Archived: Cardinal Heenan House

At the time of our visit 19 people were living at the home.

We found the following examples of good practice.

The home had comprehensive policies and procedures to manage any risks associated with the COVID-19 pandemic. This included an operational plan in the event of an outbreak in the home of this viral infection. The policies, procedures and risk assessments were updated regularly following any changes in national guidance.

Adaptations to the home had been undertaken and the staff rota amended as part of the home’s strategy and contingency plan should there be an outbreak of COVID-19 in the home.

Infection prevention and control (IPC) policies and procedures were monitored through a comprehensive and rigorous system of auditing.

People living in the home and their next of kin were supported to maintain contact through a range of methods. This included visits by appointment in a safe area within the home, or within a ‘pod’, and by window visits, video and telephone calls.

There was an ample supply of personal protective equipment (PPE) for staff and any visitors to use.

Staff had received training on the use of PPE and we observed staff wearing it correctly during our inspection. Clear signage and information was in place throughout the home to remind staff of their responsibilities.

A programme of regular COVID-19 testing for both people in the home and staff was implemented. Screening procedures were also in place for visitors to the home.

Staff who normally used public transport for travel to work were supported to use taxis to minimise the risks of infection.

The home was participating in the COVID-19 vaccination programme.

The care home accommodates up to 32 older people in one adapted building. The service is also registered to accommodate people who are living with dementia. There were 27 people living in the home when we inspected.

This was an unannounced inspection that took place on 9 October 2018. The service was last inspected in June 2016 when there were no breaches in regulation seen and the home was rated as ‘Good’. At this inspection we found the service remained ‘Good’. There was no evidence or information from our inspection or on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At the time of this 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.

The service has continued to sustain a good standard of care and support for those who lived at the home. The trustees of the company, the management and staff team were constantly striving to improve the service and this is demonstrated by their commitment towards those who live at Cardinal Heenen. The management team had introduced impressive digital technology systems, in order to provide a better quality of life for those who were living with dementia.

People were able to live as they chose and this philosophy was clearly embedded within the visions and values of the service. Staff had a good understanding of people's needs and were able to provide person centred care in a compassionate and dignified way, which enabled people to receive the support they needed in the way they preferred.

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.

There was clear evidence of a solid management structure and a dedicated team approach, which continued to drive the service forward, in order to provide a good standard of care and support. Staff who had shown particular interests in specific areas, such as infection control, falls prevention, dementia and dignity were designated 'Champions'. These champions continued to play an essential role in developing best practice, sharing learning and acting as role models for other staff.

People who lived at Cardinal Heenan told us they felt safe living at the home. Medicines were being appropriately managed and we found the environment to be clean, well maintained and safe for people to live in. Risk assessments had been conducted where necessary and staff we spoke with were confident to report any concerns about people’s safety to the appropriate authorities.

Recruitment practices were robust and new staff were guided through an induction programme, followed by regular mandatory training modules throughout their employment. This helped to ensure the staff team had the right skills and knowledge to provide support and were suitable to work with this vulnerable client group.

There were sufficient staff on duty, who were kind and caring and had developed good relationships with people who used the service. We saw that people looked comfortable in the presence of staff members and seemed relaxed within their environment.

People were assisted in a gentle and supportive way. A range of specialised equipment was provided to encourage independence, as far as possible. A lot of consideration and thought had gone into the decoration and design of the internal premises. The overall effect created was a homely and peaceful environment for people to live in. Staff we spoke with all told us they were happy working at the home.

Further information is in the detailed findings below.

We last inspected Cardinal Heenan House on 02 July 2014, when we found the service to be compliant with five of the six outcome areas we assessed at that time. The management of medications needed some improvement. We followed this up on 22 September 2014 and found the shortfall had been appropriately met.

This unannounced inspection was conducted on 30 March 2016. The registered manager was on duty when we visited Cardinal Heenan. She had managed the day-to-day operation of the service for several years.

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 of the Health and Social Care Act and associated regulations about how the service is run.

There were sufficient numbers of staff on duty to keep people safe. Staff members were well trained and had good support from the management team. They were confident in reporting any concerns about a person’s safety and were competent to deliver the care and support needed by those who lived at Cardinal Heenan. The recruitment practices adopted by the home were robust. This helped to ensure only suitable people were appointed to work with this vulnerable client group.

Some areas of the premises had been pleasantly decorated and refurbished. Equipment and systems had been serviced in accordance with the manufacturers’ recommendations, to ensure they were safe for use. A range of assessments had been conducted within a risk management framework. This helped to promote people’s safety and well-being and protect people from harm. However, we noted that there seemed to be a lack of call bells in the communal area of the home. We made a recommendation about this.

The planning of people’s care was based on a thorough assessment of their needs, conducted before a placement at the home was arranged. We found the plans of care to be, in the main, person centred, providing staff with clear guidance about people’s needs and how these were to be best met. However, on one occasion changes in an individual’s needs were not very clear and in one instance the mental health needs of another person had been identified, but guidance for staff around the management of these needs could have been more descriptive. However, staff we spoke with were easily able to discuss the needs of this particular individual and were fully aware of the care and support they required.

People were helped to maintain their independence. Staff were kind and caring towards those they supported and interacted well with the people who lived at Cardinal Heenan. Assistance was provided for those who needed it in a dignified manner and people were enabled to complete activities of daily living in their own time, without being rushed. However, we found the lunch time service to be somewhat disorganised and chaotic. We made a recommendation about this.

Staff we spoke with told us they received a broad range of training programmes and provided us with some good examples of modules they had completed. Most confirmed that supervision sessions were conducted, as well as annual appraisals. Others felt these could be organised more often.

Mental capacity assessments we saw were not person centred or decision specific and staff we spoke with had little understanding of the Mental Capacity Act [MCA] and Deprivation of Liberty Safeguarding [DoLS] procedures. We made a recommendation about this.

Staff spoken with told us they felt well supported by the registered manager of the home. They spoke in a complimentary way about her management style and described her as being, ‘approachable’ and ‘accommodating’.

Medicines were being well managed. This helped to promote people’s safety and protected people from the risk of harm.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with staff and from looking at records.

If you want to see the evidence supporting our summary please read our full report.

This inspection was carried out to focus on previous none compliance in the area of medications, which involved us examining a random selection of Medication Administration Records (MAR) and many associated documents. We also spoke with members of staff involved in the administration of medicines. We found great improvements had been made since our last visit to this location and we found the supervisor responsible for the management of medications on the day of our inspection was knowledgeable about the recent processes implemented, in order to make improvements in this area. We found our five key questions, as described above were met in a positive way.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with those who used the service, their relatives, support staff and the manager of the home and from looking at records.

We were able to speak with eight people, who lived at the home and three relatives, who all gave us positive responses to the questions we asked. If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

People we spoke with told us they felt safe living at Cardinal Heenan House and were comfortable with the care and support they received. This was observed by us during our visit to this location. Safeguarding procedures were robust and staff understood how to protect people they supported.

Systems were in place to help managers and the staff team to learn from untoward events, such as accidents and incidents. This helped the service to continually improve. Deprivation of Liberty Safeguard (DoLS) applications were made, as was needed. This helped to ensure people were not being unnecessarily deprived of their freedom to make choices about what they wished to do. People (or their relatives) were involved in making decisions about the care and support provided.

At the time of our visit to this location, we toured the premises and found the environment to be safe, clean and hygienic. Good practices to control the spread of infection had been implemented and appropriate protective clothing was provided for staff. Equipment was well maintained and serviced regularly. Therefore, people were not put at unnecessary risk.

Is the service effective?

The health and personal care needs of those who used the service had been thoroughly assessed, before people moved into the home. Special dietary needs had been identified and people were able to select the food they preferred to eat. Plans of care had been developed, in accordance with people's wishes and a wide range of external professionals were actively involved with the health care of those who lived at the home.

In general, systems were in place to ensure the service was effectively assessed, so the quality provided could be consistently monitored. However, although there was a system in place for auditing the management of medications, this was not always effective. We identified some discrepancies within the medication practices for one person who lived at the home, which should have been picked up during the audit trail.

People's needs were taken into account with signage and the layout of the service that enabled them to move around freely and safely. Visitors confirmed they were able to see people in private and visiting times were flexible. This was observed by us at the time of the inspection.

Is the service caring?

We asked those who lived at the home about the staff team. Feedback from them was extremely positive. They said staff were kind and caring towards them and helped them to meet their individual needs. When speaking with staff it was clear they genuinely cared for those they supported and were observed speaking with people in a respectful and friendly manner.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support was provided in accordance with people's wishes. Throughout the day we observed staff interacting very well with those who lived at the home and it was pleasing to see staff members chatting with people in a jovial, but courteous manner.

Is the service responsive?

Those who lived at Cardinal Heenan House were regularly involved in a range of activities, both inside and outside the home. People were encouraged to integrate with the local community and on the day of our inspection a group of school children visited to sing some songs for those who lived at the home. This activity was enjoyed by all.

Staff were seen to be responding to people well by anticipating their needs appropriately. The service worked collaboratively with other agencies and services to make sure people received care and support in a consistent way.

Evidence was available to show the home responded well to any suggestions for improvement and appropriate action was taken promptly to rectify any shortfalls identified.

Is the service well-led?

The service had a quality assurance system in place and records showed that identified problems and opportunities to change things for the better were addressed promptly. As a result, the quality of service provided was continuously monitored.

Staff spoken with had a good understanding of their roles. They were confident in reporting any concerns and they felt well supported by the managers of the service. People we talked with spoke highly of the manager of the home and everyone felt the home was very well managed. The service was described as, 'marvellous', 'wonderful' and 'first class'.

People living at Cardinal Heenan House and their relatives completed annual satisfaction surveys. These consistently provided positive comments. It was evident that the management team were receptive of suggestions for improvement, which promoted a co-operative and efficient service.

'I'm looked after well. I'm happy here'

and

"It's lovely here. I spend time with my friends. We've been on trips and the staff are lovely".

We also spoke to four relatives of people living in the home. One said, 'It's absolutely wonderful. They (the staff) just go that extra mile'. Another relative told us, "The staff care, they really do. They look after mum and they make me welcome too. I come all the time and I've no concerns'.

People told us that they were involved in their plan of care and were asked for their consent. However, we found evidence that some care plans were not always adequate to reflect the care people needed.

The provider had processes in place for the safe recruitment of new staff. We found a suitable complaints procedure was in place and people told us the manager had an 'open door', where they could raise concerns or suggestions.

We found staff to be well supported and appropriately trained and those living at Cardinal Heenan looked comfortable in their presence. We also spoke with two relatives who were very complimentary about the staff team and the managers of the home.

Comments from those living at the home and relatives included:

"The staff are champion. I am totally happy with everything."

"My Mum has only been here a few months, but I am more than happy with the care she is getting. The staff are really good with her."

"I cannot grumble about anything. We are all well looked after. They (the staff) are a smashing lot."

During our inspection we assessed standards relating to care and welfare and how people were supported to be involved in the planning of their own care. We also looked at how they were safeguarded from abuse. Standards relating to staff training and monitoring the quality of service provision were also inspected. We did not have concerns about any of the outcome areas assessed.