Healey House

Healey House is a residential care home providing accommodation and personal care to up to 25 people. The service provides support to older people and people with sensory impairments. At the time of our inspection there were 14 people using the service.

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

The registered manager had begun to make improvements to care plans but further time was needed to ensure that these changes were applied throughout. The registered manager had oversight of the service and had recently made improvements to quality assurance systems. Audits were effective in identifying areas of improvement.

Staff were kind and caring and created a calm and relaxed atmosphere for people. People told us they enjoyed living at the service and were treated well by staff. Staff worked in partnership with other health professionals to ensure people received joined up care.

People were supported by staff who knew them well. Risks to people were managed and people were protected from the risk of abuse. Improvements had been made to medicine processes since the last inspection. The home was clean and hygienic. There were enough staff to support people and staff were recruited safely.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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 13 December 2022). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

We carried out an unannounced focused inspection of this service on 14 November 2022. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve governance at the service.

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.

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 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 COVID-19 and other infection outbreaks effectively.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Healey House is a residential care home providing accommodation and personal care to up to 25 people. The service provides support to older people and people with sensory impairments. At the time of our inspection there were 19 people using the service.

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

Quality assurance processes were not always effective in identifying concerns and areas for improvement. People's care plans were not always reflective of people's needs and preferences. Care plan audits had not identified areas that required improvement. Medicine audits did not identify issues found with the safe management of people's medicines.

Improvements had been made to opportunities people received to engage in activities, but further work was needed to embed this practice. People were communicated with effectively by staff. Staff knew people well and how to support people safely.

People, relatives and health professionals were positive about how staff communicated with them. People and relatives told us staff listened when they raised concerns or had suggestions for improvement and took action to implement changes. People, relatives and staff were positive about the registered manager.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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 requires improvement (published 7 November 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last six consecutive inspections.

Why we inspected

This inspection was prompted by a review of the information we held about this service. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only. 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 has remained requires improvement based on the findings of 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 COVID-19 and other infection outbreaks effectively.

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 monitor the service and will take further action if needed.

We have identified a breach in relation to good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

At the time of our inspection, the home was closed to visitors. People were supported to keep in touch with their relatives through phone calls. The maintenance staff had built a visitor pod into a room of the home which had its own designated entrance for relatives which will be used when open to visitors. A screen had been built between the person and the visitor section, ensuring contactless visits could take place safely. The area had a speaker system to enable people and their relatives to communicate clearly and there was a call bell in the room in case people needed support from staff.

The registered manager had ensured that there were adequate supplies of personal protective equipment (PPE) throughout the pandemic. Staff were seen to be using PPE correctly and disposing of it safely. There were signs around the home to remind staff of the correct procedures for putting on and removing PPE safely.

People’s bedrooms had a sink to support handwashing and the registered manager had installed soap and paper towel dispensers on the wall above each sink. Hand sanitisers in the corridors were activated by a sensor which meant that staff did not need to touch them.

There was a regular housekeeper at the service and cleaning schedules in place. When the housekeeper had needed to self isolate, the service had used an external cleaning company. This company had been contracted to ‘fog’ the communal areas of the home as well people’s bedrooms.

Healey House is part of the Hastings and Rother Voluntary Association for the Blind, a charity set up to support people with visual impairment. It is a residential care home providing personal and nursing care to 28 people with visual impairment. At the time of the inspection 18 people were living at the home. Some people were independent and required minimal assistance while others required assistance moving around the home safely due to visual impairment, frailty, physical disability. Some had more complex needs, such as diabetes and others required additional support as they were living with dementia.

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

People were positive about the support provided at Healey House and said they felt safe and comfortable. People and relatives said the registered manager was very approachable and the staff were excellent. Staff knew people very well; they had a good understanding of their individual needs and how to provide the support they wanted. Risk was identified and recorded with clear guidance for staff to reduce it as much as possible and people were assisted to access healthcare services when needed.

The quality assurance system had improved. However, additional work was needed to ensure that the monitoring process identified people’s changing needs and action taken promptly to provide appropriate support. Activities needed to be reviewed and changes made so they reflected the interests and preferences of people living in the home.

Since the previous inspection improvements had been made to the care plans and supporting documentation and staff training. Competency assessments had been introduced for new staff as part of the induction and for senior staff responsible for administering medicines. The care plans had been personalised and reviewed regularly to reflect people’s needs, and records showed how staff provided the support and care people needed.

There were enough staff working to provide the support people needed, at times of their choice. Recruitment procedures ensured only suitable staff worked at the home. People were protected from the risks of harm, abuse or discrimination because staff had completed safeguarding training and knew what actions to take if they identified concerns.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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 requires improvement with two breaches of regulation. (Published 13 September 2018) The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

We carried out an inspection at Healey House on 30 June and 1 July 2016 when we found the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had not met the regulations in relation to safe medicine practices and had not ensured that new staff completed induction training and had been assessed as competent in their role. The overall rating was requires improvement with one area identified as Inadequate.

At the last inspection on 23 and 27 June 2017 we found there had been significant improvements and the provider had met the regulations in relation to the safe management of medicines and induction training for new staff training. However, there were still areas to improve and embed the improvements into everyday practice. The overall rating continued to be requires improvement although three key questions had been identified as Good.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and confirm it had improved. We found improvements had not been made and there were breaches of regulation. The overall rating continues to be Requires Improvement and only one area has been identified as Good.

Healey House is a 'care home'. 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.

Healey House is part of the Hastings and Rother Voluntary Association for the Blind, a charity set up to support people with visual impairment. The home is registered to provide accommodation and personal care for up to 28 older people and at the time of the inspection 18 people were living there. Some people were independent and required minimal assistance whilst others required assistance moving around the home safely due to visual impairment, frailty, physical disability or medical conditions, such as diabetes and heart failure.

The registered manager was present during 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.

Although the quality assurance system had been reviewed and a number of audits developed to monitor the services provided and identify areas for improvement it was not effective. The audits had not identified the areas of concern we found during the inspection; including the care planning process, record keeping and meeting people’s dietary needs.

Staff were supported to develop their knowledge and practice through regular supervision and yearly appraisals had been planned. Training had been provided, including fire safety, infection control and moving and handling and staff were required to attend. However, there were no records to show that new staff were supported to develop the knowledge to understand people’s needs; or that their competency had been assessed and they had the skills to provide appropriate care.

We recommended that the provider sources appropriate training for staff responsible for giving out medicines to ensure their practice is observed; they have been assessed as competent and follow the guidelines for managing medicines in care homes issued by National Institute for Health and Care Excellence (NICE).

From 1 August 2016, all providers of NHS care and publicly-funded adult social care must follow the Accessible Information Standard (AIS) in full, in line with section 250 of the Health and Social Care Act 2012. Services must identify, record, flag, share and meet people’s information and communication needs. Staff said most people could communicate well and if necessary relatives and health professionals provided support. We recommend that the provider seek advice and guidance from a reputable source, about Accessible Information Standards (AIS) to ensure staff are aware of their responsibilities.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The management and staff had attended training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and were aware of current guidance to ensure people were protected. DoLS applications had been requested when needed to ensure people were safe.

Risk had been assessed and people were supported to the independent in a safe way, the environment was well maintained; changes were based on the needs of people with visual impairment and emergency procedures were in place to support people if they had to leave the building. People were supported to be independent and staff offered assistance when people used walking aids to move around the home to ensure their safety.

Feedback was sought from people, relatives and staff about the services provided through regular meetings and people could put comments about the home on the charity's website if the chose to. People were encouraged to keep in touch with relatives and friends and visitors said they were made to feel very welcome.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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

Healey House provides accommodation and personal care for up to 28 older people. Healey House is owned by the Hastings and Rother Voluntary Association for the Blind. A number of people living at the home have a visual impairment, and some required support for a range of other health care needs.

There were 19 people living at the home at the time of our inspection which included four people staying for a period of respite care. Respite care is when people stay for a short break either as a holiday or providing support whilst their main carer is unavailable.

Healey House was last inspected on 30 June and 01 July 2016. Two breaches were of regulation were identified and it was rated as requires improvement overall, with one area identified as inadequate. We asked the provider to make improvements to ensure that care and treatment was provided in a safe way and that quality assurance systems improved. The provider sent us an action plan stating they would have addressed all of these concerns by June 2017.

This unannounced comprehensive inspection on the 23 and 26 June 2017 found that whilst there were areas still to improve and embed in to everyday practice, there had been significant progress made and that they had now met the breaches of regulation. However there were areas still to improve and embed in to everyday practice,

At the time of the inspection there was an acting manager at Healey House. The acting manager had commenced the registration process with CQC and it was confirmed by the registration team that this was in progress. An interview date had been agreed.

The provider had progressed quality assurance systems to review the support and care provided. A number of audits had been developed including those for accidents and incidents, care plans, medicines and health and safety. It demonstrated that further embedding of the audits were required now to ensure continued improvement. Some areas of documentation had not been completed or maintained to ensure accurate contemporaneous records were in place to underpin safe care and support for people at all times. This had not compromised people’s safety at this time but was an area that needs to improve.

Care plans reflected people’s assessed level of care needs and were based on people's preferences. Risk assessments included falls, skin damage, nutritional risks including swallowing problems and risk of choking and moving and handling. For example, cushions were in place for people who were susceptible to skin damage and pressure ulcers. The care plans also highlighted health risks such as diabetes. Visits from healthcare professionals were recorded in the care plans, with information about any changes and guidance for staff to ensure people's health needs were met. There were systems in place for the management of medicines and people received their medicines in a safe way.

All staff were involved in writing the care plans and all staff were expected to record the care and support provided and any changes in people's needs. The manager said care staff were being supported to do this and additional training was on-going.

Staff had a good understanding of people's needs and treated them with respect and protected their dignity when supporting them. People we spoke with were complimentary about the caring nature of the staff. People told us care staff were kind and compassionate. Staff interactions demonstrated staff had built rapport with people and they responded to staff with smiles. People previously isolated in their room were seen in communal lounges for activities, meetings and meal times and were seen to enjoy the atmosphere and stimulation.

A range of activities were available for people to participate in if they wished and people enjoyed spending time with staff. Activities were provided throughout the whole day in the adjoining day centre, five days a week and were in line with people's preferences and interests. It was acknowledged that further work on providing activities in Healey House (for those who did want to attend the day centre) was needed.

Staff and relatives felt there were enough staff working in the home and relatives said staff were available to support people when they needed assistance. The provider was actively seeking new care staff, to ensure there were a sufficient number with the right skills when people moved into the home. The provider had made training and updates mandatory for all staff, including safeguarding people, moving and handling, management of challenging behaviour, pressure area care, falls prevention and dementia care. Staff said the training was very good and helped them to understand people's needs.

All staff had attended safeguarding training. They demonstrated a clear understanding of abuse; they said they would talk to the management or external bodies immediately if they had any concerns, and they had an understanding of making referrals to the local authority and CQC. Pre-employment checks for staff were completed, which meant only suitable staff were working in the home. People said they felt comfortable and at ease with staff and relatives felt people were safe.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The provider, registered manager and staff had an understanding of their responsibilities and processes of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

Staff said the management was fair and approachable, care meetings were held every morning to discuss people's changing needs and how staff would meet these. Staff meetings were held monthly and staff were able to contribute to the meetings and make suggestions. Relatives said the management was very good; senior staff were always available and, they would be happy to talk to them if they had any concerns.

There were 22 people living at the home at the time of our inspection. Including four people staying for a period of respite care, one of whom was in hospital at the time of the inspection

Healey House was inspected in February 2015. A number of breaches were identified and it was rated as requires improvement overall, with one area identified as inadequate. We asked the provider to make improvements to ensure that care and treatment was provided in a safe way. The provider sent us an action plan stating they would have addressed all of these concerns by July 2015. At this inspection we found that although some improvements had been made, further work was needed to embed and ensure safe and good practice in all areas. Records needed to be improved to ensure people received safe and appropriate care at all times. Good governance systems were not in place to support the day to day running of the service and ensure safe standards were met and maintained at all times. In the absence of a registered manager the provider had not maintained an oversight of the service by continuing good governance to identify areas of improvement. This is a repeated breech of regulation. Some further breeches of regulation were also found during this inspection.

At the time of the inspection there was an acting manager at Healey House. The acting manager had commenced their application to registered with CQC and this was in progress.

Medicines systems needed to be monitored to ensure safe standards were met and maintained. New staff were not receiving a formal induction to ensure they were supported and appropriately confident and competent to work unsupervised. Effective systems and processes were not in place to show how the provider assessed and monitored the quality of service provided.

Some areas of documentation had not been completed or maintained to ensure accurate contemporaneous records were in place to underpin safe care and support for people at all times.

Training records were not clear and some online training had fallen behind. Staff demonstrated knowledge and understanding of people’s needs however this needed to be backed up with regular training and updates to ensure knowledge up to date and in accordance with current guidelines.

A complaints procedure was in place. However the complaints policy needed to be reviewed to ensure all information and contact details were correct.

Staff knew people well and were able to tell us about their needs and preferences however, this was not supported by up to date relevant documentation. Not all areas of risk had been appropriately assessed to ensure people were safe when they left the home or self-medicated their medicines.

Staff told us they thought there were enough staff to provide care, people and visitors agreed that staff were always available to help them and they felt staffing levels were appropriate.

Mental capacity assessments took place and changes to people’s mental health were responded to. Staff demonstrated an understanding around MCA and DoLS.

A clear system for the maintenance of equipment and services was in place. With a monthly programme to show what needed to take place each month. Fire safety had been improved, with each person having an up to date personal emergency evacuation plan (PEEPS) in place in the event of an emergency evacuation.

People were complimentary about the meals provided and told us the food was of a high standard.

Kitchen staff were aware of people’s dietary needs for example diabetic or fortified meals. Choices were offered and alternatives available if people changed their minds.

Activities were provided and people told us they enjoyed socialising at the day centre and the recent trips out that had been organised. People told us they had access to talking books, speaking clocks and other aids to assist them due to their visual impairment.

The rating for this provider in well-led is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action.

We found a number of breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we told the provider to take at the back of the full version of the report.

There were processes in place that ensured that people, wherever possible, were supported to give informed consent about the care they received.

People had their individual needs and wishes recorded in a detailed plan of care that was kept under regular review.

People were protected from risk of abuse or harm by their being safeguarding policies and procedures in place and by staff knowing how and when to use them.

Evidence we saw showed us that people were supported by a caring, experienced staff team. The staff team were well trained and well supported by the manager.

There were processes in place to audit and monitor the quality of service being provided and people told us that their views were respected.

A family member told us. 'We have no concerns at all, the manager and staff are wonderful and Mum is well and truly looked after.'

We looked at care plans and saw that they reflected the assessed needs of the people who lived at Healey House. People we spoke with told us they were happy living at the home. One person told us, 'it's good here.' This person then told us how they were going to spend their day.

Another person told us about the meal they had just eaten. They told us, 'the food is really nice.'

A visiting professional we spoke with told us they found the care at the home to be of a good standard.

Staff we spoke with were able to tell us about the care that people who lived at the home required.

Staff spoke to us about training. One staff member said that training was, 'well organised, and staff knew what training they had to do.'

We saw there were systems in place to monitor the quality of the care provided.