Heathlands Care Centre

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk of harm to people.

At our last 4 inspections, the provider was in breach of the legal regulations regarding people’s safe care and treatment. At this inspection, we found that although improvements had been made in several areas, the provider remained in breach of this regulation. The provider was no longer in breach of the regulation relating to staff recruitment, although increased oversight of these processes was required.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Systems were in place to ensure accidents and incidents were reported, investigated and action taken to minimise risks. Staff completed detailed accident and incident records, which were reviewed by the manager to ensure relevant action was taken to keep people safe. Records were reviewed to identify any trends or themes so risks could be minimised going forward. For example, an increase in the number of people sustaining minor skin injuries was identified. Additional support was offered to staff on how to support people with very sensitive skin, and aids to help people dress safely were purchased. This reduced the number of skin injuries people experienced.Initiatives to reduce the number of falls people experienced had also been implemented including the introduction of decaffeinated drinks, Call don’t Fall signs and ‘Pimp my Zimmer’ to personalise people’s walking aids, encouraging their use and making it easier for people to identify their own Zimmer frame.

The manager told us they had worked with staff to create a proactive culture when reviewing safety concerns. They told us, “It has taken a lot of reassurance to help staff understand we do not have a blame culture. We need to learn from incidents and be open and transparent.”

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Professionals supporting the service told us they had seen improvements in the way the service worked alongside them to ensure people’s care was safe and responsive. Referrals to health and social care professionals were made in a timely manner, and guidance provided was followed. Information regarding people’s needs was available to share with professionals when people required hospital treatment or referral. Where the service identified they were no longer able to meet a person’s needs they ensured a full handover was provided and contributed to the assessment processes.

The provider worked with people and healthcare partners to understand what safety meant to them and the best way to achieve it. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared potential safeguarding issues quickly and appropriately.

People and their relatives told us they felt noticeable improvements had been made to the service's safety. People said they felt safe living at Heathlands Care Centre. One person told us, “I feel that I am safe; if I am in trouble I have a bleeper [call bell] and people [staff] will come.” One relative told us of concerns they had previously experienced at the home. They added, “Things have only improved here since [manager] came. [They] listen and are approachable. [Manager] gets on with people, gets involved and makes sure things get done.”

Records showed that concerns regarding people’s safe care were reported to the local authority safeguarding team without delay. Where additional information or actions were requested, this was provided and reviewed as required. Due to the significant safeguarding concerns identified during our last inspection, the local authority had ensured frequent visits from a range of professionals. One professional told us, “I am confident in [manager]. There have been many changes for the better. They are now reporting safeguarding concerns and low-level incidents in a timely manner and accept any guidance. The number of reports we receive has greatly reduced as staff have changed and gained skills. There is an openness now.”

Systems were in place to protect people’s rights under the Deprivation of Liberty Safeguards (DoLS). This ensured that where restrictions to people’s freedoms were in place, DoLS applications were submitted in line with requirements. A register of DoLS authorisations was maintained, which enabled the manager to monitor any conditions in place and to resubmit applications as required.

Staff were not always supported with the right information to consistently provide safe care that met people’s needs. Shortfalls in risk management had been identified at the last four inspections, yet the provider had not made the necessary improvements to ensure this had been effectively and consistently monitored and managed across all areas.

Systems and processes designed to identify risks to people’s safety were not consistently effective. The manager told us that checks of people’s care, such as hydration, repositioning and pressure mattress settings, were completed regularly throughout the day. Despite this we found concerns with several people’s pressure mattress settings which meant they were not being used safely and effectively. One person’s mattress required the setting to be changed, depending on how the person wanted to lie/sit. Staff and the management team were unaware of how the mattress worked or which settings should be used at what times. This can increase people's risk of skin breakdown. The manager responded promptly to these issues and ensured the correct settings and guidance were put in place during the inspection.

Risk assessments and care records did not always contain sufficient information and guidance regarding the risks to people’s safety and well-being. The level of detail within information and guidance varied in different people’s records. In addition, information within care plans was not always consistent. The manager acknowledged the review of care plans and risk assessments was an on-going action, and they had not yet managed to fully review all people’s care plans and risk assessments.While regular staff knew people well enough to reduce some risks, there was a risk that people’s needs would not be addressed should they be supported by new staff or in a different setting.

In other areas, we found improvements in the way risks were reviewed and managed. This included areas such as the support people required during times of distress, mobility, falls and weight monitoring.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

Although risks were not always identified promptly, they were quickly addressed when highlighted, and other key safety systems were operating effectively. This indicates that while improvements are required, people were not exposed to widespread or serious avoidable harm.

Checks of the environment had not identified or addressed potential risks to people’s safety. We observed that equipment and spare beds were being stored under the stairs, which presented a potential fire hazard. In addition, a door to a cupboard which was labelled as needing to be kept locked due to electrical hazards was unlocked, and in one area of the home, the fire door signs were stuck onto doors with cello tape rather than being screwed in. The manager ensured all these areas of concern were addressed during the inspection and assured us additional checks would be added to the daily monitoring list.

In other areas, we found checks to the environment were completed as required, and equipment was serviced in line with regulations. Fire equipment, lifts and hoists, water quality, and electrical checks were all regularly risk assessed.

The provider had ensured improvements had been made in the deployment of qualified, skilled, and experienced staff and the way staff were recruited. However, additional oversight was still required in these areas. Staff received effective support, supervision and development.

People and relatives provided mixed responses regarding staffing levels within the home, with some stating staff responded quickly to requests for support and others indicating more staff were needed to provide quality support. One person told us, “The whole thing is that we need more time. The carers say they haven’t got time to give full attention to people.” Several relatives told us that although staffing levels during the week appeared adequate, they felt weekends were not as well staffed.

We observed that staff were attentive and responsive to people’s needs and requests for support. Staff were not seen to rush people and spent time sat chatting with people in the afternoon. Rotas showed that whilst the number of care staff remained the same at weekends, there was a reduction in management presence and auxiliary staff to support the service. Staff told us they felt there were sufficient staff, although they felt weekends could be busy as there was more for them to do. The manager told us that the employment of additional staff in support roles, such as activities, would relieve some of these concerns going forward.

Staff received training to support them in their roles. They told us the additional training implemented since our last inspection had led to them feeling more confident and had reduced the number of incidents. Competency assessments had also been completed with staff in areas such as moving and handling, medicines and infection control. However, the provider had not ensured that the staff members completing the competency assessments had the required qualifications. The manager acknowledged this needed to be reviewed and gave assurances that staff competencies would be reviewed.Following our inspection the provider confirmed that staff had completed training to train staff and assess their competence in moving and handling people.

Systems to ensure staff were recruited safely had improved. However, additional oversight was required to ensure that follow-up information was sought when needed. This included requesting additional information where references did not highlight the staff member’s reason for leaving and ensuring attempts to contact all previous employers relevant to the health and social care sector.

The provider assessed and managed the risk of infection. They detected and managed the risk of its spread and promptly shared their concerns with appropriate agencies.

People told us they felt their home was clean and well-cared for. One person told us, “They keep it nice, my room is always cleaned.” One relative told us, “The home has never been unclean, but you sense that the cleaning is taken more seriously recently.”

The home was cleaned to a good standard. Housekeeping staff had cleaning schedules to work to and specific chemicals to use for different tasks. Staff had access to personal protective equipment, and we observed that this was used and disposed of appropriately. Training records showed that staff had completed infection prevention and control courses to help ensure they understood good hygiene practice and had the knowledge to prevent the spread of infection.

The provider ensured people received their medicines and treatments safely. However, where people required their medicines to be administered covertly their needs were not always fully considered.

People told us they felt the staff supported them with their medicines well. One person told us, “I have quite a few medicines. I feel that side is all managed very well.”

Whilst improvements had been made in how people’s medicines were managed, further work was required regarding medicines administered covertly (without the person’s knowledge or consent). Where applicable, systems were in place to assess whether this practice was in the person’s best interests should they refuse their medicines and GP authorisation was sought. However, staff were not seen to offer people their medicines overtly first, and care plans lacked detail regarding how their medicines should be administered. No dates were built into care plans to review this practice to ensure people’s rights were protected.

In other areas, we found people’s medicines were administered safely. The home had worked closely with the Care Home Medicines Team to improve and embed systems. Records were maintained of medicine administration and stock checks completed. Staff administering medicines did so respectfully and explained what they were doing to people. Where people were prescribed medicines ‘as and when required’ (PRN), guidance on how and when to administer these was available for staff to follow. Nursing staff were aware of people’s needs in relation to specific health conditions and the support and monitoring of their medicines.