Archived: The Headington Care Home

The Headington Care Home is registered to provide personal and nursing care to adults, predominantly to those living with dementia. The service can accommodate up to 60 people, in one adapted building, over two floors. At the time of our inspection 40 people were living at the home.

We found the following examples of good practice.

The provider ensured there was a sufficient stock of personal protective equipment (PPE) and we observed staff wearing a full set of PPE. Staff had received training in infection prevention and control and how to put on and take off the personal protective equipment. There were designated PPE stations allocated around the home and these included further information and guidance to prompt staff in the infection correct procedures.

The registered manager ensured the home was cleaned regularly. This included regular cleaning of high-risk areas and frequently touched surfaces. Staff told us they changed into work uniforms on site and their uniforms were being laundered at the service to minimise the risk of cross infection.

The provider ensured regular testing for staff and people took place. The registered manager was working with local social care professionals and local public health team to manage the outbreak effectively. The registered manager informed us a week before our inspection they started process of Covid-19 vaccinations. The registered manager told us the team were very well supported by the provider’s senior management team as well as the local external health professionals.

The registered manager had ensured clear communication with people’s relatives regarding the outbreak and visiting arrangements. Where possible ground floor window visits were facilitated and where people received end of life care, relatives’ visits were supported after individual risk assessments and within the current guidelines.

People were supported by a team of committed team of staff whom they knew well, where agency staff had been used the registered manager ensured the continuity of staff was maintained. Staff used aids, such as white boards to aid the communication with people where the verbal communication was at times affected by staff wearing face masks.

Staff encouraged people to maintain social distancing, where needed people were nursed in their own bedrooms.

Staff praised the support received from management team. One staff member described the registered manager as ‘amazing’. Another staff member said, “We managed to maintain positive mood and calmness.”

Further information is in the detailed findings below.

The Headington is a residential care home providing personal and nursing care to 49 people aged 65 and over at the time of the inspection. The service can support up to 60 people.

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

People living at The Headington received safe care from skilled and knowledgeable staff. Staff understood their responsibilities to identify and report any concerns. The provider had safe recruitment and selection processes in place.

Risks to people's safety and well-being were managed through a risk management process. There were sufficient staff deployed to meet people's needs. The home used the same agency staff to ensure consistence. Staff recruitment was on-going. Medicines were managed safely and people received their medicines as prescribed.

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 were supported to maintain good health and to meet their nutritional needs.

People told us staff were caring. Staff consistence enabled people to receive good care from staff who knew them well. People had access to activities to prevent social isolation.

The Headington was well-led by a registered manager who was passionate about improving people’s care. The service had a clear management and staffing structure in place. Staff worked well as a team and had a sense of pride working at the service. The provider had quality assurance systems in place to monitor the quality and safety of the service.

Rating at last inspection:

At our last inspection we rated the service good. Our last report was published on 20 April 2017.

Why we inspected:

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

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

The Headington Care home is registered to provide accommodation for up to 60 older people living with dementia who require nursing or personal care. At the time of the inspection there were 59 people living at the service.

There was a registered manager in post. 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 registered manager worked closely with the deputy manager.

At the last inspection on 27 January 2016, we asked the provider to take action to make improvements and ensure staff were deployed effectively during meal times, staff engaged with people meaningfully and offered person centred care and ensured people received meaningful activities and stimulation. At this inspection on 7 March 2017, we found these actions had been completed. However, we still have some concerns.

People had varied dining experiences. Some people were not always supported in a timely manner during meal times. Some staff prioritised other tasks to supporting people having meals.

People who were supported by the service felt safe. The staff had a clear understanding on how to safeguard people and protect their health and well-being. People received their medicine as prescribed. There were systems in place to manage safe administration and storage of medicines.

The Headington Care home had enough suitably qualified and experienced staff to meet people's needs. People told us they were attended to without unnecessary delay. The provider had robust recruitment procedures and conducted background checks to ensure staff were suitable for their role.

People had a range of individualised risk assessments in place to keep them safe and to help them maintain their independence. Where risks to people had been identified, risk assessments were in place and action had been taken to reduce the risks. Staff were aware of people’s needs and followed guidance to keep them safe.

Staff received adequate training and support to carry out their roles effectively. People felt supported by competent staff that benefitted from regular supervision (one to one meetings with their line manager) and team meetings to help them meet the needs of the people they cared for.

The registered manager and staff had a good understanding of the Mental Capacity Act 2005 and applied its principles in their work. Where people were thought to lack capacity to make certain decisions, assessments had been completed in line with the principles of MCA. The registered manager and staff understood their responsibilities under the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be deprived of their liberty for their own safety.

Staff treated people with kindness, compassion and respect and promoted people’s independence and right to privacy. People received quality care that was personalised to meet their needs.

People were supported to maintain their health and were referred for specialist advice as required. Where people had received end of life care, staff had taken actions to ensure people would have as dignified and comfortable death as possible. End of life care was provided in a compassionate way.

Staff knew the people they cared for and what was important to them. Staff appreciated people’s unique life histories and understood how these could influence the way people wanted to be cared for. People were actively involved with the local community. People were encouraged and supported to engage with services and events outside of the home. Staff supported and encouraged people to engage with a variety of activities and entertainments available within the home. Activities were structured to people's interests and people chose what activities they wanted to do. The environment was designed to enable people to move freely around the home.

Feedback was sought from people and their relatives and used to improve the care. The provider had systems to enable people to provide feedback on the care they received. People knew how to make a complaint and complaints were managed in accordance with the provider’s complaints policy.

Leadership within the service was open and transparent at all levels. The provider had effective quality assurance systems in place.

The registered manager informed us of all notifiable incidents. The registered manager had a clear plan to develop and further improve the home. Staff spoke positively about the management support and leadership they received from the registered manager.

There was a registered manager in post. 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 registered manager worked closely with the area manager.

People who were supported by the service felt safe. The staff had a clear understanding on how to safeguard the people and protect their health and well-being. There were systems in place to manage safe administration and storage of medicines. There were enough suitably qualified and experienced staff to meet people needs. However, staff were not always deployed effectively. People had a range of individualised risk assessments in place to keep them safe and to help them maintain their independence. Where required, staff involved a range of other professionals in people’s care. Staff were quick to identify and alert other professionals when people’s needs changed.

People received care from staff who understood their needs. Staff received adequate training and support to carry out their roles effectively. Staff understood their responsibilities under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions.

People were supported to have their nutritional needs met, however, the dining experience varied. People were not always given choices and some did not receive their meals on time. We observed people during lunch time and saw people being supported with meals.

There was a calm, warm and friendly atmosphere at the service. Every member of staff we spoke with was motivated and inspired to give kind and compassionate care. Staff knew the people they cared for and what was important to them. Staff appreciated people’s unique life histories and understood how these could influence the way people wanted to be cared for. People's choices and wishes were respected and recorded in their care records.

People did not always have access to activities and stimulation from staff in the home. Activities were not always structured to people's interests. Relatives told us there wasn't always much to do. However, other people told us they were happy. We discussed these concerns with the registered manager, deputy manager and area manager who informed us a new activity co-ordinator’s post had been advertised, and staff were to receive coaching on dementia care and activities.

Where people had received end of life care, staff had taken actions to ensure people would have as dignified and comfortable death as possible. End of life care was provided in a compassionate way. Staff had also identified they needed more training in this area and the manager was arranging it.

People felt supported by competent staff. Staff benefitted from regular supervision (one to one meetings with their line manager) and team meetings to help them meet the needs of the people they were caring for.

The manager informed us of all notifiable incidents. The service had good quality assurances in place, however, these were not always used effectively. The manager had a clear plan to develop and improve the home. Staff spoke positively about the management and direction they had from the manager. The service had systems to enable people to provide feedback on the support they received.

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 this report.

All the people we spoke with were complimentary about their care, one person said, “they are fantastic, they know what they are doing and what we need” another person said, “Its brilliant, I am well cared for and understood”. One person’s relative told us, “staff are wonderful, very dedicated and caring, they get to know each individual by meeting as a team when somebody new comes”.

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. We also saw in care files that people, or family members on their behalf, gave consent for care they received and in line with best interest decision making guidance.

We found that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Where people were at risk of malnutrition or pressure damage the service responded by taking action to reduce the risk of harm. For example, the service worked with a Speech and Language therapist (SALT), dietician and memory nurse to plan care and treatment for people at risk of these issues.

People were protected from the risks of inadequate nutrition and dehydration. We found that where people had specific dietary requirements these were recorded in the kitchen and the chef was aware. People had a wide and varied range of food and drink to choose from. Recommendations from the SALT stated that one person at risk of malnutrition needed their food to be fortified. We observed this happening and the kitchen staff were aware.

People were cared for by staff that were supported to deliver care and treatment safely and to an appropriate standard. Staff told us they felt supported and that they received regular supervision and annual appraisals. Staff also told us they received regular and adequate professional development.

The provider had an effective system to regularly assess and monitor the quality of service that people received. We saw satisfaction surveys from people and their families, we also saw minutes from monthly relative meetings where we saw actions being captured and taken in response to views sought.

We were able to observe the way staff interacted with the people who used the service and they all did this in a professional and sensitive manner. We were provided with evidence that showed that people were provided with a wide range of activities, and, with the assistant of relatives, were able to exercise choice in a range of areas including menus, worship and social activities.

Through their relatives, people who used the service were able to provide feedback to the provider on a regular basis, and any concerns or complaints raised were acted upon in a timely manner.

We were shown copies of peoples’ care plan and other documentation relating to their care and wellbeing, and these were all complete and had been reviewed on a regular basis. We were also provided with evidence which showed that there were sufficient staff, who were properly trained and qualified, to provide a good quality of service.