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Heatherside House Care Centre Requires improvement

We are carrying out a review of quality at Heatherside House Care Centre. We will publish a report when our review is complete. Find out more about our inspection reports.

Inspection Summary


Overall summary & rating

Requires improvement

Updated 22 November 2018

This unannounced comprehensive inspection started on 2 August 2018. We returned for a second day on the 16 August 2018 which was arranged with the registered manager during the first inspection day. Both inspection days were carried out by two inspectors, who were accompanied on the first day by an expert by experience.

Heatherside House Care Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service provides care and support for up to 25 younger and older adults with a diagnosis of learning disability and/or autism. Some people also have sensory impairments and/or physical disabilities. There were 21 people living at the service at the time of the inspection. Three other people also used the service for respite care on a regular basis each week.

At a comprehensive inspection in March 2017, we found ongoing breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This included a breach of Regulation 12 (safe care and treatment). This was because risks to people had not been assessed and documented. Routine fire checks were not being carried out. Some medicines were out of date; medicines were not always recorded appropriately.

At that inspection we also found breaches of 17 (Good governance), 18 (Staffing) and 19 (Fit and proper persons employed). This was because recruitment processes did not always include all the checks necessary to ensure that fit and proper people were employed; staff were not up to date with all the training required and did not receive regular supervision; Quality and safety systems were not robust and had not identified areas where improvement was necessary, including medicine administration audits, building checks, staff training and changes to care records.

Following the March 2017 inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Is the service safe? Is the service effective, Is the service responsive and Is the service well-led? to at least good. Because of the concerns in respect of the governance of the home, CQC took enforcement action by serving a warning notice on the provider and on the registered manager. These warning notices gave the service six months to meet the requirements of Regulation 17, good governance.

We undertook a focussed inspection in December 2017 to check whether the service had addressed the concerns in the warning notices. At this inspection we only looked at the Well-led domain. We found that the requirements of the warning notice had not been met and there was an still a breach of Regulation 17. We identified significant ongoing concerns which included:

• A lack of robust quality assurance framework and systems

• Risks relating to health, safety and welfare of residents had not been considered or addressed

• Audits of care records had not resulted in updates and amendments where needed

• Audits of buildings and equipment had not identified or address issues

• Communication systems were not robust and did not ensure that staff would be made aware of changes to people’s care

• People and their families had not been involved in meaningful decisions about the ongoing refurbishment work in the home

• The registered manager had not been aware of current national policy including Registering the Right Support and other best practice guidance.

Following the focussed inspection, we met with the provider to discuss how they were going to meet the requirements of the warning notice and improve the service to ensure that they were good in all domains.

At the current inspection we found the quality assurance and governance arrangements for the home were still not sufficient to ensure that people received safe, effective care. Environme

Inspection areas

Safe

Requires improvement

Updated 22 November 2018

The service was not safe.

People were placed at risk of an unsafe environment as environmental checks had not identified risks or taken action to address them.

The risks associated with people managing and storing their own medicines had not been considered. Where medicines were administered by staff, this was carried out safely.

People were supported by staff who had been recruited safely. There were sufficient staff to meet people’s needs.

People were protected from the risk of infection as the home was clean and staff understood how to follow good hygiene practices.

People were protected from the risks of abuse by staff who understood their responsibilities. However, staff were not up to date with their safeguarding vulnerable adult training.

People were not protected from accidents / incidents happening again because there were no systems to learn from them.

Effective

Requires improvement

Updated 22 November 2018

The service was not effective.

The service was not effective.

People were at risk of not having their needs met as staff had not completed the training necessary to ensure they were competent and up-to-date with best practice so that they were able to meet people’s needs.

Staff had not completed or recorded assessments of people’s mental capacity where there were doubts about a person’s ability to make a decision.

Where people’s liberty was being restricted staff had not followed the Mental Capacity Act 2005 and made applications for a Deprivation of Liberty Safeguards authorisation.

People said they enjoyed the food and were supported to maintain a healthy balanced diet of their choice. People were supported to remain hydrated.

People received effective health care as Staff contacted health professionals appropriately and followed their advice.

The home did not meet the standards described in best practice guidance for supporting people living with a learning disability.

The home had undergone extensive refurbishment which meant that people now had ensuite bedrooms which they said they were very pleased with.

Caring

Requires improvement

Updated 22 November 2018

Some aspects of the service were not caring as it did not take into consideration how to support people to be as independent as possible.

People were supported with compassion and respect by staff who were caring.

People were encouraged to stay in touch with family and friends, who could visit when they wanted.

People were encouraged by staff to enjoy various activities of their choice.

People were able to communicate and be understood by staff. Staff were able to describe how they communicated with, and understood people who had little or no verbal communication.

People’s right to privacy and dignity was upheld by staff who were kind and discreet when supporting them.

Responsive

Requires improvement

Updated 22 November 2018

The service was not fully responsive.

People were at risk of not receiving the care and support they needs as care records were not all up to date and in an orderly manner.

People said they were able to complain or raise a concern. However the complaints procedure was not in a format that people with little or no communication would be able to use.

Relatives were very positive about the care provided to their family members.

Well-led

Inadequate

Updated 22 November 2018

The service was not well-led.

The service was not well-led.

People were at risk as checks and audits to ensure the safety and quality of the home had not identified environmental risks.

People were at risk as the provider did not have a governance framework which ensure they were able to monitor and address issues. This included senior staff not being aware of issues relating to staff training.

Directors from the provider organisation visited the home frequently and knew staff and people well.

Staff and families said they felt supported by the registered manager.