Heather Vale

Heather Vale is a residential care home providing personal and nursing care to 37 people aged 65 and over at the time of the inspection. The service can support up to 39 people.

Accommodation is provided over two floors, in one adapted building. Each floor has two separate wings, each providing individual bedroom and communal living facilities, such as dining rooms, kitchenette areas and specialist bathing facilities.

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

Auditing systems were not always effective or used to drive improvement in the quality and safety of the service provided. Medicine errors had not been identified or consistently addressed. Care plans did not always contain all the required information or risk assessments in line with people’s long-term conditions. This meant we could not be assured people would receive the care they required for their current needs.

The registered manager and deputy offered support to staff and had an open approach with relatives. However, overarching governance was not in place to ensure ongoing improvements were coordinated and maintained.

Infection, prevention and control was managed well, and guidance followed in line with COVID 19. Point of care hand washing facilities were not always accessible and this was addressed immediately after the inspection.

There were sufficient staff who had been recruited safely. Staff showed kindness and compassion in meeting people’s needs. Consideration was given to people’s daily choices and the decoration of their own space.

People were protected from the risk of harm and when concerns had been raised, these were investigated. Lessons had been learnt from these events. Surveys had been used to obtain people’s views and these showed positive outcomes.

The staff worked well with health and social care professionals in meeting peoples ongoing health needs.

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 Good (published 21 November 2019)

Why we inspected

We received concerns in relation to people’s care, medicine and management. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. 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 see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Heather Vale 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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to Regulation 12 (safe care and treatment) and Regulation 17 (Good Governance).

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

Heather Vale is a residential care home providing personal care for up to 39 older people, including some who may be living with dementia. There were 32 people receiving care at the service at this inspection.

Accommodation is provided over two floors, in one adapted building. Each floor has two separate wings, each providing individual bedroom and communal living facilities, such as dining rooms, kitchenette areas and specialist bathing facilities.

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

The service was now well managed and effective governance systems were re-established, to help ensure the quality and safety of people’s care. However, this was not yet demonstrated by the provider as fully embedded, sustained, or ongoing for people’s care.

Recently revised staffing, medicines, risk management and oversight arrangements for people’s care now helped to ensure people’s safety at the service. People were therefore now protected from the risk of harm or abuse. The provider had taken action when things went wrong at the service and now referred to relevant authorities involved with people’s care when required to do so for their safety.

People’s care, environment and related equipment needs were met. Staff supported people to maintain or improve their health and nutrition as agreed with them and any external health professionals involved in their care. People were supported to have maximum control of their lives and staff supported them in the least restrictive way possible. The provider’s related policies and systems supported this practice.

Staff were now effectively supervised, supported and trained to carry out their role and responsibilities. Timely information with external care professionals, authorities and providers, helped to ensure people received timely, consistent care as agreed with them; including when they needed to move between services.

People received care from kind, caring staff who ensured their dignity, equality and rights in their care. Staff had good relationships with people and their relatives. They knew people well, including what was important to people for their care and how to communicate with them in a way they understood. People were now consistently informed, involved and supported to understand, agree and make ongoing decisions about their care.

People received timely, personalised care that was tailored to their individual needs and wishes. This was now provided in a way, which helped to optimise people’s independence, inclusion and engagement in home life; and with their friends, family and local community as they chose. Arrangements were in place through consultation with relevant lead professionals; to support people living with a life limiting illness and to help ensure their dignity and comfort, including at the end of their life. Further improvements were commenced to maximise opportunities for people’s consultation and choice in a more personalised way.

People, relatives and staff were informed and now confident and supported to make a complaint or raise any concerns about the service, if they needed to. Related findings were now used to help inform and ensure any service improvements needed.

People, relatives and staff were now confident in the management and leadership of the service. Effective management arrangements had been re-established to ensure timely and accurate communication, record keeping and information handling at the service; along with relevant engagement and partnership working, to inform and promote people’s care and safety.

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 (November 2018). There were 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 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. The overall rating is now Good. However, the provider now needs to demonstrate their improvements as fully embedded, sustained and ongoing. Please see Well Led section 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.

This inspection visit took place on 16 October 2018 and was unannounced. It was completed by two inspectors, a nurse specialist and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Heather Vale is a care home registered to support 39 people. 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 accommodation is provided over two floors. On each floor there are two separate units. Each have their own dining facilities and assisted bathrooms. On the ground floor there is a large communal lounge and an accessible secure garden. At the time of our inspection 36 people were living at the home.

There was a registered manager at this location. 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 we rated the service as ‘Good.’ At this inspection we found some areas required improvement

There were not always enough staff to support the needs of people. Risk assessments had not always been updated or reflected the persons current situation. When people received their medicine support this was completed safely. However, some areas of medicine needed improvement and plans were in place for the training to be completed.

When people were nearing the end of their lives, care plans and assessments did not reflect the support needs the person may wish. Some other care plans were not up to date in reflecting changes in people’s care needs.

People were protected from the risk of infection and staff were observed to use gloves and aprons when supporting people with personal needs or support with their meal. Lessons had been learnt from events which had been used to make changes to drive improvements.

People were supported with activities to pass the day and regular entertainment or days out were planned. The staff worked in partnership with a range of professionals and local contacts. Meals provided people with a choice and supported their nutritional needs.

Complaints had been addressed and the registered manager understood their role in relation to their registration with us. Information was displayed for people and relatives to access, including the displaying of the rating of the most recent inspection.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. Health care had a focus to ensure people’s ongoing wellbeing.

Staff had received training to support their role. In addition, ongoing support was available to staff which they felt was responsive to their needs. Staff had received training in safeguarding and knew how to raise any concerns. When concerns had been raised they were investigated and addressed. The registered manager informed us of events and any actions they had taken.

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.

The service is registered to provide accommodation with personal care for up to 39 older people. There were 37 people living in the service on the day of our inspection. The service provides care and support for older people, with a range of medical and age related conditions, including mobility issues, diabetes and dementia.

At the time of our inspection there was a registered manager in place. 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.

People living at the service were safe. The management team and the staff understood their responsibilities in safeguarding people. Staffing levels were assessed to support people’s needs. Pre-employment checks were made before staff started working at the service, to ensure staff were suitable to work with people.

People received care and support from kind, caring and compassionate staff. Staff were responsive to people’s individual need, choice and preferences. Staff were friendly towards people and treated them with respect. We saw and heard a lot of chatting and laughter between the staff and the people who lived at Heather Vale.

Food provided was of a good quality and catered for people’s individual preferences. This included catering for people’s specific health and cultural requirements. Food and drinks were available to people throughout the day and night. The support provided to people with additional needs enabled them to maintain their independence, links to the community and as a result this had a positive impact on their well-being and health.

Staff attended training and used it to effectively support people. The registered manager and staff understood and complied with the requirements of the Mental Capacity Act 2005 (MCA). When decisions had been made about a person’s care where they lacked capacity, these had been made in the persons best interests. The registered manager understood their role in relation to the Deprivation of Liberty Safeguards (DoLS).

The registered manager and the staff clearly understood the needs of people who were living with dementia. We saw the service was undergoing an extensive re-decoration. The re-decoration was designed around providing people with a dementia friendly environment.

The service was well-led. People knew the registered manager and saw them as approachable. The management culture of the service was open and inclusive. People had opportunity to say how they felt about the service and the care being provided. People’s views were listened to and actions were taken in response. The provider and registered manager had systems in place to check on the quality of the service and put measures in place to reduce risks.

The accommodation was designed and adapted to meet the needs of the people living there and risks within the home had been assessed. The home was clean and was personalised to the people who lived there.

We observed that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Where people did not have the capacity to consent, we found the provider acted in accordance with legal requirements.

We saw that support plans and risk assessments were informative and up to date. Staff we spoke with were aware of their contents, which supported them to deliver appropriate and safe care. The provider had systems in place that ensured the safe receipt, storage, administration and recording of medicines. Accurate and appropriate care records were maintained and stored securely. Staff recruitment systems were robust.

People said they experienced overall care and treatment that met their needs and rights and they felt their dignity, choice and independence were promoted. All said staff, were respectful towards them. People commented favourably on the standard of their personal laundry service, their environment and cleanliness there and meals provided.

One person said, 'Staff know my needs, they are very good.' Another said, 'There is always choice of food to suit my dietary needs and if I don't fancy anything from the menu, they will always make me something else.'

We saw that staff carried out assessments to determine whether there were any risks to people and took action to reduce risks. The assessments included their health related conditions. For example, where there was a risk of falls. We found the provider took account of people's views and experiences to inform them about improvements in the quality and safety of their service. We also found that staff received appropriate professional development, training and appraisal.

Consent was not consistently obtained to some aspects of people's care and the correct procedures were not always used to obtain consent to care where they could not make decisions for themselves.