Heronlea Residential Home

Updated 15 February 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by 2 inspectors.

Service and service type

Heronlea is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Heronlea is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 7 December 2022 and ended on 20 December 2022. We visited the service on 7 December 2022.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make.

We used all this information to plan our inspection.

During the inspection

Most people using the service were unable to tell us about their experience of the care provided at Heronlea. We made observations of the care being provided in the communal areas of the service. We spoke with the registered manager, deputy manager and one member of staff.

We reviewed the care records for 9 people, and the medicines records for 7 people. We looked at 3 staff recruitment files and supervision records. A range of records relating to the quality, safety and day to day running of the service were also looked at as part of this inspection.

After the inspection

We continued to seek clarification from both the registered manager and deputy manager in relation to the evidence found. We continued to seek feedback about the service and spoke with the relatives of 2 people and 3 members of staff over the telephone. We also received written feedback from the GP and spoke with the Quality Monitoring Officer from the local authority quality assurance team.

Updated 15 February 2023

About the service

Heronlea Residential Home is a residential care home providing personal care and accommodation for up to 13 older people, most of whom were living with dementia. At the time of our inspection there were 12 people using the service. The bedrooms for the service were across 2 floors, some of which were shared. There were 2 communal lounges, a shared bathroom on the ground floor and an enclosed garden. A people carrying lift was also in place.

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

Management of risk was poor. Risks relating to people’s individual care needs had either not been identified or were poorly planned for. This included poor management of falls and distressed behaviour. Safeguarding incidents had not been identified or reported to the relevant authorities.

Environmental risks were also not managed appropriately which placed people at risk of harm. Guidance provided for staff about what action they needed to take in the event of an emergency was not detailed, and people’s personal emergency evacuation plans contained incorrect information. Recording of accidents and incidents was poor, and no analysis or learning took place from incidents to improve practice.

Concerns were noted with the management of medicines, particularly around where medicines were prescribed to be given ‘as required’ medicines. However, medicines were stored safely.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Governance processes to monitor and assess the safety and quality of the service remained ineffective and failed to drive improvement. The registered manger was not clear about the regulatory requirements, and did not submit notifications of reportable incidents in line with the regulatory requirements.

Further improvements were still required in relation to the recruitment of staff. Application and recruitment procedures were not sufficiently robust to ensure the suitability of applicants.

People’s care was not planned in a person-centred way, and did not ascertain their wishes and aspirations. Staff did not support people in a way which promoted their independence.

Staff training provision had improved, however, the effectiveness of the training did not translate into practice. Staff felt supported in their work.

Improvements had been made in relation to infection prevention and control procedures, and the kitchen had undergone some remedial works.

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 inadequate (published 29 September 2021) and was placed in Special Measures. We imposed conditions on the provider’s registration which required them to submit us monthly action plans. At this inspection we found the provider had not made the required improvements and remained in Special Measures.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 11, 17 and 27 August 2021. Breaches of legal requirements were found. The provider was in breach of regulations Premises and equipment, Safe care and treatment, Fit and proper persons employed and Good governance.

We undertook this focused inspection 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.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains inadequate.

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

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, need for consent, safeguarding people from abuse, good governance and person-centred care 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, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.