Heaton House Care Home

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 that people could be harmed.

The provider was previously in breach of legal regulation in relation to the management of people’s medicines, staff recruitment processes, training and support. Improvements were found at this assessment, and the provider was no longer in breach of these regulations.

The provider was in breach of the legal regulation relating to safe care and treatment.

This service scored 53 (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 have a proactive and positive culture of safety based on openness and honesty. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

At our last inspection, we issued a warning notice regarding good governance. We also identified concerns regarding the level of detail recorded within the providers’ service action plan. At this inspection we found not all information referred to within the warning notice had been added to the action plan. An additional service improvement plan was in place; however, we found several concerns had still not been addressed at this inspection.

At our last inspection, it was not always clear what actions had been taken to try to prevent a reoccurrence and/or reduce risk, when certain incidents occurred. At this inspection we looked at accidents forms which had been completed and saw they were now being completed with more detail; this included a description of the incident, prior circumstances, triggering factors, post incident observations and actions taken in response.

Complaints were managed in line with policy. Records detailed the nature of the complaint, findings of the investigation and response provided.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different services.

At the time of this inspection, not every person was registered with a dentist, although some people did leave the home to attend appointments where possible. Some people had oral health care plans in place stating they required support to clean their teeth; however, records were inconsistent and not always accurately completed to demonstrate this was done daily and we did not see any evidence of oral health assessments being completed for people. After the inspection, the provider told us they had now established an arrangement with a dental provider who could provide private treatment to people at NHS-equivalent rates.

Staff worked in partnership with other professionals such as GP's and dietitians and to support people to access healthcare when they needed it. For example, people were referred to speech and language therapists (SaLT) if there were any concerns regarding choking. People also received visits from the district nursing team if there were concerns regarding their skin integrity.

We saw people’s needs were assessed when they first moved into the home, which provided an overview of the care they needed. Information about people’s needs, preference, medical conditions and medication regime was available if people required a hospital visit, either following an accident or for a planned procedure.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. 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 concerns quickly and appropriately.

At our last inspection, we identified at least 1 incident for which a safeguarding alert had not been raised, despite information documented within the accident form suggesting abuse could have occurred. At this inspection we checked to see if improvements had been made.

We found there was a safeguarding policy and procedure in place which was in date and provided an overview about what people could do if they experienced any abuse. A safeguarding log was maintained, with details about any incidents reported to the local authority for further review, however, it was unclear if this was completed consistently. We noted 2 altercations between people living at the home had occurred, which were of a physical nature. Neither of these were detailed within the safeguarding log and abuse notifications had not been submitted to CQC. These 2 incidents had been reviewed by the provider and were not considered to meet the threshold for safeguarding referrals.The provider had identified issues with documentation completion and staff training and had added the required actions to the Service Improvement Plan (SIP), including further staff training and improvement in the recording and escalation of incidents.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service.

DoLS applications had been submitted as and when required, with a log used to monitor applications and their outcome. Staff understood about safeguarding and the training matrix showed staff had completed safeguarding training within the previous 12 months.

People living at the home said they felt safe. One person said, “Yes, I feel safe. I’ve never been hurt or hit or anything like that. There are enough staff. I can’t complain at all.” Another person said, “The staff are always there when you want them. They come and check on me in my room, and they come if I press [my call bell] at night.”

The provider did not work well with people to understand and manage risks. Staff did not provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

The providers’ admissions policy stated key risk assessments should be completed within 12 hours of a person being admitted, including evacuation support details, falls, malnutrition screening tools (MUST), choking, pressure ulcers and manual handling. We found these assessments were not in place for all people, and moving and handling assessments were missing.

Some people were at risk of skin break down, although there was limited information in their care plans about equipment that was required such as pressure relief cushions or mattresses. People’s mattress settings were also not clearly detailed for staff to refer to. There were also gaps in people’s re-positioning charts which had not been completed by staff; we referenced this as a concern at our previous inspection.

Where people did have risk assessments in place, they sometimes lacked important details to ensure staff had accurate information to refer to. For example, 2 people were at risk of choking and had been referred to SaLT, although the diet they required was not referenced anywhere within their choking risk assessments; this had also been raised at our previous inspection.

One person required a level 5 diet as advised by SaLT, although food intake records consistently showed this person received a level 6 diet; this could place this person at risk of choking. Shortly after the inspection, the provider sent us updated care records.

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.

Fire checks were completed including servicing of the alarm and extinguishers. A fire risk assessment had also been undertaken in the previous 12 months. Most rooms within the home had been fitted with new fire doors, although we observed some of these required further attention. For example, we saw one door held open with a cabinet and another door which was sticking to the carpet; this could prevent them from closing properly in an emergency. Another door had a relatively large gap underneath it which could allow smoke to enter the room should there be a fire in that part of the home. We gave this feedback to the provider.

Most windows were fitted with restrictors to prevent them from opening too wide, although several bedrooms were fitted with older mechanisms meaning people could potentially leave the home in an unsafe way. Health and Safety Executive (HSE) guidance states the window opening should be restricted to 10cm or less and should only be able to be disengaged using a special tool or key. We asked the provider to review all windows within the home to ensure they met this guidance.

Areas of the building such as certain window frames were old and would benefit from being replaced; on the lower ground floor, some of these windows had clearly been painted over despite being rotten. These areas didn’t appear anywhere on the service action plan as improvement actions to be worked on.

Regular maintenance checks of the building had been completed including gas safety, electrical installation, legionella and the passenger lift. At the time of the inspection, the provider was awaiting certificates for the lift and hoists, and they assured us these would be sent to us when available; the provider showed us emails of them trying to obtain the certificates.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Staffing rotas were in place, and this demonstrated how many staff were available to care for people. We observed staff were present in lounge areas where people were seated and also observed staff entering people’s rooms to see if they needed anything.

Feedback from people about staffing levels was poor. One person said, “There’s not enough staff. This morning I woke at 7am and not got up till 10am. I get fed up and start shouting. They (staff) come if I press my buzzer; the staff are good when you can get hold of them.” Another person said, “I do feel safe, but there’s not enough staff. I buzz but it’s ages before they come, maybe 10 minutes, usually I am in bed and wanting the toilet.” A third person also added, “It’s ages since I had a bath; I’d like one every week. I want one when I want one. Sometimes it feels like there’s not enough staff. Today for instance, I was buzzing this morning and one staff came in and said she was dealing with someone else and never came back; I wanted to get up. It happens quite often.”

Staff were recruited safely, with pre-employment checks carried out before staff started working at the home which included Disclosure and Barring Service (DBS) checks. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. Staff had opportunities to learn, and any poor performance was managed appropriately.

Staff told us they received enough training to support them in their role, with a training matrix in place showing which courses had been completed. Staff supervisions and appraisals had taken place, and we looked at records of these during this inspection.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

We found the home to be clean, tidy and observed domestic staff carrying out their work during the inspection. Toilets and bathrooms were equipped with appropriate hand hygiene facilities such as paper towels, liquid soap and foot operated pedal bins. Hand sanitiser was available and posters were displayed on the wall to encourage compliance.

There was an up-to-date policy on the control of infection, prevention and control (IPC) which staff could refer to if needed. Staff were trained in IPC and had access to personal protective equipment (PPE) which we saw used for tasks such as completing personal care.

Nobody raised any concerns with us about the cleanliness of the home during our inspection. One relative said, “They keep (person’s) room clean.”

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Medicines were stored securely and areas used to store medicines had the temperature monitored and staff acted when these had gone outside of recommended ranges. Staff had received training on managing medicines and had their competency assessed.

People prescribed medicines to be given when required (PRN) had person centred protocols in place to ensure staff had information in place to be able to support people to access these medicines when needed.

For one person who received their medicines covertly (hidden in food and drink) there were instructions available from a pharmacist to ensure these were given safely, however this information was not always available on the electronic medicines recording system. On the day of the inspection staff were unable to evidence relevant capacity assessments and decisions had been completed so it was unclear if this was being done in the person’s best interests.

Systems showed time critical medicines such as those for Parkinson’s disease were given at prescribed times, however we found for one person a medicine that is prescribed to be given up to an hour before other medicines was being given at the same time as other morning medicines.

Investigations and actions were carried out when a medicine error had occurred, however it was not clear from incident reporting forms if people or their relatives had been informed of any incidents, or that appropriate healthcare professionals were contacted for advice. We fed this back to the provider who told us they would take remedial action to resolve the issue.