Heathlands Care Centre

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question inadequate. At this assessment the rating has remained inadequate. At our last inspection the provider was in breach of legal regulation in relation to person centred care. Leaders and the culture they created did not assure the delivery of high-quality care.

At our last three inspections the provider was in breach of the legal regulations in relation to the management oversight and governance of the service. Improvements were not found at this assessment, and the provider remained in breach of these regulations

This service scored 32 (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 have a shared vision, strategy and culture based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. During this inspection we identified continued shortfalls in the safety of the service and the support people received. The provider had failed to ensure systems had been implemented to monitor the experience of people living at Heathlands. This had led to a continued culture of largely task-based care which was centred around staff routines and shift times rather than people’s personalised care needs. As reflected throughout the report, staff were polite to people although offered little interaction outside of providing support. Staff members told us they wanted people living at Heathlands to be happy. However, they were unable to describe information from people’s life histories, religious needs or things which were important to them. We observed staff members often appeared disinterested when supporting people.

The manager told us that since being in post they had tried to build a team spirit and believed this was starting to improve. They acknowledged they had a long way to go in developing the culture within the service. Despite this, there was no plan in place regarding how this would be achieved and embedded into the service going forward.

The provider missed opportunities to set expectations of staff and develop a shared culture when staff began working at Heathlands as induction systems were not effective. We reviewed induction packs for 3 staff members. We found these had not been completed past the first week. There was no evidence of staff practice being observed, knowledge checks being completed in relation to person centred care and no assessment of their overall performance. This demonstrated and a continued lack of managerial oversight of the service as these gaps had not been identified.

Not all leaders understood the context in which the provider delivered care, treatment and support. They did not always embody the culture and values of their workforce and organisation. Leaders did not always have the skills, knowledge, experience and credibility to lead effectively, or they did not always do so with integrity, openness and honesty. Following our inspection, we shared feedback which highlighted the serious nature of the concerns we had found. The Nominated Individual described these concerns as being small things they would put right as they had always done. This demonstrated a lack of understanding regarding the seriousness of the concerns found and the continued failure to meet regulatory standards.

Staff told us they found the manager approachable and willing to support them should they have concerns. However, several staff members indicated this was not always the case in relation to the Nominated Individual. The manager acknowledged this had been an issue for a number of staff members. They told us they had advised staff to go to them with any concerns and they would approach the Nominated Individual on their behalf as they had developed an understanding of how to work with them. The failure to have a system where staff felt comfortable in raising concerns regarding the senior management of the service did not demonstrate an open and inclusive approach.

The manager told us they had been at the service for 2 months prior to taking over the responsibility of manager so they could have a handover. They told us this was not a planned process and there was no evidence of the areas their handover had covered. No action plan or report of areas to be reviewed had been agreed between the provider and the manager during this time to ensure there was effective planning and a clear direction for the service going forward.

People did always not feel they could speak up and that their voice would be heard.

We received mixed responses regarding whether people and their relatives felt able to voice any concerns. Some people told us they did not always feel able to share concerns regarding their care because they didn’t want to upset staff as they were reliant on them for their care or didn’t wish to be seen as someone who complained. Other people and their relatives told us they found the manager to was easy to talk to and had a reassuring manner. One person told us, “The people in charge, [manager] is the latest one, [they] are nice and I think [they] will sort things out. [Manager] is lovely and knows what [they] are doing.” A relative told us, “We can speak to [manager] anytime we need or wish to.”

The manager’s office was near to the entrance of the home away from communal areas so they were not always visible to people living at Heathlands. They told us they regularly walked around the home and spoke with people. We observed they had a calm manner and spoke to people and their relatives with kindness. However, we found they did not always know people’s needs well in order to understand what was important to them and to develop relationships. The manager told us they intended to develop these relationships going forward through continued resident and relatives meeting and ensuring they were available to meet with people and their families.

The provider did not always value diversity in their workforce. They did not always work towards an inclusive and fair culture by improving equality and equity for people who worked for them. We received mixed responses regarding how staff felt they were supported. Some staff we spoke with told us they felt they were not always treated fairly or in line with the provider’s policy. The manager also expressed concern that whilst they had been on leave a number of staff had been moved into different positions without their approval or involvement in discussions. Records confirmed this included a staff member being moved into a role they had no previous experience of and had not received any training for.

Other staff members told us they felt all staff were treated equally and their diversity was respected. One staff member told us, “We have lots of different backgrounds here and come from different places. We work together like a team.”

The provider did not have clear responsibilities, roles, systems of accountability and good governance. Whilst some auditing and quality assurance systems were in place these had not been effective in identifying concerns found during this inspection. Auditing systems were mostly records based reviews and did not take into account people’s experience or review the quality of care they received. At our last inspection we found people were not always supported to eat in a dignified way. No system to monitor or audit this going forward had been implemented. At this inspection we found continued concerns regarding how staff supported people with their lunch. This included staff members being observed to place food in the mouths of 2 people despite them stating they did not want it. The lack of mealtime audits or observations meant the experience of service users at mealtime was not identified as a concern and therefore not acted upon. We also found concerns regarding the quality of activities offered to people. The activities co-ordinator had not been provided training and had limited support to plan and deliver activities. Whilst the provider told us they were planning to introduce activities training, there was no evidence the concerns identified had been recognised and no plan to ensure the risk of social isolation for those people in their rooms had been assessed.

Accurate, contemporaneous records of the care service users received were not maintained. Despite electronic devices being available to record when care was provided, staff appeared to update records at set intervals such as in the middle of the day and the end of their shift. This meant specific monitoring of assessed needs such as regular repositioning, welfare checks, frequency of support with continence needs etc could not be monitored effectively.

The provider did not understand their duty to collaborate and work in partnership, so services work seamlessly for people. They did not consistently share information and learning with partners or collaborate for improvement. During our inspection we noted a number of incidents which had not been shared with the local authority safeguarding team or with CQC in line with the provider’s regulatory responsibilities. These included incidents of unexplained bruising, skin injuries and people entering other people’s rooms without permission and causing distress. The lack of reporting to the appropriate authorities meant neither party were fully aware of the risks to people’s safety and were unable to effectively monitor and support the service and those people affected.

Feedback from partner agencies indicated they had on-going concerns regarding the leadership of the provider in relation to their transparency and understanding of how to provide robust leadership. They told us they did not feel the provider always recognised the seriousness of concerns raised with them and did not always act to mitigate risks happening again.

The provider did not focus on continuous learning, innovation and improvement across the organisation and local system. They did not encourage creative ways of delivering equality of experience, outcome and quality of life for people. The provider had failed to implement effective action plans and to ensure continuous improvement. The manager had been in post for four months but told us they had taken responsibility for the running of the service two months ago following a lengthy handover. They told us they had not been supported to develop an action plan for improvements. They were aware of a quality audit which had been completed over two months prior to our visit which contained actions but had not developed a plan of how these should be addressed. Whilst we did observe improvements in some areas of the service, there were continued concerns relating to people safety, quality of life and management oversight which had not been addressed. Systems designed to ensure staff were competent to support people safely had not been fully implemented. Staff competency monitoring showed that not all staff had competency assessments relating to moving and handling, providing oral health care, providing person centred care and supporting with oral health care. In addition, we identified staff had not completed training in the application of topical skin creams and nursing staff had not completed training in administering specific medicines despite this being part of the provider’s medication policy. This is the fourth consecutive inspection of Heathlands Care Centre where breaches of statutory regulations have been identified. This is evidence of a history of the provider failing to respond adequately to serious concerns.