatherfield Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home can accommodate up to 74 people. The home is divided into three areas for those who have general nursing, dementia care and younger physically disabled care needs [YPD]. The provider referred to these areas as units so we have used this terminology throughout the report. There were 60 people living at the service at the time of the inspection.

At our last inspection in November 2017, we found four breaches of the Health and Social Care Act 2008. These related to safe care and treatment, staffing, receiving and acting upon complaints and good governance. We placed conditions on the provider's registration to minimise the risk of people being exposed to harm. We rated the service as requires improvement overall and inadequate in the well-led key question.

At this inspection we found that improvements had been made and they were now meeting all the regulations we inspected. Following the inspection, we agreed that the conditions placed upon the provider's registration could be removed.

A new manager was in post. They had commenced employment in January 2018 and become registered with the Care Quality Commission [CQC] in April 2018. A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run.

There were safeguarding procedures in place. Staff did not raise any concerns about staff practices at the service. Safeguarding incidents were appropriately referred to the local authority and other relevant bodies.

There were sufficient staff deployed although we recommended that the provider reviews staff deployment on the young physically disabled unit because of the mixed feedback we received from people, relatives and staff from this unit. Agency staff were still used at the service. The provider tried to ensure the same agency staff were requested for consistency. Safe recruitment procedures were followed and staff had completed training in safe working practices and to meet the specific needs of people. An effective induction process was now in place which was linked to the Care Certificate. There was a supervision and appraisal system in place to help ensure staff were supported in their roles.

We checked the management of medicines. We identified several minor medicines recording issues in the nursing unit. These were addressed by our second visit to the service. Enteral feeding and medicines administration was now carried out safely. Enteral feeding refers to the delivery of a nutritionally complete feed via a tube, directly into the stomach or bowel.

Action was being taken to ensure the environment met the needs of the needs of people who used the service. New flooring was being laid and areas of interest had been added in the dementia care unit.

The maintenance of care records and charts had improved and were more detailed. They now reflected people’s needs. We identified minor shortfalls regarding enteral records which the registered manager told us would be addressed.

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 place supported this practice.

People were supported with their dietary requirements. Staff were attentive to people’s needs and provided discreet support. Portion sizes were reflective of people’s preferences and requirements. Meals appeared appetising and were served at the correct temperature.

We observed positive interactions between people and staff. Staff spoke with people respectfully and provided discreet support.

There were four activities coordinators employed, although one activities coordinator was on leave. There was an activities programme in place.

Most people, relatives and staff told us that improvements had been made. Less positive feedback was received from some people, a relative and several staff on the YPD unit. This related to staff deployment, activities and meals. Due to the mixed feedback we received, we recommended that the provider reviews the culture, involvement and person-centred approach on the YPD unit.

A complaints procedure was in place. Complaints were documented and action taken. Feedback systems were in place to obtain people and their representatives' views.

The management structure had been strengthened. The registered manager was supported by a deputy manager. New team leader posts had been introduced on each of the units to oversee the care and support provided. The head of compliance and a compliance officer oversaw the operational management of the service. Strategic oversight was provided by the head of care and the director who were both actively involved in the service and visited regularly.

New monitoring and communication systems had been introduced. These were in the process of being embedded into practice.

The service has a history of non-compliance with the regulations. Improvements which had been made at previous inspections were not always maintained. In addition, there had been a number of different managers at the service since 2013. Action was therefore required to ensure that the improvements made at this inspection were maintained and sustained.

Inspection areas

Safe

Good

Updated 18 May 2018

The service was safe.

Action had been taken to ensure good outcomes for people in this key question.

There were safeguarding procedures in place. Staff knew what action to take if abuse was suspected. Checks were carried out on the premises and equipment to ensure their safety.

There was a system in place to manage medicines safely. Safe recruitment procedures were followed.

There were sufficient staff deployed although we recommended that the provider reviews staff deployment on the young physically disabled unit because of the mixed feedback we received.

Effective

Good

Updated 18 May 2018

The service was effective.

Action had been taken to ensure good outcomes for people in this key question.

Training was available in safe working practices and to meet the specific needs of people who lived at the home.

Staff followed the principles of the Mental Capacity Act 2005.

People were supported to receive a suitable and nutritious diet and access health care services.

Caring

Good

Updated 18 May 2018

The service was caring.

People and relatives told us that the permanent staff were caring.

We observed positive interactions between staff and people.

Staff promoted people’s privacy and dignity. They spoke with people respectfully.

Responsive

Good

Updated 18 May 2018

The service was responsive.

Action had been taken to ensure good outcomes for people in this key question.

Care records now reflected people’s needs.

A complaints procedure was in place. Complaints were documented and action taken to ensure complaints were resolved.

Activities provision had improved. Some people on the younger physically disabled unit felt that more activities would be appreciated.

Well-led

Requires improvement

Updated 18 May 2018

The service was not consistently well-led.

New monitoring and communication systems had been introduced. These were in the process of being embedded into practice to ensure that improvements made were sustained.

A new registered manager was in place. The management structure had been strengthened. New team leader posts had been introduced.

The provider had notified CQC of all notifiable events at the service in line with legal requirements.