Heathlands Care Home

Heathlands is a care home providing personal and nursing care for up to 84 older people who may be living with dementia. The care home accommodates people in a single adapted building spread over three floors. There were 72 people using the service at the time of this inspection.

People’s experience of using this service and what we found

People were safeguarded from the risk of harm or abuse. Staff were recruited safely and there were enough staff on duty to meet people’s needs. People had risk assessments to reduce the risk of harm they may face. Building safety checks were carried out as required. People were protected from the risks associated from the spread of infection. The provider had a system in place to learn lessons from accidents, incidents and complaints.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People had their care needs assessed prior to admission. Staff were supported with regular training opportunities, supervision and appraisals. People’s nutritional, hydration and healthcare needs were met. The service had an ongoing maintenance and refurbishment programme in place.

We observed caring interactions between staff and people using the service. People’s cultural and religious needs were met. Staff understood how to form positive relationships with the people they supported. People and relatives were involved in decision making about their care. Staff promoted people’s privacy, dignity and independence.

Care records were detailed and personalised. There were a variety of activities offered to people and plans in place to enhance what was offered. People’s communication needs were met. The provider had a complaints procedure and complaints were dealt with appropriately. People’s end of life care wishes were documented.

People, relatives and staff spoke positively about the leadership in the service. The provider had meetings with people, relatives and staff where they could be updated on the service development. The provider worked jointly with healthcare professionals to improve outcomes for people.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 12 September 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Recommendations

We have made 3 recommendations in relation to medicines management, the dining experience and communication.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Heathlands is a care home providing personal and nursing care to up to 84 people over three floors. At the time of the inspection there were 80 people living at the service

People’s experience of using this service and what we found

Relatives told us that permanent staff were caring and attentive, however, some relatives said that agency staff members could be abrupt to their family members.

The admissions process for people receiving end of life was not always robust. This meant the provider did not always have enough information to initially meet all their needs. However, relatives of people who had been at the service for a longer period of time told us the provider looked after their residents well at the end of their lives.

People’s relatives told us the registered manager was approachable and they felt confident they would act on their input to best care for their loved ones. The registered manager completed a range of audits to monitor the quality of the service.

We were assured the provider was following national guidance in relation to infection prevention and control. They had trained staff to wear appropriate personal protective equipment. The provider completed whole-home testing had followed external professional’s advice to minimise the risk of the spread of infection when they received positive coronavirus test results.

We have made a recommendation in relation to people being admitted to the service for end of life care.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was good (published 12 September 2018). We have not rated the service following this targeted inspection and the rating remains the same.

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about end of life care. The overall rating for the service has not changed following this targeted inspection and remains good.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Heathlands is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Heathlands Care Home is a nursing home that provides care for up to 84 people. At the time of our inspection there were 83 people using the service.

The service had a peripatetic manager in place at the time of our inspection. They were awaiting the outcome of their application to become the registered manager of 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.

The service was safe and people were protected from harm. Care workers were knowledgeable about safeguarding adults from abuse and knew what to do if they had any concerns and how to report them. Safeguarding training was given to all staff.

Risk assessments were thorough and personalised. Care workers knew what to do in an emergency situation.

Staffing levels were meeting the needs of the people who used the service and care workers demonstrated they had the relevant knowledge to support people with their care.

Recruitment practices were safe and records confirmed this.

Medicines were managed and administered safely and audited on a weekly basis.

Newly recruited care workers received an induction. Training was provided on a regular basis and updated when relevant.

Care workers demonstrated an understanding of the Mental Capacity Act (2005) and how they obtained consent on a daily basis. Consent was recorded in people's care plans.

People were supported with maintaining a balanced diet and the people who used the service chose their meals and these were provided in line with their preferences.

People were supported to have access to healthcare services and receive on-going support. Referrals to healthcare professionals were made appropriately and a multi-disciplinary approach was adopted to support people.

Positive relationships were formed between care workers and the people who used the service and staff demonstrated how they knew the people they cared for well. People who used the service and their relatives told us care workers were caring and treated them with respect.

Care plans were detailed and contained relevant information about people who used the service and their needs such as their preferences and communication needs.

Concerns and complaints were listened to and records confirmed this.

People who used the service, their relatives and support workers spoke highly of the peripatetic manager and told us they felt supported by him.

Quality assurance practices were robust and taking place regularly.

The service had an acting manager who had been in place for three months at the time of our inspection. They were currently awaiting the outcome of their application to become the registered manager of 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.

The service was safe and people using the service communicated this to us. Staff demonstrated their knowledge in safeguarding adults and what action to take should they have any concerns. The service reported any accidents and incidents as well as safeguarding's to the relevant local authority and to the Care Quality Commission (CQC).

The service had robust risk assessments in place and people using the service were protected from harm where risks were identified. Risk assessments were thorough and contained clear mitigation plans.

Staffing levels were adequate for the level of need across the units and staff told us that any absences were covered. Staff were recruited safely and in line with relevant pre-employment checks.

People’s medicines were managed, stored and administered safely and audits were completed to ensure consistency.

The service was effective and we saw that people received care based on best practice from staff who had the knowledge and skills through training and supervision to carry out their roles and responsibilities. Staff told us they were supported in their roles.

Consent to care and treatment was sought and we observed examples of this. Staff had an understanding of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The service monitored how consent was obtained and this was recorded accordingly.

People were supported to have sufficient amounts to eat and drink and maintain a balanced diet. People told us they enjoyed the food and that it was varied. People told us they had a choice of food and that they were made alternative meals if they didn’t fancy what was on the menu. Dietary needs were adhered to and monitored where relevant.

People were supported to maintain good health and have access to on-going healthcare support. Referrals to healthcare professionals were prompt and records of people’s health needs were documented. The service had a good working relationship with the local CCG who provided on-going support to people using the service and management.

The service was caring and we observed positive caring relationships with staff and people using the service. People told us they were happy with their care. People were supported to express their views and be involved in making decisions about their care, treatment and support. People were given choice and independence was promoted. People’s privacy and dignity was respected. People who were at the end of their lives and receiving palliative care were cared for in a dignified manner and had specific care plans in place.

The service was responsive and care planning was thorough and detailed. People’s preferences, wishes and aspirations were identified and people were supported to follow their interests. Care plans were reviewed on a regular basis and changes were recorded accordingly.

Concerns and complaints were encouraged and responded to and people knew how to complain and share their experiences. Families were encouraged to provide feedback and relatives meetings were a regular occurrence. Management acted on the information they received about the quality of care provided and concerns and complaints were used as an opportunity to make improvements.

The service was well led and management promoted a positive culture that was open and inclusive of all staff. The service had links with the local community such as the church. The service demonstrated good visible leadership and the acting manager understood their responsibilities. Quality assurance practices were robust and records and data were collected and used to strive for improvements at the service. During the course of the inspection we found that CQC had not been sent notifications for people who had been authorised for DoLS. The manager promptly sent them through before the end of the inspection.

We found one breach of the Care Quality Commission (Registration) Regulations 2009 (Part 4). You can see what action we told the provider to take at the back of the full version of this report.

Files showed that people's needs were assessed prior to placement at the home. The assessment covered life history, medical history, psychological and emotional behaviour, mobility and body mapping.

People were not supported in promoting their independence and community involvement. We saw the home had an activities programme in place. However there was no evidence that these activities took place.

People's health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services. This was because the provider worked in co-operation with others.

People's bedrooms were personalised to suit taste and some people had furnished their rooms with personal items and photographs. People told us that they liked living in the home. One person said 'I like it because I have my own front door'.

Staff received appropriate professional development. Staff told us they have annual appraisal where they discuss their performance and any training they may need or want.

People's personal records including medical records were not accurate and fit for purpose. We found documentation relating to peoples care and support needs did not contain the most up to date information.

We observed the medication administration round after lunch and saw that each person was supported individually to take their medication with a drink, which was provided where appropriate. Consent was sort by the nurse in charge before administering the person their medicine.

We were told that staff worked well with visiting health care professionals who felt staff were well trained and took an active part in the assessment and planning of care and treatment for people who used services.

We were told by one health care professional they felt the care given to people with dementia care needs and the palliative care was excellent.