Archived: Heath Lodge

We found the following examples of good practice.

• Staff supervised all essential visitors to ensure social distancing and infection control guidelines were followed. All visitors were asked a set of screening questions to ascertain any risks posed and for track and trace.

• People could choose to use applications such as video calls to maintain contact with their families.

• The provider was fully aware of all current best practice guidance including the safe admission of people from hospital. This had been communicated to people, their families and staff as and when updates occurred.

• Better organisation of Personal Protective Equipment in designated stations throughout the service was required. This will reduce staff time putting on and taking off PPE and reduce the risk of transmission.

• Cleaning schedules were thorough. The schedules through the day were continued at night to ensure all areas were regularly cleaned to reduce the risk of transmission.

• Staff were able to seek quick healthcare support when people needed this.

• The provider and registered manager had recognised the challenges staff had overcome during the pandemic and had introduced specific support sessions staff could use to de-brief and offload their feelings. This supported staff resilience.

Further information is in the detailed findings below.

Heath Lodge is a residential care home providing personal care for up to 28 older people some of whom were living with dementia. 26 people lived at the service when we inspected.

People lived in an adapted building with a purpose-built extension. There are two parts to the service. The main area where older people live and a small unit where people living with dementia are supported.

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

People and their relatives were positive about the care and support they received at Heath Lodge. People achieved good outcomes in both their health and wellbeing. One person was pleased they had been able to take part in gardening which was a new hobby for them. Another person had been supported to walk more independently. People felt safe and were reassured staff responded when they called for support.

People were supported in a caring and dignified way if they became distressed. Not all staff had training to support them to offer support in a consistent way. This is an area the registered manager agreed to focus on.

Systems around the management of health and safety had improved. A new medicines system was managed safely. More person-centred records around when to administer ‘as and when required’ medicines were required.

The positive relationship between the provider and registered manager was clear and they worked together to check the service was safe and of good quality. Records of the checks they performed had improved. More detail was still required so they can clearly evidence the progress they make and why they make decisions. This includes completing records following any accidents and incidents which were reviewed.

Work to implement changes during the COVID-19 pandemic was effective and we were overall assured infection prevention and control measures would reduce the likelihood of an outbreak. Staff, people and their relatives were pleased with the support received from the registered manager during the recent difficult times.

People and relatives were very complimentary about the staff team and the care they provided. A relative passed on their thanks and wrote, ‘We were touched by the affection our family member showed to you (staff) which was reciprocated in no small measure. During the past few months of lockdown when we were able to make contact only through the conservatory window, it was reassuring to know her emotional and physical wellbeing were in good hands. I'll always remember their smile to the member of staff who was on hand to take them back to the lounge after these visits; it came from the heart - their speech was severely impaired, but the smile spoke volumes about their appreciation.’

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 4 April 2019) and there was a breach of regulation. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 12 February 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve governance of the service.

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

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 the service can respond to coronavirus and other infection outbreaks effectively.

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 changed from requires improvement to good. 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 Heath Lodge on our website at www.cqc.org.uk.

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.

People’s experience of using this service: People could have been at risk of avoidable harm because the provider did not have effective systems to ensure safety and quality. Areas such as fire safety, equipment and environment safety management were not robust. We made a recommendation that the provider review their medicines system to ensure current best practice was implemented. Systems to manage these areas were either not in place or did not follow known current best practice. The provider did not have thorough oversight to understand areas that required improvement. The registered manager and provider responded positively to feedback and immediately started to act to implement changes.

The registered manager and provider had worked hard since the previous registered manager left the service to make changes in response to feedback from people, relatives and staff. Areas such as the environment refurbishment, increased activities, staff support and guidance and the implementation of a strong person-centred culture. There had been a positive impact on people’s experience of using the service because of those changes.

People said staff knew them very well and could anticipate their needs and that support was delivered in a timely way. People described good provision of activities and events that were tailored to their needs. People were supported to maintain relationships and afforded support to develop and build new relationships. People and their relatives described high levels of satisfaction with the service which impacted positively on their overall wellbeing.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People were treated with respect and dignity and their independence encouraged and supported. Where people required support at the end of their life, this was carried out with compassion and dignity.

Staff had appropriate skills and knowledge to deliver care and support in a person-centred way.

The registered manager and management team were well respected. People, their relatives and staff all felt confident raising concerns and ideas. All feedback was used to continuously improve the service.

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

Rating at last inspection: Good (Published 16 August 2016).

Why we inspected: This inspection was a scheduled inspection based on the previous rating.

Enforcement: The provider was in breach of one regulation at this inspection relating to governance of the service. You can see the action we have told the provider to take at the end of the full report.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner. The overall rating at this inspection is requires improvement. We will continue to work with the provider to understand the action they have taken to improve the rating to at least good.

Heath Lodge provides residential, personal and social care for 28 older people. There is a separate, smaller unit named Alison Wing, which is used specifically for six people who are living with dementia. The home is a detached property, set in its own grounds approximately one mile from Harrogate town centre. There are secure gardens and plenty of seating outside for people to use. There is also parking within the grounds. The registered provider is Harrogate Neighbours Housing Association Limited.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 this inspection we found the service was being managed and operated in line with their legal responsibilities.

Staff told us the manager, deputy manager and other senior staff employed by the service were supportive, dedicated and approachable. They also confirmed to us that the on call arrangements were well organised, and that they could seek advice and help out of hours if necessary. This meant there was good oversight of the service, and staff were confident about the management arrangements.

The manager and staff team had a good understanding of the Mental Capacity Act. We saw consent was sought routinely before any assistance was given. People had also been supported to make their own decisions wherever possible. Where people were unable to make a decision, there was a best interest decision recorded within their support plan. We saw the person and relevant others had been involved and consulted. This meant people were given the opportunity to be involved in decision making and decisions were made in the person’s best interests. The service was in the process of implementing the Deprivation of Liberty Safeguards (DoLS) as required.

People who used the service and their relatives spoke highly of the staff team. People told us that staff treated them with kindness and respect. We saw many examples of good practice throughout our visit. People were appropriately assisted to move around the home and encouraged to eat and drink. There was a constant supply of drinks and snacks, including fruit and ice cream, during what was a very hot day. People told us this was a regular occurrence and that they could always request refreshments for themselves or visitors. Staff approaches were professional and discreet. Staff told us they had a shared interest in developing and improving the service for people. Staff also told us they had ample opportunities to reflect on the service they provided through supervision and regular contact with each other.

The service recruited staff in a safe and robust way. They made sure all necessary background checks had been carried out and that only suitable people were employed. Processes were in place to assess the staffing levels that were needed, based on people’s dependency and the layout of the building. People who used the service told us staff were always available, during the day and night when they needed them. Our observations during the inspection showed there was appropriate deployment of staff, including staff providing care, activities, catering and housekeeping tasks.

The manager had taken action to ensure that training was kept up to date and future training was planned. Records showed staff received the training they needed to keep people safe.

The service was well maintained, clean and comfortable overall. One area of the home was not fresh smelling. This was discussed during the inspection. Plans were in place to have the existing floor covering lifted, the floor treated and a new floor covering fitted. Work was also being done to adapt a bathroom to a ‘wet room.’

People told us they felt safe and this was confirmed by a visiting health care professional and relatives. Staff knew the correct procedures to follow if they considered someone was at risk of harm or abuse. They had received appropriate safeguarding training and there were policies and procedures in place to support them in their role. Risk assessments were up to date to identify risks due to people’s medical, physical and mental health conditions. Arrangements were in place to make sure identified risks were minimised.

Medicines and creams for people who used the service were managed safely. Staff had received the appropriate training and checks took place to make sure medicines were given safely and at the appropriate times. The temperature of the storage area for the medicines trolley was not being monitored. This was attended to during the inspection visit.

People told us the food was good, mainly home cooked and well presented. People had access to a varied menu, with at least two hot choices at the main meal which was served at lunchtime. If people were at risk of losing weight or becoming dehydrated, we saw plans in place to manage this. This included regular weighing and monitoring of their food and fluid intake. People had good access to health care services and the service was committed to working in partnership with both healthcare and social care professionals.

People had their care needs assessed and planned, and regular reviews took place to make sure people received the right care and support. Information in people’s care plans was person centred and contained sufficient detail to guide staff.

Activities took place regularly and people were supported to attend the activities they wanted to be involved in. Visitors could come and join in if they wished.

A complaints procedure was in place and records were available to show how complaints and concerns would be responded to. People who used the service and their representatives were encouraged to give feedback. There was evidence that feedback had been listened to, with improvements made or planned as a result.

The manager submitted timely notifications to both CQC and other agencies. This helped to ensure that important information was shared as required. We found audits were taking place consistently and were effective in highlighting any issues before they arose and when improvements were needed.

There were issues with the policies and procedures being used in the home as many of these were out of date which meant that practice may have been unsafe and in breach of current legislation in relation to areas such as health and safety.

Improvements were also required to the systems used to regularly assess and monitor the quality of the service that people received. We also found at the last inspection that people were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not being maintained.

One inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people and the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

Not applicable. We did not inspect this area.

Is the service effective?

Staff we spoke with were knowledgeable about the people they supported and knew people very well. Suitable arrangements were in place for staff to receive updated training to ensure they had the skills, knowledge and experience to meet the needs of people who used the service. Staff received the necessary support from their managers to ensure they did their job well. This ensured that the outcomes for people would continue to improve.

Is the service caring?

People looked well cared for and we observed good care practices taking place. We observed the lunchtime experience and saw that staff were calm and unhurried and they spent time with people.

People we spoke with told us that the overall care at the home was good. One person said 'We get well looked after' another said 'Overall I am very happy here.'

Is the service responsive?

Not applicable. We did not inspect this area.

Is the service well-led?

At this inspection, we found improvements had been made and the issues we identified at the last inspection had been addressed.

Effective management systems were in place to promote and safeguard people's safety and welfare. Such as health and safety records and people's care records were up to date and had been reviewed regularly.

The quality assurance system included audits and checks carried out by staff at the service and by other people from within the organisation. Records showed that issues were identified and responded to in a timely way. As a result the quality of the service was continuously improving.

Effective management systems were in place to promote and safeguard people's safety and welfare. Such as health and safety records and peoples care records were up to date and had been reviewed regularly.

All the homes policies and procedures had been reviewed and updated. This ensured that staff were following up to date and current practice.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People had been cared for in an environment that was appropriately maintained. There were some checks that were not being carried out to ensure that the environment was safe. Staff were recruited safely and given training to ensure that they were able to meet the needs of the people living at the home. A member of the management team was available on call in case of emergencies.

Staff personnel records contained all the information required by the Health and Social Care Act 2008. This meant the provider could demonstrate that the staff employed to work at the home were suitable and had the skills and experience needed to support the people living in the home.

There were issues with the policies and procedures being used in the home as many of these were out of date which meant that practice may have been unsafe and in breach of current legislation in relation to areas such as health and safety.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well. One person told us. "I am quite happy. Staff listen and are respectful'. Staff had received some training to meet the needs of the people living at the home.

There was a lack of systems in place to monitor the quality and effectiveness of the support being provided. This had not improved since our last visit when these issues had been highlighted.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers were patient and gave encouragement when supporting people. People told us they were able to do things at their own pace and were not rushed. Our observations confirmed this. One person told us 'When I have needed extra help the staff have provided it and are very good". Another person told us "The staff have asked me if I am happy with everything and I told them that I am'.

Is the service responsive?

People's needs had been assessed before they moved into the home. There was a keyworker system in place although there was not consistent recording of keyworker activity. Records confirmed people's preferences, interests, aspirations and diverse needs had been recorded although these were sometimes inconsistent. People had access to activities.

Where medical assistance or intervention was required this was sought appropriately and staff followed instructions from medical and social care professionals when caring for people.

There was some evidence of the provider gathering feedback from staff or people who used the service but there was no action planning in place regarding ongoing improvements to the service or any planning relating to analysing this feedback.

Is the service well-led?

Staff had a good understanding of the ethos of the home. People told us that they could talk to the manager or staff about any issues. Staff told us they were clear about their roles and responsibilities. They said the management were approachable and that they felt generally well supported by the manager. One person told us 'The manager is very nice but needs to be sterner with staff'. Another person told us 'The manager does listen to grumbles although they can be slow to react'.

There were senior roles in place to act as manager when the manager was not in the home. The manager lived on site and attended for part of the inspection.

There were a lack of systems and processes in place for monitoring the effectiveness of the care provided and policies and procedures were out of date and no longer relevant to the support that was being delivered on a daily basis in the home.

Appropriate arrangements were in place in relation to obtaining, handling, storing and administering medication. We looked at the medicines records and stock for all the people's controlled drugs and found these to be correct.

Appropriate arrangements were not always in place for assessing and monitoring the quality of service provided at Heath Lodge. We have asked the provider to address this issue.

We found suitable arrangements were not in place for maintaining clear, accurate records that were fit for purpose. We have asked the provider to address this issue.

Appropriate arrangements were not in place for the reporting of incidents at Heath Lodge. This is a legal requirement and by not submitting them the provider is committing an offence. We have written to the provider separate to this report to inform them of this offence.

We used a number of different methods to help us understand the experiences of people using the service, including talking to people and observing the care provided.

We spoke with a number of people who use the service and they told us that it was 'a good place to be'. People said that staff were 'kind and helpful'; that the food was 'lovely' and that there was a good programme of activities.

We asked people whether their privacy and dignity was respected and everyone we spoke with said it was.