Heronlea Residential Home

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.

Heronlea Residential Home is a care home providing personal care and support for up to 13 older people, all living with dementia. At the time of the inspection, all rooms were occupied. The service had bedrooms across two floors, with communal bathing facilities on the ground floor. There was a people carrying lift in place and access to an enclosed garden area.

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

People were not protected from harm and risks relating to the standard of care provided, or the condition of the care environment. There was poor storage of items which could cause harm to people, and equipment people used was not always well maintained. Where people experienced individual risks, such as having falls, timely action was not taken to ensure staff received guidance from external professionals to mitigate the risk of reoccurrence. There were poor fire safety standards in place, putting people living at the service at risk. This resulted in an onward referral to the fire service by Care Quality Commission (CQC) to seek assurances around people’s safety and any additional action required by the registered manager.

There were insufficient pre-employment checks in place to protect people from the risk of staff working at the service who were not suitable to work in care settings. Improvements were required in relation to people’s medicine management, and to ensure they were able to communicate their need for pain relief medicines to staff.

The service needed to improve overall levels of cleanliness, and there were shortfalls in the protection of people from the spread of infectious conditions, such as COVID-19. Staff, including the registered manager were found not to comply with current government guidelines in the management of COVID-19, particularly in relation to the wearing of personal protective equipment. People did not receive consistently high standards of safe care. Overall, people were not supported to meet their maximum potential and lead meaningful lives.

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 Good (published 17 July 2017). In response to the pandemic, there had also been an infection, prevention and control inspection visit completed in January 2021.

Why we inspected

The inspection was prompted in part due to concerns received about the standards of safe care and support being provided to people living at the service, as well as a recent police investigation. A decision was made for us to inspect and examine those risks. 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.

The overall rating for the service has deteriorated to inadequate.

We have found evidence that the provider needs to make improvements. Please see the 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 Heronlea Residential Home on our website at www.cqc.org.uk.

Enforcement

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 will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, premises and equipment, good governance and the required level of safety checks when employing staff.

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 re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is now 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.

We found the following examples of good practice:

The service was proactive in closing doors to visitors prior to the first national lockdown to help keep the people who lived at the service safe.

The service was proactive in securing good stocks of personal protective equipment (PPE) including shoe protectors and overalls, above what was required by guidance. There were good systems in place to ensure appropriate use.

People who lived at the service with dementia who walked with a purpose were cohorted in a specific lounge when they tested positive for COVID-19, with staff support to keep them safe.

One of the entrance halls was changed to make a suitable area, with a plastic screen, for relatives to visit people who lived in the service, safely.

Heronlea is a residential care home which provides accommodation and personal care for up to 13 people. At the time of our inspection, there were 11 people using the service.

There was a registered manager 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 range of activities available were not always appropriate or stimulating for people living with dementia. They did not meet people’s individual or specialist needs.

Staffing level arrangements were being reviewed by the registered manager to ensure they met the needs of people using the service at all times. Staffing levels were observed to be adequate throughout the day, and staff were available when people needed support.

People were supported to eat sufficient amounts and maintain a balanced diet. However, improvements were needed in the lunchtime experience for people, and we have made a recommendation about this.

The service was meeting the requirements of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS). Staff understood the need to obtain consent when providing care.

Staff respected people's privacy and dignity and interacted with people in a kind and caring manner.

Risk assessments were in place in respect of people’s care, treatment and daily living.

Staff knew about how to safeguard people from abuse and what to do if they suspected abuse was occurring. Safe recruitment procedures were in place, and staff had undergone recruitment checks before they started work to ensure they were suitable for the role.

There was a complaints procedure in place for people to access if they needed to.

People were protected by safe processes in place in respect of the storage, administration and recording of medicines. Staff received training and their competence was periodically assessed.

There were systems and processes in place to support the safety and quality of the service.

We saw how the service ensured that they provided the care and treatment the person would want, by speaking with relatives, working beside people and using advocacy services as appropriate. Care records were clear and gave good information to staff.

The service had robust recruitment practices in place and all staff were given opportunities to attain a qualification in care. Staff felt well supported and had been trained sufficiently so that they could meet people's needs. No complaints had been received by the service and there was a complaints procedure in place that was being updated. Staff were aware of people's moods and changes so that any dissatisfaction with how they were being cared for would be identified and acted on.