Heathfield (Horsham) Limited is a residential care home providing personal care and accommodation for up to 36 older people. At the time of the inspection 26 people were living at the service. Heathfield (Horsham) Limited accommodates people in one adapted building.
People’s experience of using this service and what we found
There was not an adequate process for assessing and monitoring the quality of the services provided and that records were accurate and complete. People's care plans and risk assessments lacked important detail to guide staff on how to keep people safe. People did not always receive timely support with pain relief, guidance for staff about what to do when people refused prescribed medicine was not available in people’s care or medicine records.
Aspects of leadership and governance of the service were not effective in identifying some service shortfalls, such as failing to assess, monitor and mitigate risks relating to the health and safety and welfare of people and medicine administration.
People were relaxed, comfortable and happy in the company of staff and told us they felt safe. People's independence was considered important by staff and their privacy and dignity was promoted. Staff had a caring approach to their work, which was observed at inspection.
People and their relatives had the opportunity to share their views about the service and felt they were listened too.
People and relatives spoke confidently about the registered manager and were positive in their feedback. One person said, “She is marvellous.” A relative told us the registered manager was, “Very approachable, fair, deals with things.”
Systems were in place to protect people from the risk of abuse and improper treatment and staff knew how to identify potential harm and report concerns.
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.
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 28 June 2019). We also carried out an infection prevention and control inspection (published 10 August 2020) This inspection was not rated.
Why we inspected
The inspection was prompted in part due to concerns received about falls, pain relief and management of the service. A decision was made for us to inspect and examine those risks. This report only covers our findings in relation to Key Questions, Safe and Well-led. The ratings from the previous comprehensive inspection for the key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Heathfield (Horsham) limited on our website at www.cqc.org.uk.
We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this report.
You can see what action we have asked the provider to take at the end of this full report.
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.
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.
We have identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulation 17- Good Governance. There was a failure to ensure adequate systems to assess, monitor and improve the quality and safety of services provided. Accurate, complete and contemporaneous records were not always maintained regarding people's care and Regulation 12- Safe Care and Treatment. The provider had failed to ensure that staff had sufficient guidance to administer medicines. There was a failure to assess and manage risks relating to people's health and welfare.
Please see the action we have told the provider to take at the end of this report.
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.