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Heatherfield Care Home Requires improvement

The provider of this service changed - see old profile

Inspection Summary


Overall summary & rating

Requires improvement

Updated 8 February 2018

We last inspected Heatherfield Care Home in December 2016 where we identified two breaches of the regulations relating to safe care and treatment and good governance. We rated the service ‘requires improvement.’

Following our inspection, the provider sent us an action plan which stated what action they were going to take to improve.

Heatherfield Care Home provides accommodation and care for up to 74 people. The home is divided into three units for those who have general nursing, dementia care and younger physically disabled needs. Accommodation is spread over two floors. There were 68 people living at the home at the time of the inspection.

A manager was in post. She had commenced employment in May 2017 and applied to register with the Care Quality Commission as 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.

Prior to the inspection, we received information of concern regarding staffing levels, the maintenance of records and certain aspects of people’s care. We brought forward our planned inspection in order to check the concerns raised.

There were continued shortfalls and omissions with regards to the management of medicines. We identified concerns with the care and treatment of people who required enteral feeding. Enteral feeding refers to the delivery of a nutritionally complete feed via a tube, directly into the stomach or bowel.

A high number of agency staff were used. At the time of the inspection, we found there were insufficient suitably qualified, competent, skilled and experienced staff employed.

Staff were knowledgeable about safeguarding and told us they would report any concerns. There were three ongoing safeguarding investigations. Two of these were being investigated by the police. We will monitor the outcome of these safeguarding investigations and action taken by the provider.

The local authority had placed the service into organisational safeguarding. This meant that the local authority was monitoring the whole home.

There was a lack of evidence to demonstrate that safeguarding incidents were monitored and lessons to be learned considered to help identify any changes in practice to ensure continuous improvement.

The training matrix had gaps against certain training courses. Some people, relatives and staff raised concerns about the communication and skills of agency workers. Records of the clinical skills and competencies were not available for most of the agency nurses. There was no evidence of clinical supervision.

We checked the design and décor of the service. There were extensive accessible gardens which had won a number of awards. The service had its own hydrotherapy pool. There was an additional charge if people wished to use this facility. The service also had a cinema room, hairdressing salon and kitchen areas where people could make hot drinks and prepare snacks. However, we found that not all aspects of the environment met best practice guidance relating to supportive environments for people living with dementia. We recommended that the design and decoration of the premises is based on current best practice in relation to the specialist needs of people living at the service.

Some people’s care records had omissions. This meant it was not clear whether care and treatment had been provided.

A complaints procedure was in place. We found however, that not all complaints were recorded or dealt with in line with the provider’s complaints procedure.

An activities programme was in place. Some people and relatives told us that more activities would be appreciated. We recommended that access to and the variety of activities available is kept under review in light of the feedback we received.

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

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.

We found shortfalls in many areas of the service including the management of medicines, training, the care and treatment for those who required enteral feeding and dealing with complaints. In addition, records relating to people, staff and the management of the service were not always accurate, complete or securely maintained.

Since 2013, we found the provider was breaching one or more regulations at five of our six inspections. This meant that systems were not fully in place to ensure compliance with the regulations and good outcomes for people.

Following our inspection, the head of compliance sent us an action plan and further information detailing the actions they had taken/planned to take to address the shortfalls we identified.

We found four breaches of the Health and Social Care Act 2008. These related to safe care and treatment, staffing, receiving and acting on complaints and good governance.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Inspection areas

Safe

Requires improvement

Updated 8 February 2018

The service was not always safe.

There were insufficient suitably qualified, competent, skilled and experienced staff deployed to ensure care was delivered as planned.

There were continued shortfalls and omissions in the management of medicines.

Pre-employment checks were carried out prior to staff starting work at the service.

Effective

Requires improvement

Updated 8 February 2018

The service was not always effective.

There was a lack of evidence to confirm the competency and skills of nursing staff. The training matrix had gaps against certain training courses.

Not all aspects of the environment met best practice guidance relating to supportive environments for people living with dementia

We received mixed feedback about meals at the home. The dining room experience for those living with dementia had improved.

Caring

Good

Updated 8 February 2018

The service was caring.

Most people and relatives told us that the permanent staff were caring.

We observed positive interactions between staff and people.

Staff spoke with people respectfully and provided discreet support.

Responsive

Requires improvement

Updated 8 February 2018

The service was not always responsive.

Some people’s care records had omissions. This meant it was not clear whether care and treatment had been provided.

A complaints procedure was in place. We found however, that not all complaints were recorded or dealt with in line with the provider’s complaints procedure.

An activities programme was in place. Some people and relatives told us that more activities would be appreciated.

Well-led

Inadequate

Updated 8 February 2018

The service was not well-led.

We identified continued shortfalls in medicines, the maintenance of records and training.

Since 2013, we found the provider was breaching one or more regulations at five of our six inspections. This meant that systems were not fully in place to ensure compliance with the regulations and good outcomes for people.

There was a manager in post. She had applied to register with CQC as a registered manager.