Archived: Heathercroft Care Home

Heathercroft Care Home is a 'care home.' The service is registered to provide nursing and personal care for up to 88 older people across two purpose-built units; Heathercroft unit is for people with nursing and personal care needs and the Ashberry unit is for people living with dementia. Following our last inspection, we imposed conditions to remove the nursing element of the location's registration. At the time of our inspection there were 41 people being provided with accommodation and personal care.

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

People's health, safety and wellbeing were sometimes put at risk due to a number of concerns identified during this inspection. Risk management was not always consistent, and people and family members did not always feel assured about their safety. Staff did not always have the right skills, knowledge or experience to carry out their role safely and effectively.

There were not enough assurances that the service consistently met current national guidance and standards in relation to infection prevention and control (IPC). Staff had limited knowledge about some IPC procedures, including the removal and disposal of PPE. There was limited assurance that staff were taking part in regular COVID-19 testing. The provider did not always make sure that adequate measures were in place to prevent the spread of infection; particularly in relation to COVID-19.

The service had experienced a long history of inconsistent management and poor compliance with regulations. This had lead to low staff moral and poor team cohesion. Family members told us communication from managers was poor, and people spoke negatively about the constant change in management. Staff felt the service was disorganised due to lack of consistent management and provider support.

There were widespread, significant shortfalls in the way the service was led which had resulted in multiple and continued breaches of regulations. Governance systems were not robust enough to identify issues and drive improvement. Staff did not feel involved, appreciated or engaged with.

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 (report published 29 October 2020) and there were multiple breaches of regulations.

Why we inspected

This inspection was prompted in part due to concerns received about staffing, lack of staff training and inconsistent management. A decision was made for us to inspect and examine those risks and to follow-up on concerns identified at the previous inspection and to check whether any improvements had been made.

This report only covers our findings in relation to the Key Questions Safe and Well-led. 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 remained inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report.

The provider took some actions following the inspection to mitigate some risk.

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 to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified repeated breaches in relation to Regulation 12 (Safe care and treatment), Regulation 17 (Good governance) and Regulation 18 (Staffing). We have also identified a new breach of Regulation 13 (Safeguarding people from abuse).

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 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service remains in special measures'. 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.

Heathercroft Care Home is a ‘care home.’ The service is registered to provide nursing and personal care for up to 88 older people. The service is purpose built. There are two units within the service. Heathercroft unit is for people with nursing and personal care needs and the Ashberry unit is for people living with dementia. On the day of our inspection there were 69 people living in the service.

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

People were happy to live at Heathercroft but one person felt they waited a long time for support and two people didn't think there was much to do at the service. Most relatives were positive but had some feedback about having to depend on staff to use their own mobile phone data to contact them. They felt the service should help provide better access to the internet to help them speak with their relatives and they felt the communications could be improved. Two relatives had concerns about their family members care which we have referred to the provide to investigate formally within their complaints procedures.

Care plans within the nursing unit were not consistent and did not contain the most up to date information about people's health care needs and requirements. Care records lacked person centred detail and some did not reflect and take into account peoples actual needs and preferences.

Risk assessments were not always accurately completed or managed to minimise risks to people within the nursing unit. Daily care records were not maintained. People’s care, support and treatment had not always been carried out or monitored. Care records did not evidence appropriate care provided which exposed people to a risk of harm. During the inspection we identified people who were at significant risk of harm and we made safeguarding referrals to the council.

We found concerns around how continence care, personal care, pressure care and wound care was provided. A visiting professional raised their concerns about one person and felt the care was inappropriate and not meeting their needs.

Recruitment practices showed incomplete checks and lacked actions to demonstrate support for a new member of staff. There was a high number of staff off sick during the inspection which meant a higher number of agency staff were brought in to provide care. There was a lack of appropriate management and supervision of the agency staff who relied on long standing staff members to direct them to provide care to people within the nursing unit.

The physical environment was clean and tidy. But some areas within bedrooms identified clear risks with torn and worn floor coverings that created trip hazards.

Recent visits by the local authority and the infection control team had identified some inconsistent use of personal protective equipment (PPE) amongst staff. Most staff wore masks during the inspection but some staff walked around the building with the mask under their nose which was not the correct way to wear PPE and could pose potential risks to people. Hand washing audits had not been regularly carried out and highlighted potential risks amongst the staff team with management of infection control.

Quality assurance and auditing processes had been reviewed by the provider to help generate improvements to the service. However on-going concerns regarding clinical leadership, poorly maintained records, specifically in the nursing unit continued to be an issue highlighted by both the local authority and within the inspection. Governance systems within the nursing unit did not mitigate risk to the health and welfare of people living at the service.

We noted some personal records accessible and unlocked throughout the inspection to the nursing office. This was a continued concern noted at the previous inspection. It showed a potential breach of confidentiality.

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 May 2019) and there were two breaches of regulation.

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 not enough improvement had been made and the provider was still in breach of regulation. We also identified new breaches of regulations, meaning that the service had further deteriorated.

Why we inspected

We undertook this focused inspection due to concerns in relation to recent safeguarding's and to check the provider 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.

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 deteriorated to Inadequate. The service is therefore in 'Special measures'. 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 Heathercroft Care 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 monitor the service to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified repeated breaches in relation to Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance) at this inspection. We have also identified new breaches of Regulation 18 (Staffing.)

Follow up

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

As the service is now in ‘special measures’, 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.

Heathercroft Care Home 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. Heathercroft is set in its own grounds in the Woolston area of Warrington. The registered provider is Ashberry Healthcare Limited.

The home is registered to provide nursing and personal care for up to 88 older people. There are currently two units within the home: Heathercroft unit for people with nursing and personal care needs and Ashberry unit for people living with dementia. On the day of our inspection there were 74 people living in the home.

People’s experience of using this service:

People who used the service were happy about the service being delivered to them. We received mixed comments from relatives regarding staffing levels, use of agency staff, activities and care charts not always being completed.

Staff noted they had on-going problems with the recording and managing of their electronic system for ordering and recording of medications. We identified a breach of regulation regarding safe care and treatment and management of medications.

Support plans described the support people needed. People were referred to appropriate health and social care professionals when necessary. However, we found various issues with the lack of accurate updates regarding people's records which created risks in managing accurate care planning. We identified a breach of regulation regarding to good governance.

Quality assurance processes were detailed and regularly carried out to show actions and improvements to the service in the last 12 months. However on-going concerns regarding poorly maintained records and staff competencies to improve records continued to be an issue highlighted by both the local authority contracting team and within the inspection. There was a continued breach of regulation relating to good governance.

Staff were knowledgeable of local safeguarding procedures. The service had learnt from recent safeguarding incidents however improvements were still needed in the recording and delivery of care to those people cared for in their bedroom.

Health and safety systems provided regular oversight and support to consistently manage safe processes at the service. We noted some areas of wear and tear that the registered manager advised was part of their ongoing maintenance and decorating programme.

The home was clean and staff used appropriate techniques to prevent the spread of infection. One room had an unpleasant smell and staff took action to improve this room.

Staff and visiting members of multidisciplinary teams noted improvements to the service since the registered manager commenced in post. Staff felt supported and listened to.

Staffing was supported by agency staff to cover for vacancies and sickness. The registered manager advised they were recruiting and advertising posts and had recently recruited a new activities organiser. People living at the service and visiting relatives were unsure how many staff they could expect to see on duty each day.

People told us they enjoyed the food and drink provided. We observed mealtimes and saw that people had a choice of meals. Mealtimes were noisy at times with staff busy in various departments and could be heard carrying out their work while dining room doors were left open.

We noted some personal records accessible and unlocked throughout the inspection to the ground floor office. This highlighted potential concerns about people being able to access confidential information.

We have made a recommendation that the service review storage of confidential information.

Rating at last inspection: Requires Improvement (published 25 May 2018).

Why we inspected: This was a planned inspection based on the previous rating. We had received information of concern prior to the inspection from two safeguarding incidents that had been reviewed by Warrington local authority and were partially substantiated.

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

Follow up: You can see what action we told the provider to take at the back of the full version of the report. We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner. We will be meeting the provider to discuss the repeated breaches of regulations.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Heathercroft Care Home 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. Heathercroft is set in its own grounds in the Woolston area of Warrington. The registered provider is Ashberry Healthcare Limited.

The home is registered to provide nursing and personal care for up to 88 older people. The facility includes a 28 bedded unit for people who have dementia. There are currently two units within the home: Heathercroft unit for people with nursing and personal care needs and Ashberry unit for people living with dementia. On the day of our inspection there were 58 people living in the home.

The home does not have a registered manager. The manager in post who assisted with this inspection is applying to be registered with the Care Quality Commission. 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 last comprehensive inspection took place on 7 and 8 August 2017. At that inspection we identified six breaches of the relevant regulations in respect of the safe management of medicines, staffing, consent, person centred care, record keeping and governance. We served a notice asking the provider to be compliant with the regulations by 31 January 2018.

A further responsive inspection took place on 10 January 2018 following concerns raised about a specific incident. This inspection looked at the safe and well-led domains. We rated the provider inadequate and placed the service into special measures. We found the provider to be in breach of four regulations in respect of risk assessments, staffing, safeguarding and governance.

At this inspection, we found that there had been significant improvements and the provider had met the conditions of the warning notice. The provider is no longer in special measures. We did however find that the provider remained in breach of two regulations in relation to staff training and governance.

We asked staff members about training and supervision. Staff told us they received regular training and supervision throughout the year, however when we checked the records, we found there were significant numbers of staff where their training was out of date. Staff had been contacted by the provider and advised that this needed to be addressed. Supervisions were taking place, but there was still scope for improvement in this area.

The provider had a quality assurance system in place and regular audits were being completed, however we found inconsistencies in the standard of the audits. We found some where it was clear who was responsible for taking action and the timescales involved, whereas others did not contain this information. This meant that it was not always clear to see whether the actions identified had been completed.

We found that care plans provided clear guidance to staff on how to support the people living at Heathercroft. We saw most plans were updated regularly and were clear, however we saw that there was scope for improvement as a couple of plans had not been evaluated robustly when changes had occurred. Where additional monitoring of people’s needs was required, records were consistently kept.

We found that the arrangements for the administration, storage and disposal of medication were safe. However, there were issues with the electronic recording system. The electronic system was in operation for administering all medication with the exception of homely remedies, which were done via a paper record. This meant there was the potential for mistakes as both systems needed to be checked to ensure medications were given safely. We spot checked medication records and stock and found that no errors had occurred.

Risk assessments were more detailed; however there was scope for improvement in the evaluation of risks to people when changes occurred as these were not always updated appropriately.

The home was sufficiently staffed by suitably qualified and experienced staff who met the needs of the people living there.

We saw that the service had a safeguarding policy in place. This was designed to ensure that any safeguarding concerns that arose were dealt with openly and people were protected from possible harm. All the staff we spoke with confirmed they were aware of the need to report any safeguarding concerns.

We looked at recruitment files for the most recently appointed staff members to check that effective recruitment procedures had been completed. We found that appropriate checks had been made to ensure they were suitable to work with vulnerable adults.

There was a flexible menu in place which provided a good variety of food to the people using the service. People were positive about the food that was provided.

We observed caring, positive relationships between staff members and the people living in the home.

The manager continually sought feedback from people living in the service, relatives and staff in order to improve the service through regular meetings. Staff members and relatives spoke positively about how the improvements they had seen in the home since the new manager had been in post.

Heathercroft is a purpose built care home set in its own grounds in the Woolston area of Warrington. The registered provider is Ashberry Healthcare Limited.

The home provides nursing and personal care for up to 88 older people. There are currently three units within the home: Heathercroft unit for people with nursing and personal care needs; Ashcroft unit for people with nursing needs living with dementia and Ashberry unit for people living with dementia. On the day of our inspection there were 73 people living in the home.

The home does not have a registered manager. The manager in post who assisted with this inspection is applying to be registered with the Care Quality Commission. 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 last inspection took place on 7 and 8 August 2017. At that inspection we identified six breaches of the relevant regulations in respect of the safe management of medicines, staffing, consent, person centred care, record keeping and governance. We also found that the provider was not always appropriately notifying CQC of incidents. At this inspection, we found that there were some improvements in the safe management of medicines; however the provider remained in breach of five regulations in the safe and well-led domains.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

Risks to people were not managed safely and there was no clear guidance for staff on how to reduce the risks identified. There was no oversight or learning from incidents and accidents that happened in the home.

We found instances where safeguarding incidents had not been adequately recorded. Furthermore they had not been appropriately referred to the local safeguarding and related statutory notifications had not been sent to the Commission in a timely manner. There was little managerial oversight of these incidents so there was no learning on how things may be improved or prevented in the future.

There were insufficient staff to meet the needs of the people living in the home. Relatives, people living in the home and visiting professionals all commented on low staffing numbers within the home. Throughout our inspection, call bells were constantly ringing and we saw from records of previous days that these were not always answered promptly meaning that people were at potential risk and not receiving adequate standards of care. The provider had a heavy reliance on agency staff who at times did not attend for their shifts. The provider was actively recruiting for more staff and had addressed the issues with the agency around staff not attending.

We found that there had been some improvements in the management of medication such as medication was being stored and administered safely, but further improvement was required. Where medicines were given covertly, the correct procedures had not been followed, and there was no advice as to how these medications were to be taken and whether this was the most appropriate means of administering the medication.

We found that the provider had ineffective systems to monitor and improve the standard of care provided throughout the home. Whilst we saw that some improvements had been implemented on one of the units, there were serious shortfalls in another unit.

The registered provider did not have an effective quality assurance system in place. Where action plans were in place, it was not always clear to see what progress had been made against these plans. Insufficient progress had been made since the last inspection throughout the home as the systems that were in place had failed to identify the breaches that we found as part of this inspection.

We saw regular checks on the property were undertaken and the premises were safe without restricting people’s ability to move about freely.

Recruitment of staff within the home was safe.

Following this inspection, we are taking further action against the provider for repeated and serious failures to meet the regulations. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Heathercroft Care Home was previously inspected in November and December 2014 when it was found to be meeting all the regulatory requirements which were inspected at that time.

The home provides accommodation, personal and nursing care for up to 89 older people, some of whom have dementia care needs. The home is located in Woolston, a suburb of Warrington in Cheshire. The service is provided by Ashberry Healthcare limited. At the time of our inspection the service was accommodating 77 people.

Heathercroft Care Home is a purpose built, ground floor level home. One of the units within Heathercroft accommodates people in need of nursing or residential care. There is also another unit within Heathercroft for people living with dementia who have nursing needs. The home has a separate two storey extension named ‘Ashberry House’ which accommodates people living with dementia.

At the time of the inspection there was no registered manager at Heathercroft Care Home as the manager had resigned from post during June 2017. A new home manager had been appointed who was due to apply for registration with the CQC. 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.

During the inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 related to: person centred care; staffing and training; records and medicine management; need for consent and governance. We also found a breach of the Care Quality Commission (Registration) Regulations 2009 as the registered person had not always notified the Commission of incidents or allegations of abuse. You can see what action we told the provider to take at the back of the full version of the report.

There were not always enough staff on duty to ensure people received appropriate levels of care and support.

The management of medicines was in need of review to ensure adequate protection from the risks associated with unsafe medicines management and safeguarding records and processes were in need of review to ensure the welfare of people using the service was fully protected.

We found that best interest decision making processes and associated records had not always been completed in accordance with the Mental Capacity Act.

Staff training and development was in need of review to verify and evidence that staff had completed all the necessary training relevant to the work they are required to undertake.

People using the service did not always receive personalised care and support that was responsive to their needs and ensured they were treated with dignity and respect.

Care plan records, risk assessments and supporting documentation were in need of review to ensure the information recorded was up-to-date. Furthermore, governance systems and processes to ensure the quality of the service delivered required attention.

People using the service had access to a choice of menu and received wholesome and nutritious meals that were well presented and took into consideration each person's dietary needs.

Records showed that people also had access to a range of health care professionals subject to individual need.

We gathered information from a number of sources which included speaking with people who use the service and relatives of people who use the service. We also spoke with the manager of the service, the clinical lead, the cook and staff providing support to people during our visit. Comment cards were also made available to people who use the service, visitors and staff for them to tell us their experiences.

In addition to the themed inspection programme we also looked at how outcomes for people who use the service in relation to consent to care and treatment, nutrition and complaints. We included these outcome areas as we had received concerns in relation to the service sometime prior to our visit.

We observed staff speaking to people with dementia with respect and kindness and an awareness of individual's needs in relation dementia care.

We saw that people with dementia had good access to health care professionals such as their GP and speech and language therapists.

We looked at how people with dementia had their care planned. We saw that the documents were not always person centred and did not demonstrate that individuals had been involved in the planning of their care.

Audits of care provision were carried out by the staff supporting people with dementia however, we saw that improvements needed to be made in relation to how the provider measured the quality of the service delivered.