Scotia Heights

Scotia Heights is a residential care home providing personal care and nursing care to 49 people at the time of the inspection. The service supports older people and younger adults who may have a mental health condition and physical disability.

Scotia Heights can support up to 60 people in six units across two floors. Each unit has its own communal dining and living areas with a kitchenette. A passenger lift gives people and staff access to all floors within the home.

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

Despite concerns being raised prior to our inspection, people were supported by sufficient staff to help them stay safe and meet their needs. Following an increased use of agency staff, more permanent staff had been recruited and were waiting to start working at the home, which will improve the consistency of care. Recruitment practices were safe and appropriate checks were completed on potential new staff to make sure they were suitable to work with people living in the home.

Overall, safe infection prevention and control procedures were followed and the registered manager addressed issues with staff's use of personal protective equipment (PPE) following our inspection. People and staff had access to COVID-19 testing and vaccination. All visitors were tested in line with government guidance.

Safeguarding systems were in place for staff to follow which protected people and kept them safe. Staff knew how to and were confident in reporting any concerns they may have about a person’s safety.

Care plans reflected how care should be provided to people to minimise any risks to them; they were regularly reviewed to adapt the level of support needed in response to people's often rapidly changing needs.

People were supported to take their medicines safely and when they needed them. New systems were in place which had been effective in helping to reduce the frequency of medicine errors which had been occurring.

The leadership, management and oversight of the home had improved since our previous inspection. The provider had a governance framework in place which was effectively identifying and addressing issues. There was a focus on continuous learning and improvement to improve standards at the home.

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 overall, with well-led rated as requires improvement (published 15 December 2020).

Why we inspected

We had received concerns in relation to a high volume of medicine errors and concerns about staffing levels. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe and well-led list sections of this full report.

The overall rating for the service has not changed. 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 Scotia Heights on our website at www.cqc.org.uk.

Scotia Heights is a residential care home providing personal and nursing care to 47 people aged 65 and over at the time of the inspection. The service can support up to 60 people.

The service accommodates people in a purpose-built building, across six separate units. Each unit has the capacity to support ten people each. The units have their own lounge and dining facilities alongside a small kitchenette. Some units specialise in more physical health needs whereas other units are more focussed on providing support for people’s mental health.

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

The service had recruited new staff. However, we were not sure if all staff were aware of their role and the regulatory requirements within which they worked. This was because we could not find evidence to confirm competency assessments had been completed as part of their staff induction.

Risks to people’s safety were assessed and the service was able to meet the needs of people currently living in the service. Sometimes this meant staff needed to leave their unit to help other units within the home.

People received their medicine as prescribed and were safeguarded against the risk of abuse.

People were supported by sufficient numbers of staff who had been recruited following the application of safe recruitment procedures.

We were assured that the provider was following the guidance around preventing and controlling infection in regard to Covid-19.

The provider could evidence lessons had been learnt when things went wrong and had increased governance the systems in place to ensure they was greater oversight of people's care needs.

The culture of the service presented as positive and people told us they were listened to and able to contribute to the development of the service. The provider worked in partnership of others and understood their duty of candour.

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 requires improvement (published 17 September 2020). At the inspection a number of breaches were identified. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced focussed inspection of this service on 03 February 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, staffing and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe and well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those 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 requires improvement to good. This is based on the findings at this inspection.

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 coronavirus and other infection outbreaks effectively. The ratings from the previous comprehensive inspection for those 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 requires improvement to good. 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 Scotia Heights on our website at www.cqc.org.uk.

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.

Scotia Heights provides accommodation and personal care for up to 60 people. On the day of our inspection 58 people were living in the home.

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

People told us they felt safe living at the home. Although the registered manager was confident about the staffing levels provided in the home, people who used the service told us staff were not always available to support them when needed.

Medicine management needed to be reviewed to ensure everyone receives their medicines as prescribed. Staff did not have access to accurate and consistent guidance about how to restrain people safely. People did not always receive regular welfare checks to ensure their comfort and wellbeing. The provider’s governance was ineffective to ensure the service was being assessed and monitored to drive necessary improvements.

Staff were aware of how to safeguard people from potential abuse and had shared concerns with the commission which, prompted this inspection. Systems were in place to promote good hygiene standards.

The provider had a registered manager in place who was aware of their responsibility to take action when things went wrong. However, the registered manager was unaware of some of the shortfalls we identified during our inspection visit.

The provider worked with other agencies and people were supported by staff to maintain links with their local community. The registered manager was aware of the duty of candour and to be open and transparent when things went wrong. We identified concerns during this inspection and the registered manager took prompt action to address them.

Rating at last inspection

The last rating for this service was 'good,' (published 11 February 2019).

Why we inspected

We received concerns in relation to insufficient staffing levels and poor hygiene standards. As a result, we undertook this focused inspection to review the Key Questions of Safe and Well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those Key Questions 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.

We have found evidence that the provider needs to make improvement. Please see safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Scotia Heights on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to the management of medicines, safe staffing levels and the management of behaviours at this inspection.

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.

Follow up

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

People were supported by safely recruited staff who had the skills and knowledge to provide safe and effective support. People were supported safely to manage their risks, whilst promoting their independence. Medicines were managed safely. Effective care planning was in place which guided staff to provide support that met people’s needs which were in line with their preferences.

People consented to their care and were supported in their best interests. People were supported to eat and drink sufficient amounts in line with their assessed needs. People’s diverse needs had been planned for which ensured they received individualised care in all aspects of their life. Professional advice had been sought and acted on to ensure people’s health and wellbeing was maintained. Systems were in place to ensure people received consistent care across the service and when accessing external services.

Staff were kind and caring towards people and promoted choices in line with individual communication needs. People were treated with dignity and their right to privacy was upheld.

People were supported to be involved in hobbies and interests that were important to them. People and their relatives were involved in the planning of their care, which meant people were supported in line with their preferences. Complaints systems were in place, which people and relatives knew how to use. People’s end of life wishes and needs were taken into account to ensure they received individualised care at this time of their lives.

Systems were in place to monitor the service, which ensured that people’s risks were mitigated and lessons were learnt when things went wrong. There was an open culture within the service, where people and staff could approach the registered manager who acted on concerns raised to make improvements to people’s care. The provider continually sought ways to improve the service people received.

The service met the characteristics of Good in all areas; more information is available in the full report below.

Rating at last inspection:

Requires Improvement (supplementary report published 15 December 2018)

About the service:

Scotia Heights is a care home that was providing personal and nursing care to 48 people at the time of the inspection.

Why we inspected:

This inspection was brought forward due to information of concern we had received and to check the provider had made improvements since the last inspection.

At the last comprehensive inspection in February 2018 the service was rated requires improvement overall (in the key questions of Safe, Responsive and Well Led). There was a breach in regulation because the governance systems in place were not effective in identifying and mitigating risks to people, which placed them at risk of poor care.

We carried out a responsive inspection in June 2018 and July 2018 due to information of concern and found improvements were still required in the key questions of Safe and Well led. There was a continued breach in regulation because the systems in place to monitor and manage the service were not effective. We served a warning notice and asked the provider to make improvements within a specific timescale.

At this inspection the required improvements had been made and the service had met the characteristics of Good in all areas. The overall rating is Good.

Follow up:

We will continue to monitor the service through the information we receive.

Scotia Heights is a care home that provides nursing care. 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.

Scotia Heights is registered to provide a service for up to 60 people who have a neurological disability, enduring mental health, brain injury, stroke and early onset dementia. On the days of our inspection there were 52 people living in the home. The home is situated on three floors and divided into six units of which were accessed by a passenger lift.

We carried out an unannounced comprehensive inspection of this service on 7 and 9 February 2018. The provider was found to be in breach of regulation 17, Good governance. After that inspection we received concerns in relation to the safety and wellbeing of people who used the service. As a result, we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Scotia Heights on our website at www.cqc.org.uk

At the previous inspection in February 2018, the service was rated ‘Requires Improvement.’ We carried out an inspection on 26 and 27 June 2018 and 23 July 2018. At this inspection we found concerns relating to care and support provided to people. We shared these concerns with the operation manager and the operation support manager who assured us that action would be taken to improve the service provided to people. On the third day of our inspection the provider had taken some action to improve the safety and welfare of people. The overall rating for this service is ‘Requires Improvement.’

The home has been without a registered manager since November 2017. This meant the provider was in breach of the conditions of their registration. 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. In the absence of a registered manager the home was being run by two interim managers who were supported by the operation support manager who informed us they would be applying to registered with the commission.

At this inspection we identified that improvements were needed to ensure the safe management of medicines. We found the risks to people were not managed effectively or safely and this compromised their wellbeing. When we returned on the third day to complete our inspection. The provider had taken some action to ensure people received their medicines as directed by the prescriber. The risk to people had been reviewed and some systems put in place to reduce the risk of potential harm to them.

Since our last inspection in February 2018, additional staff had been recruited to ensure people received consistency with the care and support provided. People could be confident that practices and systems in place would reduce the risk of cross infection. People had access to information about who to talk to if they had any concerns about abuse and staff were aware of their responsibilities of safeguarding people from the risk of potential abuse.

Since the last inspection visit the management team had changed. The provider’s governance was ineffective in assessing, monitoring and to drive improvements. However, the operation manager told us about systems and practices to assess and monitor the quality of service which had recently been implemented and as such we have not been able to assess the sustainability of these new systems. People who used the service and staff were encouraged to be involved in the management of the home. People were supported by staff to maintain links with their local community. The provider worked with other agencies to provide care and support for people.

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

Scotia Heights is registered to provide a service for up to 60 people who have a neurological disabilities, enduring mental health, brain injury, stroke and early onset dementia. On the days of our inspection there were 56 people living in the home. The home is situated on three floors and divided into six units of which were accessed by a passage lift.

At the previous inspection in March 2017, the service was rated ‘Requires Improvement.’ At this inspection we found that the provider had taken some action to improve the quality of service provided to people. However, there were still areas that required improvement. The overall rating for this service remains as ‘Requires Improvement.’

The home has been without a registered manager since November 2017. 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. In the absence of a registered manager the home was being run by a peripatetic manager. In this report we refer to this person as the ‘manager.’

The management of medicines needed to be improved to ensure people received their treatment as prescribed. People were at risk of not receiving consistent care and support due to the frequent use of agency staff who were unaware of their needs. However, we found that staff had been recruited safely. People may be discriminated against due to their disability and where their first language is not English. The provider’s governance was ineffective to identify the shortfalls we found and to ensure people received a safe and effective service.

Staff had access to risk assessments to support their understanding about how to care for people safely. The hygiene standards within the home were satisfactory. Systems were in place to learn from near misses to ensure people’s safety. People felt safe living in the home and staff were aware of their responsibility of safeguarding them from the risk of potential abuse.

People were cared for by skilled staff who were supported in their role by senior staff. The principles of the Mental Capacity Act were adopted in care practices to promote people’s human rights. People were supported to eat and drink sufficient amounts and had access to a choice of meals. The involvement of other healthcare professionals assisted in maintaining people’s physical and mental health.

People were cared for by staff who were kind and attentive to their needs. People’s involvement in their care planning ensured they received care and support the way they liked. People’s right to privacy and dignity was respected by staff and they were supported to maintain contact with people important to them.

People were supported by staff to pursue their interests. Complaints were listened to and acted on. People were given the opportunity to discuss their wishes regarding dying and end of life care.

People and staff were encouraged to be involved in the management of the home. People were complimentary about the new management team and were happy with the improvements made. The manager was supported in their role by the operations manager and the operations support manager. The managers had positive aspirations to drive improvements to ensure people received a good standard of care.

Scotia Heights provides accommodation and nursing care for up to 60 people. On the days of our inspection 55 people were living in the home. The provider offers a service for people who have a neurology disorder and brain acquired injury.

The home had a registered manager who was present for 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.

Prior to our inspection we received information from a person who wanted their identity to be protected. They alleged there were insufficient staffing levels provided to meet people’s needs.

At this inspection we found that one unit was not sufficiently staffed to ensure people’s needs were met. The provider’s recruitment process entailed safety checks to ensure the suitability of staff. The risk of harm for some people was not always managed effectively. People were at risk of not receiving the appropriate support to take their prescribed medicines. People told us they felt safe living in the home. Staff were aware of their responsibility of sharing concerns of potential abuse with the registered manager to protect people from the risk of further harm.

People were cared for by skilled staff who were supported in their role by the management team. People confirmed they were able to make their own decisions. Staff were aware of the principles of the Mental Capacity Act and the Deprivation of Liberty Safeguards. People were supported by staff to eat and drink sufficient amounts and were assisted to access healthcare services when needed.

People received different care and attention depending on what unit they lived on. People were encouraged and supported to be involved in planning their care to ensure they received a service the way they liked. People’s right to privacy and dignity was respected by staff. Practices and access to appropriate equipment helped people to maintain their independence.

People’s involvement in their care assessment ensured their care preference was met. Some people were supported by staff to pursue their interests and hobbies. People were supported by staff to maintain contact with people important to them. People knew how and who to share their concerns with.

The provider’s governance was not entirely effective to ensure people’s needs were always met. People were encouraged to have a say in how the home was run. The home was managed by the registered manager who was supported in their role by the operation manager.

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

As part of the inspection process we ask the following five key questions; is the service safe, effective, caring, responsive and well-led?

During our inspection we spoke with two people who used the service and one relative. We also spoke with eight members of staff and the clinical nurse manager. The registered manager was not present during our inspection.

We looked at four people's care records to see if their records were accurate and up to date. We also looked at records relating to the management of the home. These included incident forms and staff rotas.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service, their relatives and the staff told us.

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

Is the service safe?

The service was not consistently safe. The provider could not assure people that their care was delivered in accordance with their agreed plans to protect their safety and welfare.

People's personal and confidential information was not kept safe and secure. This meant there was a risk it could be lost or accessed without their consent.

Is the service effective?

The service was not consistently effective. The provider could not assure people that the advice of health care professionals was followed to enable their nutrition and hydration needs to be met.

Is the service caring?

People told us the staff were caring. We observed that staff provided care in an unrushed manner.

Is the service responsive?

We did not answer this question during this inspection because our inspection was focussed upon the areas of concern that had been shared with us.

Is the service well led?

The service was not consistently well led. Effective systems were not in place to check that people had received their care in accordance with their agreed plans. This meant the effectiveness and quality of the care was not being adequately monitored.

There was no effective system in place to ensure changes were made in response to incidents to reduce future incidents from occurring.

We considered our inspection findings to answer the questions we always ask;

Is the service safe?

People who used the service had their needs assessed and risk assessments had been completed to reduce any risks to their health and well-being. Staff had received training in meeting people's needs including safeguarding and recognition and reporting of abuse, manual handling and health and safety.

Staffing levels were sufficient to meet people's personal care needs, but the provider may find it useful to note that improvements to the deployment of staff should be considered.

Is the service effective?

People we spoke with told us, 'I am okay here'. A relative told us, 'Things are improving'.

People's care needs were assessed and plans were in place, including people's nutritional needs. People who used the service had choices of meals at each meal time that reflected their specific needs. Meetings or food forums were held so that people could discuss the food provided and make comments on menus. The provider may find it useful to note there were some gaps in the food and fluid records. This meant that the people's nutritional intake was not always monitored effectively.

Is the service caring?

People told us they were supported by staff who knew them well. One person said, "They are lovely and nice". A relative told us, "The staff are fantastic, I have no concerns they treat my relative really well'. We observed that care staff spoke with people in a friendly and respectful manner.

We saw that people's preferences about their social care needs were recorded and the service provided a full programme of opportunities to ensure people were occupied and actively engaged. This meant people had stimulating and interesting things to do.

Is the service responsive?

The home had a complaints procedure. Information was available to people to tell them how to raise areas of concern. A relative told us, 'I feel that I'm listened to when I have raised concerns'. People's views of the service and those of their relatives or supporters were sought to ensure the service was meeting people's needs. This meant that the provider was seeking people's views about their care to identify areas for improvement.

Is the service well led?

The service had a new manager. The manager was not registered with us (CQC). We were assured that they were in the process of submitting a registration application.

Systems were in place to monitor and audit the service, records of audits included medication and care records.

The views of staff were being sought, they received individual appraisal and supervision. Staff meetings were also arranged, but the provider may find it useful to note, they were not always held frequently.

We spoke with two relatives and five members of staff.

We found that improvements had been made regarding medication. There were safer processes in place for ordering, storing and administering medication.

We looked at the care records and saw that these have been improved. The care records contained detailed information which was relevant to the person to ensure that safe and appropriate care could be provided.

Whilst we were at the home we became concerned about staffing levels. The staffing rotas we looked at did not provide reassurance that enough staff were being allocated to safeguard the health and welfare of the people using services. A relative told us, "I don't feel that this is safe with all of these patients needing such complex and high level care".

We have asked the provider to provide us with a plan of action to improve the staffing ratio.

We found that the staffing arrangements at the home had improved. We spent time on all of the five units at the home and found the care environment was relaxed and organised. Staff had time between care tasks to engage with people socially. One relative we spoke with told us, 'Over recent months there has been a change for the better and right now I feel that the care my son receives is high quality.'

The arrangements for the assessment and planning of care ensured that people's care and health needs were met. We found structured and detailed assessments and care plans were in place. Some records were not always fully completed or detailed to support decision making and the review of people's needs. When people were unable to discuss or express what they wanted or agreed to, an assessment of what was in their best interests would be completed.

A programme of audits and checks were in place to support the on-going monitoring of the quality and safety of care. Improvements were needed to ensure the safe management of medicines in the home.

During this inspection, we spoke with two people who lived at the home and two visiting relatives. We also spoke with four members of staff. Relatives told us that the management team was more accessible than they had been. One relative told us that they had previously been concerned about a previous lack of continuity of staff. They said, 'The new nurse in charge is a breath of fresh air, I have every confidence in them. In my opinion, the staff changes are for the better.'

Our inspection evidenced that changes had been made to address the shortfalls in the management of the home. The monitoring and management of the home ensured that day to day performance issues and concerns were now being identified and responded to. The provider had recruited a number of new permanent nursing staff. There was a clear rota management system in place where the use of agency staff was matched to people's needs. Time for training was also being planned separately to the main duty rota. The home did not have a physiotherapist at the time of this inspection. We found that people's physiotherapy needs had not always being met.

The provider still did not have a satisfactory system in place to protect people living at the home from the risk of harm. The monitoring and management of the home still did not ensure that day to day performance issues and concerns were always identified and responded to. Relatives we spoke with expressed their concerns about how well the provider was listening to their views and experiences.

The planning and allocation of staffing did not ensure there was always enough staff, with the appropriate skills and knowledge, to safeguard the health and welfare of the people who used the service. The provider was more frequently using agency staff to try and meet assessed nursing staff needs across the home. The provider could not provide evidence to support that the skills and experience of agency nurses had been satisfactorily addressed with the supplying agency.

One person told us that, 'Some staff very good but they never have much time.' A relative told us that, 'The girls are brilliant but you have to search for a nurse.' This relative told us they had general concerns about the competency and skills of new nursing staff to meet their relative's specific needs.