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Heathgrove Lodge Care Home Requires improvement

Reports


Inspection carried out on 27 June 2019

During a routine inspection

About the service

Heathgrove Lodge Care Home is a residential care home providing personal and nursing care to 29 older people at the time of the inspection.

The care home accommodates 29 people in one adapted building

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

Due to inconsistencies in records, we could not be assured two staff members were involved in the repositioning of people where needed and people received care and support that was safe.

The décor and layout of the building was not adapted to meet people’s needs. Aspects of the home were not dementia friendly, easily accessible to people with mobility needs and did not encourage and promote independence and social interaction. People were dependent on staff to take them to other parts of the home when needed.

Medicines were not managed safely, discrepancies were found with medicines stock counts.

People were encouraged to eat healthy food for their wellbeing. However, some fluid intake records had not been completed to ensure people were sufficiently hydrated.

There were systems in place to assess and monitor the quality of the service provided. However, these were not effective to sustain improvement.

The majority of people spoke positively about the service. They said they felt safe and their needs were being met. Care and support was personalised to individual needs. Staff followed appropriate infection control practices. Assessments were carried out to ensure, people’s needs could be met. Where risks were identified, there was guidance in place for staff to ensure that people were safe.

The provider had systems in place to record and respond to accidents and incidents in a timely manner. Any lessons learnt were used as opportunities to improve the quality of service.

Staff had the knowledge and experience to support people's needs and were supported through induction, training and supervision to ensure they performed their roles effectively.

People were supported to maintain good health and had access to healthcare services.

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's privacy, dignity and independence was promoted. People told us staff were kind and caring.

There were procedures in place to respond to complaints. The provider had investigated and responded promptly to any concerns received.

The provider worked with healthcare services and professionals to plan and deliver an effective service.

Rating at last inspection and update

The last rating for this service was requires improvement (published 6 July 2018) and there was one breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, enough improvement had not been sustained and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on previous rating.

Enforcement

We have identified breaches in relation to safe care and treatment, premises, person centred care and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner

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

Inspection carried out on 9 May 2018

During a routine inspection

Heathgrove Lodge is a 'care home'. The accommodation is purpose-built with passenger lift access to all four floors. People in this care home receive accommodation along with nursing and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a registered manager, which is a person who has registered with the Care Quality Commission 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.

The service is registered to provide accommodation and personal care for up to 36 people, although the registered manager told us the maximum practical occupancy is 33. There were 27 people using the service at the start of this inspection. The service specialises in dementia care and is operated by a national care provider.

This was an unannounced comprehensive inspection, to make sure the service was providing care that is safe, caring, effective, responsive to people's needs, and well-led.

At our last inspection of this service, in April 2017, we found three breaches of legal requirements. These were in respect of receiving and acting on complaints, fit and proper persons employed, and duty of candour. The service was rated 'Requires Improvement.' The provider completed an action plan to show what they would do and by when to improve the rating of key questions of 'Is it Safe?', ‘Is it Responsive?’ and 'Is it Well-Led?' to at least ‘Good.’

At this inspection, we found the necessary improvements had been made to addresses the previous regulatory breaches. However, we also found there were not enough call-bell pagers available for all staff to be aware of anyone’s call-bell being activated, and so we found call-bells were not always promptly attended to. We found that up-to-date information in people’s care plans was not always easily accessible in support of ensuring staff provided people with an individualised service. The service was also not making sure any conditions on Deprivation of Liberty Safeguard (DoLS) authorisations were being met.

There were many auditing processes at the service that fed into an overall improvement plan that was kept under review. However, these processes had not identified and addressed the care delivery concerns we identified, which demonstrated weaknesses in the provider’s governance framework.

Some people praised the service and told us they would recommend it, and no-one said they would not. Most relatives and representatives agreed.

Community professionals praised the service for working well with them in support of meeting people’s needs. People were supported to have access to healthcare services and receive ongoing healthcare input, for example, in relation to skin care or nutritional concerns. People were safely supported to eat and drink enough and maintain a balanced diet.

There were a number of systems in place to monitor and improve on the way staff interacted with people. This helped ensure people were treated respectfully.

The service assessed people’s needs so that care and support was delivered in line with standards to achieve effective outcomes. There was good oversight of people’s significant and developing needs.

The service assessed and managed risks to people, to balance their safety with their freedom. This included for individual needs and in terms of health and safety across the premises. Improvements were being made to help ensure the adaptation, design and decoration of premises supported people's individual needs to be met, as the design of the building was not ideal.

People's medicines were managed and administered safely, so that people received their medicines as prescribed.

The service provided people with daily communal activities that at

Inspection carried out on 27 April 2017

During a routine inspection

This was an unannounced inspection that took place on 27 April and 5 May 2017. Heathgrove Lodge Care Home is a nursing home for up to 36 people. There were 31 people using the service when we inspected, and we were informed that their maximum practical occupancy is 33 and hence there were two vacancies. The service’s stated specialisms included dementia care. The accommodation is purpose-built with passenger lift access to all floors.

The service had a registered manager, which is a person who has registered with the Care Quality Commission 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 the last inspection in February 2016, we found the service to be compliant with relevant regulations. Our findings at this inspection have, however, identified breaches of regulations.

There was insufficient evidence at this inspection to demonstrate that complaints were consistently handled and monitored effectively. Complaint response letters were not always written. Those that were sent did not fully inform the complainant of what they could do if dissatisfied with the response. Actions agreed in response to one complaint had not occurred. Two verbal complaints had not been recorded on the provider’s complaints monitoring system, and a third had not been recorded accurately, meaning that the provider may not have been able to effectively monitor complaints at the service. This reflected mixed views we received about complaints systems at the service.

The provider’s Duty of Candour policy had not been followed in respect of two incidents, which did not reflect a culture of learning from incidents so as to minimise the risk of reoccurrence.

Staff recruitment processes were not robust enough to ensure that only suitable staff provided care and treatment to people. This was due to failures to explore employment gaps and acquire appropriate written references.

There were a number of systems used to scrutinise the service in good detail and implement improvements. However, they had not picked up on the above matters. We were not assured the management changes at the service provided the consistent leadership and direction required of a well-led service.

Whilst most people spoke of staff being responsive and helpful, we found that two people did not have access to their calls bells when we checked on them. There had also been no recent meeting for people using the service and their relatives for them to share views.

Most people and their relatives praised the service highly, describing it as “excellent” for example. However, some felt they would not recommend the service.

People were treated well at the service on a day-to-day basis. There were good visiting and contact arrangements for people’s friends and relatives. Activities provision had been expanded to seven days a week, and there was ongoing work to improve on people’s levels of engagement. There were enough staff supplied to meet people’s needs.

Good attention was paid to people’s individual healthcare care needs, and liaising with community healthcare professionals in support of that. The service supported people to take medicines as prescribed.

People spoke positively of the food provided at the service, and we saw that people’s nutritional needs and preferences were kept under review and addressed.

People’s care plans were up-to-date and reflected their individual needs and preferences, including for people newly using the service. Risk assessments were regularly reviewed.

Appropriate attention was paid to ensuring the safety of equipment and the premises. There was a good standard of cleanliness and sufficient attention to the prevention and control of infection.

The provider was ensuring that an empowering and positive leadership culture was being set up at

Inspection carried out on 5 February 2016

During an inspection looking at part of the service

We carried out an unannounced comprehensive inspection of this service on 16 October 2015. Breaches of legal requirements were found. We rated the service as Requires Improvement, and we served an enforcement warning notice on the provider and manager in respect of safety breaches because of the potential impact on people using the service. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report mainly covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Heathgrove Lodge Nursing Home on our website at www.cqc.org.uk .

Heathgrove Lodge Nursing Home is a nursing home for up to 36 people. There were 31 people using the service when we inspected, and we were informed that their maximum practical occupancy is 33. The service’s stated specialisms included dementia care. The accommodation is purpose-built with passenger lift access to all floors.

There was a registered manager in place at the service at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission 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.

We found that the provider had followed their plan to address our previous concerns, and so they were now meeting legal requirements in support of ensuring appropriate care and treatment of people using the service.

Care plans were now promptly set up for new people using the service, to help ensure their safe care and treatment.

Where anyone had wound care needs, action was taken to monitor and address the needs effectively.

Records of care and treatment delivery such as repositioning charts for people at risk of pressure ulcers were now kept up-to-date and were used effectively.

The service provided good support of people’s health and nutritional needs, and worked in partnership with community healthcare professionals.

There was good overall feedback, from people using the service and their representatives, about the services provided.

Where people or their representatives were unhappy with any aspect of the service, or raised a complaint, timely action was taken to try to improve matters. Further staff training had been completed in support of this.

The provider had effective systems in place to monitor service quality and identify care and treatment risks.

People overall received personalised care and treatment that was responsive to their needs and preferences.

Inspection carried out on 16/10/2015

During a routine inspection

This unannounced inspection took place on 16 October 2015. Our previous inspection, of 3 January 2014, found there to be no breaches of regulations.

Heathgrove Lodge Nursing Home is a nursing home up to 36 people. There were 30 people using the service when we inspected, and we were informed that their maximum practical occupancy is 33. The service’s stated specialisms include dementia. The accommodation is purpose-built with passenger lift access to all floors.

There was a registered manager in place at the service at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission 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.

The service tried to respond to people’s requests. The basis of this was a comprehensive assessment of needs and preferences. However, whilst people’s care plans were regularly reviewed, care plans were not promptly set up for new people using the service, which may not have ensured safe care and treatment for these people.

Whilst there was prompt healthcare support in some circumstances, we found that reasonable actions to address wound care needs were not always being taken. Records of care and treatment delivery did not consistently demonstrate safe care and treatment of people.

Some complainants’ experiences and inconsistent staff training demonstrated that an effective complaints system was not always being operated at this service.

The service was not consistently well-led. This was because the breaches we found were foreseeable, and effective systems of governance should have identified and addressed the consequent risks to the health, safety and welfare of people using the service.

The service’s strengths included that staff attended to people in a friendly manner, people were offered care choices, and people’s choices were listened to. People were treated with respect, and we found that positive relationships were developed.

People received meals that were appetising and freshly prepared. They received support with eating and drinking enough. People’s medicines were adequately managed, and there were enough staff deployed to keep people safe.

The service took appropriate action if they believed a person needed to be deprived of their liberty for their own safety.

Staff received support to deliver care to people appropriately, including through regular training and supervision. The service was promoting a positive, open and person-centred culture, and a number of audit tools were in use to help ensure service quality.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are taking enforcement action against the registered provider and registered manager for one of these breaches because of the potential impact on people using the service. You can see what action we have told the provider to take at the back of the full version of this report.

Inspection carried out on 3 January 2014

During an inspection looking at part of the service

At our last inspection of this nursing home, the provider was not compliant with one standard. We had found that people's call-bells were not always responded to in a timely manner. This did not always meet people's individual needs or ensure their safety and welfare. The provider sent us an action plan addressing our concerns.

At this inspection we found that improvements had been made. Systems had been set up to ensure and monitor that call-bells were answered in a timely manner. For example, there were enough call-bell receivers for all staff working, and records showed that most activations of the call-bell were now responded to in less than five minutes.

We spoke with five people using the service during the inspection. They confirmed that call-bells were responded to quickly. One person said, �they respond quickly and with genuine concern.� Despite this, there were some concerns expressed about staff being too busy. However, it was evident that staffing levels were kept under review, and extra staff had been provided during the day recently. This helped to ensure that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

Most people fedback positively about the overall services provided. Comments included, �they�ve very good, it�s lovely here� and �I don�t want for anything.�

Inspection carried out on 25 September 2013

During a routine inspection

We spoke with eleven people who use the service and five visitors. People praised the care and treatment provided. Comments included, �it�s quite good, nine out of ten.� Everyone talked positively about the staff. �They�re very good,� one person said. A visitor told us, �staff treat with care and reassure people.� However, some people fed back concerns about their experience of activities, which the provider may find useful to note.

Seven of the eleven people we spoke with gave us feedback that care and treatment was not always provided in a timely manner. Comments included, �they don�t have enough helpers. If you ring the bell, its ages before they come and they�re always too busy to talk" and "they could do with more staff. You can press this button and wait 10-15 minutes.�

We checked records of response times to people�s call-bells, which confirmed that they were not always responded to in a timely manner. This failed to ensure that each person was properly protected against the risks or receiving care or treatment that was inappropriate or unsafe.

There had been recent refurbishment of the environment and d�cor, for which there was positive feedback. We found that people were protected against the risks of unsafe or unsuitable premises and equipment.

We also found that there were appropriate arrangements in place to manage medicines, and to identify the possibility of abuse and prevent abuse from happening.

Inspection carried out on 25 January 2013

During a routine inspection

We spoke with 12 people who use the service and a community healthcare professional. Most people were positive about the overall services provided. Comments included, �everything�s fine here.�

People we spoke with were happy with the recent refurbishment of the home. One person told us that great care had been taken to ensure people were not upset by the process, and that �the whole place looks a lot nicer.�

Most people said that they received the care and support they needed. �The staff are all lovely,� one person told us. We saw that care was delivered at a relaxed pace that met people�s needs. Staff knew how to communicate with people, and interacted warmly with them.

There were systems in place aimed at ensuring people experienced care and treatment that met their needs. However, we found that some pressure-relieving equipment was not being used and maintained correctly. This may have failed to protect people against inappropriate or unsafe care and treatment.

Inspection carried out on 1 July 2011

During an inspection in response to concerns

We received some information of concern in June 2011 which initiated this review. The allegations included that people who use services tended not to have soap and paper wipes available in their rooms, that staff re-used disposable gloves, and that people�s dignity was compromised by there not being enough bed-sheets available for use.

We spoke to people who use services and looked around the home in respect of these allegations. People were generally quite positive about standards of cleanliness, and as one person put it, �It�s new gloves for every patient.� There were also no concerns about bed linen. However one person told us that there were no paper hand-towels available in the downstairs toilets. When we checked, there was nothing to dry hands on, in either of the two communal toilets near the lounge. The manager was informed, who arranged for this to be addressed immediately.

We asked people who use services about the standard of furnishing in the service. Whilst there was satisfaction overall, some people pointed out that some furnishings were chipped. New equipment had however been ordered to address this.

We asked people about the standard of care and support provided. Feedback was positive, for instance, someone telling us that they were �quite satisfied� with the care overall. We saw staff treating people respectfully and considerately. Comments about staff included, �The staff are all very nice.� People thought that there could be more staff working, however there was no evidence that people�s needs were not met.

People who use services were generally satisfied with the standard of care and support provided by the service. As one person put it, �I�ve no complaints at all.�

Inspection carried out on 31 March 2011

During a routine inspection

People who use services gave us a range of responses that were overall reasonably positive about the quality of services provided. Most praise was given for the food and the cleanliness of the home, with comments such as �The food tastes very good� and �The cleaning is very good, very thorough.�

There was good feedback about the overall standards of care and support, with comments such as, �They look after my health needs very well.� Staff were praised but with some reservations. As one person put it, �They�re not patient enough sometimes. But they�re very kind too.� Most people felt that there were not always enough staff to meet their needs. Staff were however generally seen as capable.

Some people were happy with the environment and the equipment available in the home. Some others expressed reservations, for instance about tables being the wrong height, and about the narrow corridors and doorframes which made independent wheelchair use more difficult. A relative also commented that the d�cor was old.

In summary, people were reasonably happy with services. Their overall comments were best summarised by one person who said, �There�s a few things that could be improved but it�s pretty good here.�

Reports under our old system of regulation (including those from before CQC was created)