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Heatherfield Care Home Requires improvement

The provider of this service changed - see old profile

Reports


Inspection carried out on 3 November 2017

During a routine inspection

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 carried out on 13 December 2016

During a routine inspection

This inspection took place on 13 and 14 December 2016. The visit on the 13 December 2016 was unannounced. This meant that the provider and staff did not know we would be visiting. 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 nursing and younger physically disabled care needs. Accommodation is spread over two floors. There were 71 people living at the home at the time of the inspection.

The last comprehensive inspection of this service was carried out in February 2015. At that time the service was in breach of Regulation 12 HSCA (RA) Regulations 2014 Safe Care and Treatment. We followed up on this breach at a focussed inspection in August 2015 and saw the breach had been met, however that inspection found the service in breach of Regulation 17 HSCA (RA) Regulations 2014 Good Governance.

During this inspection we found that whilst some actions had been taken to improve the quality and monitoring systems, shortfalls in care remained. The provider’s system had not identified the shortfalls which we found during our inspection.

A registered manager was in post. 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.

Risks related to the receipt of care had not been mitigated. Two people at risk of developing pressure damage were using pressure relieving mattresses which were set incorrectly for their body weight. Nursing staff were unable to tell us when the settings were last checked as there was no formal process for monitoring this equipment.

Risks related to covert medicines had not been assessed. Records were not kept to note where medicines administered via a patch on people's skin had been applied, putting people at risk of discomfort.

People and relatives told us they thought one area of the home was understaffed. The registered manager advised staffing was determined by an assessment of people's needs. We saw from rotas that staffing numbers in the home had met the assessed number. During our inspection the atmosphere was unhurried and people were responded to quickly.

Robust recruitment procedures had been followed to ensure checks the suitability of potential employees had properly considered.

Steps had been taken to mitigate the risk of infection.

During observations in the dementia care unit over lunchtime, we found there were not enough staff to support the people with the highest level of need so they had to wait a considerable amount of time before staff could support them to eat. There was not enough room in the dining room to accommodate people comfortably.

People in the dementia care unit were not offered a choice of meal, and steps had not been taken to ensure that choices could be provided in a way which would meet people's needs.

Care Quality Commission (CQC) is required by law to monitor the operations of the Mental Capacity Act 2005 (MCA), and to report on what we find. MCA is a law that protects and supports people who do not have the ability to make their own decisions and to ensure decisions are made in their ‘best interests’.

Where decisions had been made on people’s behalf, records showed capacity had been assessed and best interests process followed. The provider had sought authorisation to deprive people of their liberty where it was considered they would not be able to keep themselves safe if they left the home alone.

The provider had identified a set of training modules for all staff to undertake. We saw this training was monitored to ensure staff stayed up to date with any refresher training required. We have made a recommendation about staff training on the complex needs of some people using the service.

New staff inductions included policies and procedures, shadowing experienced staff and undertaking training. Staff received regular supervisions sessions, an annual appraisal and opportunities to develop their skills and knowledge.

The home was purpose built, and had been designed to meet the needs of the people who used it. Steps had been taken to aid people's orientation on the dementia care unit, but the manager advised us further improvements were planned in this unit to ensure it met best practice for people with dementia conditions.

People and relatives told us the staff were warm and friendly. We observed staff were considerate of people’s privacy and dignity.

Processes were in place to ensure that people were supported in compassionate way, by appropriately trained staff, at the end of their lives.

Assessments of people’s needs and the care plans which described how they should be cared for did not always contain accurate information and some were out of date, which put people at risk of receiving inappropriate care.

The home employed four activities coordinators but some people and relatives told us that there was not enough for people to do.

The provider did not have a robust system to monitor the quality of the service provided. Whilst a scheduled of audits were carried out regularly they had not addressed the shortfalls which our inspection highlighted.

We found two breaches of the Health and Social Care Act 2008. These related to safe care and treatment and good governance.

The provider had not sent us notifications which are a legal requirement of their registration. This was a repeated breach of regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

We will continue to work with the provider to monitor and improve service. You can see further action we have asked the provider to take at the back of the full version of this report.

Inspection carried out on 7 and 13 August 2015

During an inspection to make sure that the improvements required had been made

We carried out an unannounced comprehensive inspection of this service on 2 February 2015. A breach of legal requirements was found in relations to medicines management. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) regulations 2010 - management of medicines.

We undertook this focused inspection on 7 and 13 August 2015 to check that they had followed their plan and to confirm that they now met legal requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Heatherfield Care Home on our website at www.cqc.org.uk

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 nursing and younger physically disabled care needs. Accommodation is spread over two floors. There were 73 people living at the home at the time of the inspection.

We checked medicines management and found improvements had been made. We noted however, that some of the medicines systems which had been introduced had not been fully implemented. One person’s allergies had not been documented on her medicines administration record. In addition, protocols for the use of ‘as required’ medicines such as sedatives were not fully in place. The manager told us that this would be addressed immediately.

We spent time looking around the home and saw it was clean and well maintained. We found that one person was able to override the restrictor on his window. This risk had not been assessed. The manager told us that this would be addressed.

Some people and staff informed us that more staff would be beneficial. We observed that staff carried out their duties in a calm unhurried manner. Records were not fully available to evidence that safe recruitment procedures were followed. Following our inspection, the manager informed us that recruitment records were now stored in her office.

We did not plan to look at the well-led domain which relates to the management and governance of the service. However, we found concerns which led us to look at aspects of this domain.

The manager had been in post since December 2014 and was not yet registered with CQC. We had rejected her applications to register with CQC in May and August 2015, because they had been incorrectly completed. We have written to the provider to ascertain what actions they are going to take to ensure that an appropriately completed application is submitted to make sure that the manager is registered with CQC in line with legal requirements.

We found that the provider had not notified us of certain events at the service. These included safeguarding concerns, one death and an incident involving the police. In addition, the manager had not notified us of the outcome of Deprivation of Liberty Safeguards applications in a timely manner. She said that she was in the process of completing these notifications.

Following our inspection, the provider promptly submitted retrospective notifications regarding these incidents and events.

We examined falls analysis records which were completed monthly. We found that the number of falls which were documented on the monthly analysis logs did not always tally with the actual number of falls which had occurred at the service. This meant there was no accurate overview of falls in place.

The provider was not able to provide evidence that other incidents, such as certain safeguarding concerns, were monitored and analysed. We were not made aware of these notifiable incidents until staff informed us and we read people’s care plans. There was no overview of the number of incidents which had occurred and what actions had been taken. This meant patterns or themes of events involving people who lived at the service could not be readily identified and acted upon.

Following our inspection, the provider submitted a notification to amend their name on our system from Heatherfields to Heatherfield Care Home.

We found one breach of the Care Quality Commission Registration Regulations 2009. This related to the failure to notify us of other events and incidents which had occurred at the service which the provider is legally required to inform us of. This is being followed up and we will report on any action when it is complete.

We also found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to good governance. The action we have asked the provider to take can be found at the back of this report.

Inspection carried out on 4 and 5 February 2015

During a routine inspection

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 carried out on 21 February 2014

During an inspection to make sure that the improvements required had been made

We spoke with 10 people, seven relatives and 10 care workers about the care and support provided by the service. One person told us, “I enjoy it here and I think the staff are good and all the girls are really canny. It took me a while to settle in, but I’m happy now.” One relative commented, “We love the place; it’s a really smashing place and they look after her very well.” Another relative said, “The staff all seem to understand my mam very well and she gets good care and support.”

We were unable to speak to all of the people who used the service because of the nature of their condition. We spoke with staff and observed their practices to determine how care and support was delivered.

Relationships between people and staff were clearly good. Relatives told us and we saw in practice staff treated people with respect and helped them to remain as independent as possible.

We found people’s needs were assessed and care and treatment was planned and delivered in line with their individual care plans. Relatives we spoke to were positive about the care and support people received. One relative said, “They understand all my mam's needs. Her care and support is very good and she is well looked after.” Another relative told us, “She gets good care here, without a doubt. She’s happy, she is well looked after, the care is spot on and that’s good enough for me.”

We found that there were suitable numbers of skilled, trained and experienced staff. One relative commented, “The staff all seem confident and competent in what they are doing.” Another relative told us, "They were having staffing problems, but recently there has been a definite improvement and I've seen an increase in staff."

The service had a complaints procedure that detailed the process to be followed in the event of a complaint. This indicated complaints should be documented, investigated and responded to within a set timescale. People and relatives told us that they felt able to raise any concerns or comments about the service.

Inspection carried out on 8, 11 October 2013

During an inspection in response to concerns

We carried out this inspection after we received information of concern about staffing levels and care provided at the service.

We spoke with seven people and 16 relatives to find out their opinions of the care and treatment at the service. One person told us, “The care and support is good when I can get it.” One relative said, “I’m glad she’s here, she’s well looked after.” Another relative told us, “The lack of staff impacts on people’s care and treatment. They can't tend to their needs properly.” One person told us, "There's always a high turnover of staff."

We were unable to speak to all of the people who used the service because of the nature of their condition. We spoke with staff and observed their practices to determine how care and support was delivered.

We found that people’s care, support and treatment were not always properly assessed and their care was not always planned and delivered in a way which met people’s individual needs.

People, relatives and staff told us and we found that suitable numbers of skilled and qualified staff were not always on duty. We spoke with seven people, 16 relatives and 10 members of staff. Six people, 14 relatives and nine members of staff told us they felt that more staff on duty would be appreciated.

The service did not have an effective complaints recording system available. Complaints people made were not always documented or responded to appropriately, in line with the providers own complaints policy.