Heathcote

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question good. At this assessment, the rating has remained good. This meant people were safe and protected from avoidable harm.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The provider had robust systems in place to record, review, and learn from incidents. The home had an open culture where staff felt able to discuss concerns and reflect on good and poor practices. Staff observations, training, and induction helped to embed good working practices and the registered manager led by example. Care documents recorded day to day care but also highlighted incidents, accidents and safeguarding concerns which required the registered manager and senior management sign off to ensure actions taken were appropriate.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The registered manager knew people very well as did the rest of their staff team. Working in partnership with other agencies was key to the success of this service. Adaptations and equipment were provided where required and people’s needs were kept under review. Continuity of care was provided and where people needed secondary care services, staff would make arrangements with family or support people if appropriate.The GP was regular and knew the service well.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm, and neglect. The provider shared concerns quickly and appropriately.

Systems and processes were in place to ensure staff were trained and help them recognise what constituted abuse and what safeguards should be put in place to keep people safe. Staff had safeguarding training and had opportunities to discuss any concerns they might have about people’s safety. Staff told us they were aware of the safeguarding and whistle-blowing policy which were accessible to them. Staff told us they felt able to raise concerns. Staff were confident in management and said an open-door policy meant they were able to speak to the manager or other senior staff when they needed to.

No concerns were raised about people’s safety and people told us they felt safe.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive, and enabled people to do the things that mattered to them.

Relatives did not raise any concerns about safety. One relative said, “Mentally, they are very alert, but physically too weak to hold a cup. The care workers are very helpful. They do everything for them and use a hoist safely. They pop in to check on them every few hours.”

We observed staff being attentive and being mindful of risk ensuring people had what they needed to stay safe. Care plans identified any risks in relation to health, mobility, and eating and drinking. Steps were recorded to show what actions were taken to reduce risk such as regular weights, monitoring, equipment, and referral to other agencies for support and advice.

Very few incidents or accidents had occurred due to the proactive nature of the service but there were systems in place to record any incidents and lessons learnt.

Staff monitored people at risk of dehydration. People had fluid targets which if not achieved would be acted upon via the GP or other medical professional. Some people were able to drink independently and recognise when they were thirsty and could access their own fluids. We reminded the service to remove records where there was not a need to monitor the person as no risk had been identified. We attended the staff handover and found this was detailed and staff passed on any changes or risks in people’s needs and actions necessary.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

We reviewed a range of files including water management, maintenance, health and safety, fire safety, and quality assurance. The water management folder was well organised, with evidence of Legionella training, regular flushing of little-used outlets, monthly temperature checks, quarterly descaling, and external sampling with all results passing, which showed good oversight of water safety.

Maintenance records evidenced daily room checks and monthly workplace inspections. Some issues, such as cracked windows, had been identified and were being monitored, with confirmation from maintenance that these had been assessed a slow risk and logged on the provider’s system. This showed risks were identified and managed, although the audit trail could be clearer in evidencing actions and follow-through.

Fire safety records included a current fire risk assessment, clear zoning, and detailed personal emergency evacuation plans (PEEPs) for each person using the service. These included photos for residents, which supported safe evacuation planning. Weekly fire alarm checks were also up to date. One PEEP lacked detail about evacuation from the second floor. The registered manager explained some bedrooms were only suitable for people who were mobile and physically independent and could exit the home unaided and this was kept under review. Staff spoken with demonstrated a good understanding or fire safety and horizontal fire evacuation. We reviewed the fire risk assessment and a couple of remedial actions had been rectified without delay.

A stairs risk assessment was in place, but we raised a concern about internal stairs and uneven flooring and stated this should be included in individual risk assessments where appropriate. Some of the rooms were not suitable for people with advanced cognitive issues or mobility issues. Some rooms and hallways were too narrow for equipment, so the registered manager was very careful in terms of their admission process and reviewing people’s needs in an ongoing way. The provider had other provisions which may be more suited for people with advanced care needs.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Staffing levels matched people’s needs and the manager carefully considered during the pre-admission assessment whether they could safely meet the persons needs or not. Staff told us staffing was flexible and should someone be unwell or require extra support this was provided.

The most striking feature of this service was that all the staff had been at the service for a long time, including the registered manager, two deputy managers and senior carers. There were no staff vacancies other than maternity leave and this post had already been back filled. The service every year had students from a local university in Norwich who undertook work placements at the home. These were students looking to become GP's and gave them an inside into social care. They were provided with relevant training. This evidence demonstrates collaborative working with partners to help support the workforce and people at Heathcote. Staff retention was good and staff were supported to progress within the company if that is what they chose to do. Employee of the month helped to keep staff motivated and strive for excellence.

Staff had designated roles including champions where they had a lead responsibility for an area of practice such as dignity champions. They also had key working duties where they over saw people’s care. In addition here was a solid management structure with managers getting time to do administrative duties as well as supporting staff with day-to-day care. All staff worked inclusively regardless of their role and strong team work which meant the service was flawless and enhanced people’s experiences and safety.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

There were good infection control practices within the home to reduce the risk of infection spreading from one person to the other. Domestic staff were employed across the week and supported by care staff in keeping the home clean and completing daily schedules and monthly deep cleans. Staff were well trained and competent and knew people well and what support they needed in keeping their personal spaces clean.

Our observations were that the home was spotless with no overpowering odours and where a person needed support with continence management this was given in a timely way.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities, and preferences. Staff involved people in planning, including when changes happened.

The home used an electronic system to manage medicines safely and staff were trained and competent in using the system and there were adequate numbers of staff trained. People were supported to take their medicines correctly and in line with their needs and preferences.

A staff member was observed administering medication confidently, and staff described medicines processes as ,"Straightforward and simple", and told us the training was effective.

Medication audits helped ensure medicines were available and kept under review. Regular weekly GP visits helped ensure people’s health care needs were met and medicines prescribed remained appropriate.

Topical creams were stored safely and where a person could be involved in any part of their medication administration this was encouraged. For example, one person managed their own insulin administration with support of staff thus facilitating their independence.