Heathlands Care Centre

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

At our last inspection the provider was in breach of legal regulation in relation to person centred care. At this inspection we found some improvement had been made and the provider was no longer in breach of this regulation. However, there was a breach of legal regulation in relation to robust management oversight of the service and the failure to ensure the support people received was personalised.

This service scored 50 (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 did not always make sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them. People and their relatives we spoke with were not all aware if they had a care plan in place or how it was updated. Other relatives told us they had been involved in the assessment process and were regularly updated regarding any changes to their relative’s care and support.

Processes were in place to assess people’s needs prior to them moving into Heathlands and then at regular intervals. Staff told us they felt they had sufficient details within people’s care plans to provide their care. However, we found pre-admission assessments were brief, and records contained different levels of detail, clarity and guidance for staff on how to meet people’s assessed needs. Whilst the majority of assessments listed what was important to people, staff were not always aware of this information when asked.

The provider did not always plan and deliver people’s care and treatment with them in line with best practice guidance. Whilst the environment was maintained to a safe standard this was not designed in line with current best practice for people living with dementia. This was of particular concern for those people living or visiting the ground floor. The lounge and dining area were not clearly designated and there were a large number of people using a variety of different equipment in one area. The open plan design and the way seating was arranged meant the area was very noisy and that people were unable to sit together in smaller groups. The manager told us they were aware this was an issue and were looking at different ways to arrange the area and utilise other rooms.

In other areas we found best practice and guidance in relation to people’s care and support was followed. Where guidance from the Speech and Language therapy team had been issued in relation to people being at risk of choking we saw this was implemented. Staff were aware of the International Dysphagia Diet Standardisation Initiative (IDDSI) framework which gives guidance on modifying food and fluid to support people with swallowing difficulties. People’s meals were prepared in line with the guidance and staff were aware of people’s need in relation to this.

The provider did not always work well across teams and services to support people. The staff team had not been developed in a way which enabled individual staff members to take initiative whilst working together. We observed care staff relied heavily on nurses for their direction throughout the day, particularly when anything outside of the plan or routine of the day occurred. This put additional pressure on the nursing team who were frequently seen trying to juggle different demands.

In other areas we found staff communicated well with each other to support people’s safety. For example, during the day shift we noted staff alerted each other when they were leaving the lounge area. This ensured there was always a staff member available should they be needed. There was a whole home approach in relation to staff from different departments being involved in supporting people. We observed housekeeping and maintenance staff had developed positive relationships with people. The maintenance manager took time to respond to one person’s questions at length. They were also heard speaking to a person in their own language and accompanying another person on a short walk at their request.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. People told us they had access to healthcare professionals and relatives confirmed they were informed when healthcare professionals had been involved in their relative’s care.

Despite these comments we found systems in place to monitor people’s health outcomes were not always effective. Clinical risk meetings were held on a weekly basis with the aim of monitoring concerns arising. However, the meetings did not routinely involve clinically trained staff and did not provide detail regarding what support was being provided to minimise risks, how effective this was or if any changes were required. This meant it was not possible for the management team to assess when referrals should be made or if care plans were effective in meeting people’s needs.

In other areas we found people were supported with their health outcomes. For example, the menu was designed to offer people healthy and nutritious options in line with their preferences. People were supported to have enough drinks through the day and fruit was available to people at all times.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and

consistent, or that they met the needs and expectations of people themselves.

Systems in place to review people’s care were not always effective in improving the quality of people’s lives. There was an acceptance of some people living with low level anxiety rather than looking at ways to support them to develop different routines or to adapt how activities were provided to suit individual needs.

In other instances, we observed staff were aware of how to support people in reducing their anxiety such as going for walks and talking about things which were important to people. For example, staff supporting one person observed they were trying to leave the area so accompanied them on a walk outside. Staff were also heard discussing a person’s favourite football team with them which had a positive effect on their mood. Our observations showed this level of understanding from staff was in relation to people who received a more intense level of support and had frequent visits from family members who shared information.

The provider did not always tell people about their rights around consent or respect these when delivering care and treatment. People’s rights were not always respected in line with the Mental Capacity Act 2005 (MCA). Capacity assessments had not always been completed where restrictions were in place such as people receiving 1-1 support or where a person’s opportunity to smoke was restricted. Where capacity assessments relating to other decisions had been completed, best interest decisions recorded what action had been taken. They did not show if any less restrictive options had been considered. The failure to ensure people’s rights were protected in line with the MCA had not been identified by the manager or provider.

With the exception of some people’s support when they were eating, we observed staff took time to explain to people what they were doing and sought their consent prior to providing their care.