Heightside House Nursing Home

Heightside House Nursing Home is a residential care home providing personal and nursing care to up to 78 people. The service provides support to older people and younger adults with mental health support needs. Accommodation is provided in 4 units; The House, The Mews, Close Care and The Gate House. The House is an adapted building, over 4 floors and incorporates the High Dependency Unit, The Mews is purpose built and consists of one 6 bedded unit, shared bungalows and flats, Close Care is purpose-built and includes a 7 bedded unit and a bungalow and The Gate House is an adapted building and can accommodate up to 3 people. No-one was living in The Gate House at the time of our inspection. There is also a separate activities centre. At the time of the inspection 47 people were living at the service.

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

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.

People’s medicines were not always managed safely or in line with national guidance. People told us they felt safe living at the home, and we found that risks to their health, safety and wellbeing were managed well. Staff were recruited safely and knew how to protect people from abuse and avoidable harm. Staffing levels were appropriate to meet people’s needs and people told us they did not wait long for support. Staff did not always wear appropriate personal protective equipment (PPE) to protect people from COVID-19 and the risk of cross infection. We have made a recommendation about this. Appropriate action was taken to manage accidents and incidents, and the safety of the home environment was checked regularly.

The audits completed by staff and management did not identify many of the shortfalls in medicines processes and practices that we found during our inspection. Where audits had identified that improvements were needed, action had not always been taken. The registered manager and staff understood their roles and responsibilities. They worked in partnership with community health and social care professionals to ensure people received any specialist support they needed. Management sought people’s views about the service and acted upon them. People and staff were happy with the management of the service and felt it had improved under the new registered manager.

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

Rating at last inspection and update

The last rating for the service was requires improvement (published 22 July 2021).

For those key questions not inspected, we used the ratings awarded at the last inspection where those key question were reviewed, to calculate the overall rating.

Why we inspected

We carried out an unannounced focused inspection of this service on 21 June 2021. Breaches of legal requirements were found. We issued the provider with Warning Notices and requested they be compliant by 5 August 2021.

We undertook this focused inspection to check whether the Warning Notices we previously served in relation to Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this focused inspection and remains requires improvement.

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 breaches in relation to the management of people’s medicines and the provider’s oversight of medicines processes and practices 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 work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Heightside House Nursing Home is a residential care home which provides accommodation, nursing care and personal care for up to 78 older people and younger adults with mental health support needs. Accommodation is provided in four units; The House, The Mews, Close Care and The Gate House. The House is an adapted building, over four floors and incorporates the High Dependency Unit, The Mews is purpose built and consists of one six bedded unit, shared bungalows and flats, Close Care is purpose-built and includes a seven bedded unit and a bungalow and The Gate House is an adapted building and can accommodate up to three people. No-one was living in The Gate House at the time of our inspection. There is also a separate activities centre. At the time of the inspection 53 people were living at the service.

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

People’s medicines were not always managed safely; we found a number of shortfalls in medicines practices at the service. People told us they felt safe living at the home and there were enough staff available to meet their needs. Staff supported people to manage risks to their health and wellbeing and understood how to protect people from the risk of abuse. The provider followed safe recruitment practices when employing new staff. Staff followed safe infection control procedures and wore appropriate personal protective equipment (PPE), to protect people from the risk of infection and contracting the COVID-19 virus. The safety of the home environment was checked regularly.

The ongoing issues with medicine management at the service, meant that the provider did not have effective processes in place to monitor the quality and safety of the service and ensure improvements were made when needed. The service worked in partnership with community agencies to ensure people received the support they needed. People, relatives and staff felt the service was managed well. People’s views were sought about the service; however, it was not always clear what action was taken in response to the feedback they provided. We have made a recommendation about ensuring people’s views about the meals provided at the home are considered and acted upon. We will follow this up at the next inspection.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 17 February 2020). At that inspection we found two breaches of regulation relating to the management of people’s medicines and a lack of effective systems to monitor and improve the quality and safety of the service. The provider completed an action plan after that inspection to show what they would do and by when to improve. At this inspection we found that not enough improvement had been made and the provider was still in breach of those regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last six consecutive inspections.

Why we inspected

We undertook this focused inspection to check that 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 of Safe and Well-led which contain those requirements.

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 requires improvement. 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 Heightside House Nursing Home on our website at www.cqc.org.uk

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

At this inspection, we have identified breaches in relation to the unsafe management of people’s medicines and the lack of effective systems in place to ensure the quality and safety of the service. Please see the action we have told the provider to take at the end of this report.

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.

Heightside House Nursing Home is a residential care home which is registered to provide personal and nursing care and for up to 78 adults with mental ill health. At the time of the inspection 54 people were accommodated.

Accommodation is provided in four separate 'units.' The House, The Mews, Close Care and The Gate House. There is also a separate rehabilitation and activities centre.

The House is an adapted premises and incorporates the High Dependency Unit. The Mews is purpose built and consists of one six bedded unit, shared bungalows and flats. Close Care is a purpose-built premises and includes a seven bedded unit and a bungalow. The Gate House, which was not occupied, is an adapted building and can accommodate up to three people.

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

Medicines were not always managed safely which placed people at risk of harm. We found shortfalls with provider's systems to monitor and improve the quality of care people experienced.

Progress had been made with assessing and managing risks to people's individual well-being and safety. We observed people were relaxed and content in the company of staff and managers. People expressed some concerns about the behaviours of others, but told us they felt safe at the service. Processes were in place to maintain a safe and hygienic environment.

Recruitment practices made sure appropriate checks were carried out before staff started work, some information was missing; this was rectified during the inspection. There were enough suitable staff available to provide care and support; the registered manager had introduced a process to monitor and review staffing levels. Staff had received training on positively responding to people and safeguarding. Staff were aware of the signs and indicators of abuse and they knew what to do if they had any concerns.

Processes were in place to assess people's backgrounds, their needs, abilities, preferences and risks, before they used the service. 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.

People again had mixed views about the catering arrangements, there was ongoing consultation to make improvements. A variety of meals and drinks were offered and healthy eating was promoted Individual dietary needs and choices were known and catered for. Ongoing progress had been made to improve the décor and furnishings for people's needs, comfort and wellbeing. The provider offered staff a programme of training, development and supervision. People were supported with their healthcare needs, medical appointments and general well-being.

People made some positive comments about the staff and managers. We observed staff interacting with people in a kind, pleasant and friendly manner. Staff knew people well and were respectful of their choices and preferred routines. People's privacy and dignity was respected and their independence was encouraged.

Progress had been made with the planning and delivery of person-centred care and support. Care plans were relevant and detailed, reviews were consistent, and people were more actively involved. There were opportunities for people to engage in a wide range of community based and in-house activities. People were supported to have contact with families and friends. Processes were in place to support people with making complaints. Some complaints records were unclear. We were assured action would be taken to make improvements.

Heightside House had a welcoming, friendly and inclusive atmosphere. Management and leadership arrangements supported the effective day to day running of the service. There were processes to consult with people who used the service and others, to assess and monitor the quality of their experiences and make improvements. Links had been established with partner agencies and community resources.

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 9 January 2019). 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 some improvements had been made, however the provider was still in breach of one regulation and we identified a additional breach. The service remains rated requires improvement. This service has been rated requires improvement for the last five consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the safe management of medicines and checking systems at this inspection.

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

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Heightside House Nursing Home is a care home which is registered to provide nursing care and

accommodation for up to 78 adults with mental ill health. People in care homes receive accommodation and nursing 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.

Accommodation is provided in four separate 'units.' The House, The Mews, Close Care and The Gate House. There is also a separate rehabilitation/activities centre.

The House is an adapted premises and incorporates the High Dependency Unit and has both single and double bedrooms over four floors. Some bedrooms have en-suite facilities. There are two lounges, one lounge/dining room, a separate dining room and a room for people who smoke. A passenger lift provides access to all floors. The Mews is purpose built and consists of one six bedded unit, shared bungalows and flats. Close Care is a purpose built premises and includes a seven bedded unit and a bungalow accommodating four people. The Gate House is an adapted building and can accommodate up to three people. All the bedrooms are single occupancy and there are communal lounges/dining areas.

The service was managed by a registered manager; however, they were not available at this 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.

At our last inspection on the 19, 20 and 21 February 2018 the overall rating of the service was Requires Improvement. The provider was in breach of two regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014. The breaches related to a lack of robust processes for mitigating and managing risks to individuals, also quality monitoring and oversight.

We also found some further progress was needed with acting upon people's views, ideas and suggestions, we therefore made a recommendation on this matter. Following the inspection, we received an action plan from the provider outlining the action they would take to make improvements. As this was the third time the service had been rated Requires Improvement, we held a meeting with the provider to discuss their plans going forward and their governance arrangements at the service.

At this inspection we found the provider was in breach of three regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014. The breaches related to a lack of robust processes for managing risks to individuals, unsafe medicines management and a lack of person centred care planning. This was the fourth consecutive time the service was rated as Requires Improvement. You can see what action we told the provider to take at the back of the full version of this report.

There was a management team in place to provide leadership and direction of the service. The provider had introduced better processes for monitoring and checking the service and making improvements. Some of these processes were new, therefore time was needed to show how they worked and if they would ensure there was effective monitoring and development at the service.

We again found some individual risk assessments had not been properly completed or regularly reviewed. We could see some improvements had been made, but progress had been slow in ensuring risks to people’s well-being and safety were identified and managed. We also found improvements were needed with supporting people safely with their medicines.

Processes for planning and delivering people’s care required improvement, to make sure it was personalised to them and met their individual needs, goals and choices. Progress was needed in involving people in the care planning process and showing they consented to their care and support.

Systems were in place to maintain a safe environment for people who used the service and others.

We found some matters to make improvements were ongoing. Processes were in place to prevent and control the spread of infection.

Recruitment practices were in place to make sure appropriate checks were carried out before staff started working at the service. There were enough staff available to provide care and support and staffing arrangements were kept under review.

People made positive comments about the care and support they received from staff. We observed positive and respectful interactions between people who used the service and staff. People’s individuality and dignity was respected.

Staff were aware of the signs and indicators of abuse and they knew what to if they had any concerns. Staff had received training on safeguarding and protection matters. They had also received training on positively responding to people's behaviours.

There had been some safeguarding incidents and allegations, some were ongoing. The service monitored safeguarding matters, to learn from them and make improvements.

Arrangements were in place to gather information on people's backgrounds, their needs, abilities and preferences before they used the service.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. Policies and processes at the service supported this practice.

People had mixed views about the quantity and variety of meals provided at Heightside House. Some were not satisfied and had therefore raised their concerns, we found action was being taken to make improvements.

Arrangements were in place to support people with their healthcare needs, further improvements had been identified and were being made.

People had opportunities for skill development and confidence building. They were supported with their hobbies and interests, including activities in the local community.

New systems were in place to respond and manage people’s complaints and general dissatisfaction. People had been consulted on their experience of the service, but their comments and suggestions were not always acted upon to their satisfaction.

Heightside House Nursing Home is a care home which is registered to provide nursing care and accommodation for up to 78 adults with mental ill health. People in care homes receive accommodation and nursing 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.

Accommodation is provided in four separate ‘units.’ The House, The Mews, Close Care and The Gate House. There is also a separate rehabilitation/activities centre. The House is an adapted premises and incorporates the High Dependency Unit and has both single and double bedrooms over four floors. Some bedrooms have en-suite facilities. There are two lounges, one lounge/dining room, a separate dining room and a room for people who smoke. A passenger lift provides access to all floors. The Mews is purpose built and consists of one six bedded unit, shared bungalows and flats. Close Care is a purpose built premises and includes a seven bedded unit and a bungalow accommodating four people. The Gate House is an adapted building and can accommodate up to three people. All the bedrooms are single occupancy and there are communal lounges/dining areas.

The service was managed by a registered manager. 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.

At our last inspection on the 22 and 23 February 2017 the overall rating of the service was ‘Requires Improvement’. We found progress was needed with medicines management, checking systems and provider oversight of the service. We therefore made recommendations on these matters.

During this inspection we found the provider was in breach of two regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014. The breaches related to a lack of robust processes for mitigating and managing risks to individuals, also quality monitoring and oversight. You can see what action we told the provider to take at the back of the full version of this report. We also found some further progress was needed with acting upon people’s views, ideas and suggestions and have therefore made a recommendation on this matter. This was the third consecutive time this service has been rated Requires Improvement.

We found there were good management and leadership arrangements in place to support the day to day running of the service. However it was not clear the provider had proper oversight of the service. We noted there was a lack of information to show how they assured themselves about the quality and safety at the service.

Systems were in place to maintain a safe environment for people who used the service and others. Processes were in place to prevent and control the spread of infection. We found some matters were in need of attention and the registered manager commenced action to make improvements.

There were safe processes in place to support people with their medicines, but some improvements were needed.

Recruitment practices were in place to make sure appropriate checks were carried out before staff started working at the service. There were enough staff available to provide care and support and staffing arrangements were kept under review.

Staff were aware of the signs and indicators of abuse and they knew what to if they had any concerns. Staff had received training on safeguarding and protection matters. They had also received training on positively responding to people’s behaviours. The service monitored incidents and accidents and to ensure there was a proactive ‘lessons learned’ approach.

Arrangements were in place to gather information on people’s backgrounds, their needs, abilities and preferences before they used the service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Policies and processes at the service supported this practice

We found people were supported with their healthcare needs and medical appointments. Changes in people’s health and well-being were monitored and responded to. Policies had been introduced to provide guidance for staff on supporting people who refused support with their healthcare needs.

People had mixed views about the quality and variety of meals provided at Heightside House. However we found action was being taken to make improvements.

People made positive comments about the care and support they received from staff. We observed positive and respectful interactions between people who used the service and staff.

Each person had a care plan, describing their individual needs and choices. This provided guidance for staff on how to provide support. People had been involved with planning and reviewing their care. However we found improvements were needed with some aspects of care planning and reviews.

People had been actively involved with the up-grading of the premises, including choosing furniture, colour schemes and soft furnishings.

People were supported with their hobbies and interests, including activities in the local community and keeping in touch with their relatives and friends. There were opportunities for skill development and promoting independence.

There were processes in place for dealing with complaints. There was a formal procedure to manage, investigate and respond to people’s complaints and concerns.

There were systems in place to consult with people who used the service, to assess and monitor the quality of their experiences.

Heightside House is registered to provide nursing care for up to 78 people who have mental health care needs. The service provides long and short term care/support and rehabilitation. There are extensive grounds with walkways, lawns, gardens and a greenhouse. There is access to public transport at the bottom of the drive. At the time of the inspection there were 55 people accommodated at the service.

Accommodation is provided in four separate units: The House, The Mews, Close Care and The Gate House. There is also a separate rehabilitation/activities centre.

The House incorporates the High Dependency Unit and has both single and double bedrooms over four floors. Some bedrooms have en-suite facilities. There are two lounges, one lounge/dining room, a separate dining room and a room for people who smoke. A passenger lift provides access to all floors.

The Mews consists of one five bedded unit, shared bungalows and flats. Close Care includes a seven bedded unit and a bungalow accommodating four people.

The Gate House can accommodate up to three people. All the bedrooms are single occupancy and there are communal lounges/dining areas.

The service was managed by a registered manager. 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.

At the previous inspection on 12 and 13 August 2015, we asked the provider to make improvements in relation to: effective and safe staff recruitment procedures, the safe management of medicines, preventable and avoidable risks of harm to individuals, the safety and security of premises and equipment, the processes for receiving and acting on complaints and the processes in place to ensure the service is operated effectively. We received an action plan from the provider indicating how and when they would meet the relevant legal requirements. At this inspection we found sufficient improvements had been made in rectifying these matters. However further progress was needed with medicines management and some checking systems for provider oversight of the service. We have therefore made recommendations on these matters.

People spoken with did not express any concerns about the way they were treated or supported. We did not observe anything to give us cause for concern about people’s wellbeing and safety. People had access to information on abuse, protection and safeguarding. Individual risk assessments had been carried out and staff were given instructions about how to manage any risks to help keep people safe. Staff expressed a good understanding of safeguarding and protection matters; they knew what to do if they had any concerns.

Recruitment practices made sure appropriate checks were carried out before staff started working at the service. There were enough staff at the service to provide people with support and changes to staffing levels could be made if needed.

There were some good processes in place to manage and store people’s medicines safely. We found some improvements were needed; we have therefore made a recommendation about the management of medicines. Staff responsible for supporting people with medicines had completed training. This had included an assessment to make sure they were capable in this task.

Arrangements were in place to promote the safety and security of the premises, this included maintenance, servicing and checking systems. We noted refurbishment had been carried out to up-grade and improve the environment; however we requested that some areas were attended to during the inspection.

People’s needs were being assessed and planned for before they moved into the service. Assessments had been completed on people’s physical, mental health and lifestyle. People were supported with their healthcare needs and medical appointments.

Each person had a care plan to guide staff on how to respond to their needs and choices. A process was being introduced to involve people in working towards their mental health recovery. Care plans were kept under review. We found some care records were lacking in detail, but action was in progress to make improvements.

The service was working within the principles of the MCA (Mental Capacity Act 2005). During the inspection we observed staff involving people in routine decisions and consulting with them on their individual needs and preferences.

People were happy with the variety and quality of the meals provided at the service. Support was provided with dietary requirements in response to individual needs. We found various choices were on offer. Drinks were accessible and regularly offered. Some people were supported to cook their own meals as part of the rehabilitation process.

People spoken with indicated they were treated well. They said their privacy and dignity was respected by staff. Throughout the inspection we observed staff interacting with people in a kind, pleasant and friendly manner. They were respectful of people's choices and opinions.

There were opportunities for people to engage in a range of suitable group and individual activities. People told us how they were accessing the community and keeping in contact with families and friends. There were opportunities for people to develop and learn independence skills. We suggested ways of further encouraging self-help skills.

People were encouraged to voice any concerns in day to day discussions with staff and managers, during their reviews, in residents meetings and in surveys. There was a formal complaints system to manage and respond to people’s concerns and any dissatisfaction with the service. However we found one complaint had not been properly dealt with and was unresolved.

There were systems in place to ensure all staff received regular training and supervision. We found some staff appraisals and supervision meetings were overdue, but action had been taken to address this matter.

The service had a management and leadership team to direct and support the day to day running of the service. There were systems in place to consult with people who used the service and others, to assess and monitor the quality of their experiences. We have made a recommendation to improve the quality monitoring and governance systems at the service.

We found the training matrix had been updated and staff had undergone training in topics relevant to the service to ensure there was a well trained staff team. All four members of staff we talked with said they had undergone a lot of training over the last few months. Some staff told us they were also booked on further courses to update their knowledge.

We looked at four care plans because the manager said part of the training had been to upgrade and improve the plans. We found the plans had been standardised between the three different units and had been greatly improved. The improvement was in the quality of the forms used, regular review and the inclusion of people who used the service.

Plans of care contained sufficient detail for staff to follow good practice.

People who used the service told us, "I am happy here. I enjoy doing what I want. I really enjoy helping out in the garden when I can “ and " I like it here. I can come and go when I like". People were able to follow their activities and hobbies if they wished.

There was an accessible complaints procedure which enabled people who used the service to voice any concerns.

Two staff members we spoke with told us, "I love working here. There is a good atmosphere" and "I like working here. It is different every day. We have a good staff team and we all work well together. I enjoy looking after people". Staff were motivated to look after the people accommodated at the home.