About the service Heathlands Care Centre is a residential care home providing personal and nursing care to up to 46 people. The service provides support to older people including with dementia and other mental health needs. The service is provided over two floors. At the time of our inspection there were 16 people using the service.
People’s experience of using this service and what we found
The provider and the registered manager did not operate effective quality assurance systems to oversee the service. These systems did not identify shortfalls in the quality and safety of the service or ensure that expected standards were met. People's, relatives' and staff’s feedback were not continuously sought to use for making improvements to the service. We are mindful that relatives’ and people’s feedback was positive compared to our inspection’s findings and observations. To be fair and proportionate, we have include their feedback throughout the report.
The provider and the registered manager did not ensure consistent actions were taken to reduce risks to people and plans were not in place to minimise those risks. Effective recruitment processes were not in place to ensure, as far as possible, that people were protected from staff being employed who were not suitable. The management of medicines was not always safe. Not all staff were up to date with, or had received, their competency checks and mandatory training. We did not have evidence the management team kept their knowledge and competencies checked and up to date. Staff did not have regular supervision and appraisals, and team meetings.
When incidents or accidents happened, it was not always clear that it was fully investigated, and if any lessons were learnt or themes and trends reviewed. The registered manager did not ensure that clear and consistent records were kept for people who use the service and the service management. The registered manager did not inform us about notifiable incidents in a timely manner. Staffing levels did not always support people to stay safe and well. Staff deployment was not always managed effectively as we observed people did not always receive timely support. People were at risk of social isolation because the provider did not ensure activities were more personalised and people had opportunities for social engagement according to their interests.
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.
People’s families and other people that mattered felt they were involved in the planning of their care. However, the care plans did not contain information specific to people’s needs and how to manage any conditions they had. Staff did not have detailed guidance for them to follow when supporting people with complex needs. Staff were not always following the care plan to provide the right support to people. Staff did not understand they used restrictive practice with people and did not have any guidance how to support people when they were anxious or distressed. People had meals to meet their nutrition needs. Hot and cold drinks and snacks were available between meals. However, we were not assured people’s hydration needs were monitored and met in a consistent way. Relatives said they were kept informed about their relative’s health and welfare. Care plans and related documents had some information about people, but it did not always contain information specific to people's needs and how to manage any conditions they had.
We have made a recommendation about the premises being suitable for people living with dementia. We have made a recommendation about compliance with the Accessible Information Standard.
People and relatives were positive about staff being kind, caring and respectful. However, our observation did not confirm this during the inspection. Staff also did not always uphold people's privacy or respond in a way that maintained people's dignity. People and relatives felt they could approach the management or staff with any concerns and felt they had good communication and relationships with the service.
Most of the staff members felt staffing levels were sufficient to do their job safely and effectively. However, some made comments that more staff were needed to complete their tasks as part of the job. The registered manager appreciated staff’s work, contributions and efforts to ensure people received the care and support. Staff felt they could approach the management team for support and advice.
People said they were safe living at the service and relatives felt their family members were kept safe. Staff told us they understood their responsibilities to raise concerns and report incidents or allegations of abuse. They felt confident issues would be addressed appropriately. The management team was working with the local authority to investigate safeguarding cases and make other improvements.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk.
Rating at last inspection
This service was registered with us on 19 April 2022 and this is the first inspection.
Why we inspected
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.
The inspection was prompted in part due to concerns received about people’s safety and wellbeing, care and risk management, and staff skills in supporting people such as moving and handling techniques. A decision was made for us to inspect and examine those risks. We have found evidence that the provider needs to make improvements. Please see all the key question sections of this full report. You can see what action we have asked the provider to take at the end of this full report.
Enforcement and Recommendations
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 quality assurance; risk management; notification of incidents; record keeping; effective and person-centred care planning; seeking consent, respecting people’s decisions and using restrictive practices; privacy and respect, management of medicine; staff training, competence, and recruitment at this inspection. We have made a recommendation about the premises being suitable for people living with dementia. We have made a recommendation about meeting the Accessible Information Standard.
We took civil enforcement to ensure people's safety and ensure improvement occurred at the service. We served a warning notice to the provider following the inspection for the breach of regulation 17 (Good governance). A warning notice gives a date the service must be compliant by and we inspect again to check that compliance against the content is achieved within the timescale.
Please see all the actions 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.
Special Measures
The overall rating for this service is ‘Inadequate’ and the service is therefor in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.