Background to this inspection
Updated
9 September 2023
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
This inspection was carried out by 2 inspectors, a medicines inspector and Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
Heaton House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Heaton House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations. At the time of our inspection there was a registered manager in post.
Notice of inspection
We gave the service 24 hours’ notice of the inspection. This was because we needed to be sure that the provider or registered manager would be in the office to support the inspection .
Inspection activity started on 21 June and ended on 4 July 2023. We visited the location’s service on 21 June 2023.
What we did before the inspection
We reviewed information we had received about the service since our last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all of this information to plan our inspection.
During the inspection
We spoke with 4 people and 5 relatives about their experiences of the care and support provided. We also spoke with 8 staff members, including a director, the registered manager, senior care and care workers and other members of staff who work in the home. We also made observations of people’s care and support.
We reviewed a range of records. This included 4 people’s care records, medicine administration records and other associated documentation. We also looked at other records relating to the management of the home and risk management. We looked at safety information and certificates, staff rotas, accident and incident records, menus and meal monitoring, meeting minutes, audits and governance information. The registered manager was also registered as the providers nominated individual. They are responsible for supervising the management of the service on behalf of the provider.
We also used technology such as video calls to enable us to engage with people using the service and staff, and electronic file sharing to enable us to review documentation.
Updated
9 September 2023
About the service
Heaton House is a residential care home providing accommodation for people who require personal and nursing care to up to 21 people. The service provides support to older people some of whom had dementia. At the time of our inspection there were 18 people using the service.
People’s experience of using this service and what we found
People’s medicines were not always managed safely; record keeping and systems relating to the management, storage and administration of people’s medicines were inconsistent. The provider had recently lost a number of staff and had carried out rolling recruitment; however, in some cases there were gaps in references and the correct service was not recorded on staffs DBS certificates; we discussed this with the provider who addressed this immediately. Risks relating to the safety of the environment had been identified but not actioned for significant periods of time. The provider was unable to evidence any actions to address risk identified in relation to the building. We identified the provider had not always responded effectively to safeguarding concerns. We have made recommendations relating to risk assessments and safeguarding procedures.
The provider and registered manager had not maintained oversight of systems and processes. There was no evidence of audits being carried out by the provider or registered manager which had led to a number of issues we identified during this inspection not being addressed. Audits which had been completed by other members of staff identified similar actions for a number of months without action being taken. The provider were not always clear on when notifications to CQC were required; however, we were assured this was due to a lack of oversight and governance as safeguarding referrals had been made and the provider had liaised with CQC. Staff reported feeling supported by the management team and felt confident changes being made would improve the service. We have made a recommendation the provider ensures systems relating to duty of candour are robust and effective.
The provider had not implemented systems which ensured staff were suitably skilled, qualified and had the relevant experience to provide care and support. Training records provided during our inspection did not provide assurances staff received robust training in all areas required. Additionally, staff feedback relating to their induction varied significantly and we found evidence within records which further corroborated this Information relating to people’s mental capacity had been recorded in care records and support plans; however, occasionally this was inconsistent and capacity assessments were not always decision specific. Communication with external professionals was not always recorded. We have made a recommendation the provider ensures all correspondence and involvement with external professionals involved in people’s care is recorded.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice .
The provider had not implemented a meaningful and varied programme of activities. We observed little evidence of people being engaged in activities and people and relatives feedback corroborated our observations. The provider had not always worked in accordance with their complaints policy; prior to our inspection the provider was made aware of a number of complaints. During our inspection we found only one complaint had been logged which meant an audit trail to evidence what action the provider had taken and when, could not be reviewed. Additionally, lessons learnt from complaints could not be evidenced due to their being only one complaint recorded. People’s care plans and support plans had been improved since our last inspection particularly oral care and communication plans. We have made recommendations in relation to activities and end of life care training.
People and their relatives felt care was provided by staff who understood how to meet their needs, promote their independence and dignity and protect their privacy. Staff demonstrated a good understanding of person centred care and how to support people as individuals. Staff told us this culture was apparent across the staff team and people confirmed this by describing staff as “kind, “hardworking” and “beautiful”.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 24 October 2022) and breaches of regulations were identified. The service remains rated requires improvement. Under the current provider this service has been rated requires improvement for the last two consecutive inspections.
The provider completed an action plan after the last inspection to show what they would do and by when to improve.
At this inspection we found the provider remained in breach of regulations.
At our last inspection we recommended that the provider reviewed training compliance, activities, people’s communication plans and their duty of candour systems. At this inspection we found improvements had been made to people’s communication plans; however, further development was needed in the other areas.
Why we inspected
This inspection was prompted by a review of the information we held about this service.
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 the overall governance of the service, people’s safety and low staffing levels. A decision was made for us to inspect and examine those risks.
You can see what action we have asked the provider to take at the end of this full report.
Enforcement and Recommendations
We have identified breaches in relation to safe care and treatment, premises and equipment and good governance at this inspection.
We have issued warning notice's against the breaches relating to safe care and treatment and good governance. We issued a requirement notice against the breach relating to premises and equipment.
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.