Archived: Heathfield Lodge

Heathfield Lodge is a residential ‘care home’ which provides accommodation and personal care for up to 26 older people, including people living with dementia. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Heathfield Lodge is large Victorian property with accommodation located over three floors. The upper floors are accessible via a passenger lift. There are two dining areas on the ground floor and a large lounge. A garden area is located at the rear of the building and parking at the front. At the time of the inspection 21 people were living at the service.

There was a registered manager in post. A registered manager is a person who has registered with 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 2008 and associated regulations about how the service is run. During the inspection we found the registered manager to be open, transparent and receptive to the feedback provided.

At the last inspection which took place in October 2017 we identified breaches of Regulations 12, 17 and 20A of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Heathfield Lodge was awarded an overall rating of ‘Requires Improvement’. Following the inspection, we asked the registered provider to complete an action plan to tell us what changes they would make and by when. During this inspection, we looked to see if the registered provider had made the necessary improvements.

At the last inspection, we found the registered provider was in breach of regulation in relation to ‘Safe Care and Treatment’. Medication management processes were not safely in place and the health and safety of people living at Heathfield Lodge was being compromised. During this inspection we found that the registered provider was no longer in breach of this regulation in relation to ‘Safe Care and treatment’. However, this area of care could be further developed.

We have recommended that the registered provider reviews the medication processes to maintain the level of safe care people receive.

At the last inspection, we found the registered provider was in breach of regulation in relation to ‘Good Governance’. The systems which were in place did not effectively monitor and assess the quality and safety of care people received. During this inspection we looked at the governance systems, audits and checks which were in place and found that improvements had been made. Although the registered provider was no longer in breach of regulation in relation to ‘Good governance’ further developments could be made in relation to this area of care.

We have recommended that the registered provider reviews some of the quality assurance systems to further improve the quality and safety of care being provided.

At the last inspection, we found that the registered provider was in breach of regulation in relation to the ‘display of performance assessments’. The registered provider was not clearly displaying the previous inspection ratings which must be displayed for people, visitors and staff to see. During this inspection we found that the registered provider was clearly displaying the ratings from the last inspection and therefore was no longer in breach of this regulation.

Risk assessments were in place for people who lived at Heathfield Lodge. People’s level of risk was identified from the outset and measures were put in place to keep people safe. Staff were familiar with people’s risks, they told us they received regular updates in relation to people’s health and well-being.

People told us they felt safe living at Heathfield Lodge. Staff were familiar with safeguarding and whistleblowing procedures. The registered provider had necessary policies in place for staff to follow.

Recruitment was safely managed. People who were employed had undergone the necessary recruitment checks. Pre-employment and Disclosure Barring System checks (DBS) were carried out and appropriate references were sought prior to employment commencing.

Staffing levels were safely managed. We received positive feedback about the amount of staff employed at the home; people told us they received the support they required in a responsive and timely manner.

Accidents and incidents were monitored. There was an accident and incident reporting policy in place, staff routinely completed accident and incident documentation and risks were safely managed.

The registered provider was complying with the principles of the Mental Capacity Act, (MCA) 2005. People’s capacity was assessed from the outset and records contained the relevant information in relation to the persons capacity and Deprivation of Liberty Safeguards (DoLS).

Staff received regular supervision and were supported with training, learning and development opportunities. Staff told us they received support on a day to day basis.

People’s nutrition and hydration support needs were effectively managed. Appropriate referrals were made to external healthcare professionals and any guidance which was provided was incorporated within care plans.

We received positive feedback about the quality and standard of food people received. People shared their suggestions in relation to likes, dislikes and preferences and kitchen staff were familiar with people’s dietary support needs.

People were treated with dignity and respect. Staff provided kind, sincere and compassionate care. We received positive feedback from people and relatives about the care people received from Heathfield Lodge staff.

A person-centred approach to care was evident. Care records had improved since the last inspection; records were tailored around the needs of the person and staff demonstrated their understanding of the people they supported.

The registered provider had a complaints policy in place; people and relatives were familiar with the complaints process and how to raise any concerns.

We received positive feedback about the range of activities that were taking place. There was no dedicated activities co-ordinator in place at Heathfield however, staff ensured there was always a schedule of activities for people to participate in.

The registered manager was aware of their regulatory responsibilities. The registered manager notified CQC of events and incidents that occurred in the home in accordance with statutory requirements.

This unannounced inspection was conducted on 23 October 2017.

Heathfield Lodge care home provides accommodation and personal care for up to 26 older people. It is a large Victorian property with accommodation located over three floors. The upper floors are accessible via a passenger lift. There are two dining areas on the ground floor and a large lounge. A garden area is located at the rear of the building and parking at the front. At the time of the inspection 23 people were living at the service.

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.

During the last inspection we found that people’s medication was not always stored and administered in accordance with good practice. As part of this inspection we checked to see if the necessary improvements had been made and sustained. We saw that stock levels were not always accurate, some signatures were missing from administration records, PRN (as required medicines) protocols were missing and the temperatures of the room and refrigerator where medicines were stored were not monitored and recorded.

You can see what action we told the provider to take at the back of the full version of this report.

During the last inspection we saw that some fire doors were propped open with chairs while others did not fully close. As part of this inspection we checked to see if the necessary improvements had been made and sustained. We found that some bedroom doors did not have an automatic closure device fitted while other did not close fully. We also saw one bedroom door that was kept open by a footstool. This meant that they would not provide sufficient protection in the event of a fire. Evacuation equipment was insufficient to safely evacuate the building. Some personal emergency evacuation plans (PEEP’s) did not contain sufficient information to inform staff or emergency services of people’s requirements during an evacuation.

You can see what action we told the provider to take at the back of the full version of this report.

The ratings from the previous inspection were not displayed as required.

You can see what action we told the provider to take at the back of the full version of this report.

We saw evidence that the registered manager and provider conducted regular audits. However, the processes had failed to identify issues picked-up during the inspection. The majority of these issues were identified at the previous inspection and satisfactory improvements had not been made or sustained to keep people safe.

You can see what action we told the provider to take at the back of the full version of this report.

Essential safety checks, for example, gas safety and electrical safety were completed in accordance with the relevant schedule by suitably qualified external contractors. There was no evidence that water systems had been flushed or recently tested to reduce risk.

We made a recommendation regarding this.

The provider had not always submitted notifications to the Commission as required.

We made a recommendation regarding this.

At the last inspection we highlighted that evidence of people’s involvement in reviews of care plans was weak. As part of this inspection we looked at care records to see if practice had improved. We saw that some care records did not contain personalised information. For example, about people’s life histories and their likes and dislikes.

We made a recommendation regarding this.

There was a risk that two care staff would be unable to support people to effectively evacuate the building in the event of an emergency at night. The registered manager subsequently confirmed that an additional carer had been deployed at night.

Staff were able to explain how they helped keep people safe and made appropriate reference to training, monitoring and safeguarding procedures. The training records showed that all staff had received recent training in adult safeguarding. Staff knew how to recognise abuse and discrimination.

We saw evidence in care records that risk was assessed and regularly reviewed for each person living at the home. Risk was assessed in relation to; nutrition, falls, fire and pressure care. The service provided evidence of clear recording of all incidents/accidents and safeguarding concerns. However, it was identified during the inspection that records had not been recently reviewed.

Staff were trained in a range of subjects which were relevant to the needs of people living at the service including; infection control, administration of medicines and safeguarding adults. However, the records relating to staff induction remained inconsistent.

Some supervisions had not taken place as scheduled. The registered manager assured us that the supervision schedule would be brought up to date as a priority.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

The service was operating in accordance with the principles of the Mental Capacity Act 2005 (MCA).

For the majority of the time we saw staff engaging with people in a positive and caring manner. Staff spoke to people in a respectful way and used positive, encouraging language. On two occasions during the inspection we saw that there were no care staff available to observe people or provide care.

Relatives told us that they were free to visit at any time and always made to feel welcome.

The majority of the people that we spoke with enjoyed the activities on offer. A schedule of weekly activities was displayed in the reception area.

The home had an extensive set of policies and procedures. Policies included; adult safeguarding, MCA and person-centred care. Policies were detailed and offered staff guidance regarding expectations, standards and important information. However, it was not clear when some policies were last reviewed.

People spoke positively about the registered manager and the quality of communication. Staff understood what was expected of them. They told us that they enjoyed their jobs and were motivated to provide good quality care.

Heathfield Lodge care home provides accommodation and personal care for up to 26 older people. It is a large Victorian property with accommodation located over three floors. The upper floors are accessible via a passenger lift. There are two dining areas to the ground floor and a large lounge. A garden area is located at the rear of the building and parking at the front. At the time of the inspection 23 people were living at the service.

A registered manager was in post. However, the registered manager was not available on the day of the inspection. 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.

As part of the inspection process we were escorted around the building by a senior carer. We saw that some fire doors were propped open with wedges or chairs while others did not fully close.

People were placed at risk of serious injury because staff had not followed a management instruction to keep a door leading to the basement locked.

Water temperatures were not effectively monitored giving vulnerable people access to hot water at excessive temperatures.

Some people expressed concern about the safety of staffing levels at night-time.

We have made a recommendation regarding this.

Staff were safely recruited however, checks on the suitability to work with vulnerable adults had not been updated over a prolonged period. This meant that the provider could not be certain that staff were not barred from working with vulnerable adults.

We have made a recommendation regarding this.

People’s medication was not always stored and administered in accordance with good practice. We spot-checked Medicine Administration Record (MAR) sheets and stock levels. In most cases stock levels were accurate and the MAR sheet completed correctly. However, one MAR sheet indicated a stock balance which was not accurate. We also saw that staff were not counter-signing when controlled drugs were administered. The service did not have protocols in place to instruct staff under which circumstances PRN (as required) medicines should be administered.

People told us that they felt safe living at Heathfield Lodge. Staff were able to explain how they helped keep people safe and made appropriate reference to training, monitoring and safeguarding procedures.

We saw evidence in care records that risk was assessed and regularly reviewed for each person living at the home. Risk was assessed in relation to; nutrition, falls, fire and pressure care.

Staff were trained in a range of subjects which were relevant to the needs of people living at the service including; infection control, administration of medicines and safeguarding adults. We saw evidence of training in staff records which indicated that all training was up to date or had been arranged.

Staff told us that they received regular supervision and appraisal from senior staff or the registered manager. We saw evidence that these meetings had taken place and that important information had been shared.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

The records that we saw demonstrated that the home was operating in accordance with the principles of the MCA. We saw evidence that people’s capacity to consent to care had been assessed as part of the care-planning process. Some people had indicated their consent to care by signing care plans.

People told us that they were offered plenty of drinks throughout the day. We saw people being offered hot and cold drinks with their meals and throughout the course of the inspection.

The people that we spoke with had a good understanding of their healthcare needs and were able to contribute to care planning in this area. We asked people if they could access healthcare professionals when necessary. Each person said that they regularly saw healthcare professionals and attended appointments with the support of relatives and staff.

People spoke positively about the staff and their approach to the provision of care. Throughout the inspection we saw staff engaging with people in a positive and caring manner. Staff spoke to people in a respectful way and used positive, encouraging language.

People’s privacy and dignity were respected throughout the inspection. Care records were stored securely and staff were sensitive to the need for discretion when discussing confidential information. We saw that staff were attentive to people’s needs regarding personal care.

We saw that some people had signed documents indicating their involvement in the production of care plans. However, the evidence that people or their relatives were involved in regular reviews of care was weak.

We observed that care was not provided routinely or according to a strict timetable. Staff were able to respond to people’s needs and provided care as it was required.

Information regarding compliments and complaints was displayed with a suggestion box. The people that we spoke with said that they knew what to do if they wanted to make a complaint.

We saw evidence that the registered manager and provider conducted regular audits. However, the processes had failed to identify some issues and concerns relating to the safety of the building and the administration of medicines.

Records relating to the provision of care and staffing were extensive and sufficiently detailed. However, there was a reliance on hand-written information which was sometimes difficult to read and organised differently in some files. This meant that some important information was more difficult to access than was necessary.

The provider distributed annual surveys to people and their relatives. The responses that we saw were almost 100% positive in relation to; visiting, hobbies/interests, complaints, the environment, hygiene and staffing. In response to their own findings, the provider had started a programme of refurbishment of communal areas and individual rooms. Staff told us that they and people living at the service had been involved in choosing wallpapers and colours.

People spoke positively about the registered manager and the quality of communication.

Staff understood what was expected of them. They told us that they enjoyed their jobs and were motivated to provide good quality care. We saw that staff were relaxed, positive and encouraging in their approach to people throughout the inspection.

People were positive about the staff team and the care they received. They told us they could make choices about how they spent their day. One person said, 'I can get up and go to bed when I want.' We heard from other people that they could choose where to eat their meals but most people opted to have meals in the dining room. A family member told us, 'The family are happy with the treatment [relative] is receiving.'

The staffing levels throughout the day and night had been increased and people were pleased with this change. One person said to us, 'There are more staff than there was 12 months ago and they are all very kind.'

Throughout the day we observed staff engaging with people in a kindly manner and involving them in decisions about activity related to their care needs. One person said, 'The staff are most kind and will spend time talking with me.'

Effective processes were in place for on-going assessment and monitoring of the quality and safety of the services provided at Heathfield Lodge.

Complaints were managed appropriately to the satisfaction of the complainants.

People told us they were satisfied with the care. They said staff were respectful of their wishes and choices. One person told us, 'I am asked to join in activities but if I don't want to, I don't have to.' Another person said, 'The staff are wonderful and very kind.' Throughout the day we observed staff speaking to, and supporting, people in a respectful and kind way.

People told us they liked the food and got plenty to eat. They said they could choose from a couple of menu options for each meal. People were offered plenty of drinks throughout the day.

Records of care provision were in place for each person. We found that risk assessments had not been completed and care plans had not been developed for people with known risks. An incident reporting system was in place but it was not up-to-date as recent incidents had not been recorded.

Although not fully clear from the record of staff training, staff confirmed they were up-to-date with required training. In addition, they told us they received regular supervision and an annual appraisal.

An effective system for managing complaints was not in place.

Detailed care records were in place. We could see that general assessments, risk assessments and care plans had been developed. They were regularly reviewed to reflect people's changing needs.

Additional measures had been put in place to ensure the safety of the environment. Effective systems were in place to regularly monitor the quality and safety of care and support provided at the home.