Healey Lodge Residential Home

Healey Lodge is a residential care home providing personal care to up to 24 people in a two-storey adapted building. The service provides support to younger people, people over 65 years, autistic people and people with a learning disability. At the time of our inspection there were 22 people using the service.

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

Medicines were not always managed safely. Recruitment checks were not always being completed. We have made a recommendation about infection prevention and control measures and seeking the views of people. Required health and safety checks were being carried out. There were enough staff to meet people’s needs. People told us they felt safe and well cared for in the service. Staff were able to recognise abuse and knew how to report.

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 supported this practice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Systems and processes were not always effective to oversee and manage the service. Staff meetings were occurring. The home had a positive culture. Staff and people provided positive feedback on the registered manager and found him to be approachable and supportive. The service is working with other professionals to meet people’s health needs.

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

Rating at last inspection

The last rating for this service was good (published July 2018).

Why we inspected

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.

This inspection was prompted by a review of the information we held about this service. We received concerns in relation to personal care delivery, skin integrity management and communication. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Healey Lodge on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe management of medicines, safe recruitment and oversight of the service 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 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.

We found the following examples of good practice:

There were clear infection prevention and control procedures which were understood and followed by staff. All staff were trained in the use of personal protective equipment (PPE), handwashing techniques and participated in the testing programme. During our visit, the staff were wearing appropriate PPE and plentiful supplies were available around the home.

There was a good standard of cleanliness in the areas seen. Additional cleaning schedules were in place and followed. There were effective policies, procedures and risk assessments in place to maintain good practice in relation to infection control and to provide safe and kind care.

The provider’s infection prevention and control policies were up to date and regular audits had been carried out. A Covid-19 Response Plan and business contingency plan were in place and had been followed. The management team were liaising with the local authority and other partners including the community nurses.

People were supported to maintain contact with their relatives in different ways including the use of technology, window visits and telephone calls. There were procedures in place for essential visitors, which included temperature and health checks.

The atmosphere in the home was peaceful and calm. Staff were attentive to people's needs and requests for assistance.

We were assured this service met good infection prevention and control guidelines.

Further information is in the detailed findings below.

About the service

Healey Lodge Residential Home is a residential care home providing personal and nursing care to 24 people. At the time of the inspection, there were 24 people living in the home, some of who were living with dementia.

The home is set in its own gardens and accommodation is provided on two floors.

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

People were happy about the care and support they received and with the way the home was managed. They were complimentary about the registered manager and the staff team. The registered manager and the provider monitored all aspects of the service and took appropriate action to improve the service. The registered manager considered people’s views about the quality of care provided and used the feedback to make improvements to the service.

People told us they felt safe and staff were kind, friendly and caring. Staff had access to safeguarding adults' procedures and understood how to protect people from abuse. Recruitment processes ensured new staff were suitable to work in the home and there were enough numbers of staff to meet people's needs and ensure their safety. People received their medicines when they needed them from staff who had been trained and had their competency checked. Risk assessments were carried out to enable people to retain their independence and receive care with minimum risk to themselves or others. People were protected from the risks associated with the spread of infection.

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 care needs were assessed prior to them living in the home. Arrangements were in place to ensure new staff received induction training. Staff received ongoing training, supervision and support. They felt valued and supported. People enjoyed the meals and were supported to eat a nutritionally balanced diet and had access to various healthcare professionals, when needed. People were happy with their bedrooms and the communal areas. A development plan was in place to ensure ongoing refurbishment and redecoration. We shared our concerns about the uneven driveway, with the registered manager. Following the inspection, we were told action was underway to obtain quotes.

Staff treated people with dignity, respect care and kindness and knew people well. Our observations during the inspection, were of positive and warm interactions between staff and people who lived in the home. Staff spoke with people in a friendly and patient manner and we overheard lots of laughter and friendly banter. Staff knew about people’s backgrounds and about their routines and preferences and people told us they received the care they needed and wanted. People or their relatives, where appropriate, had been consulted about their care needs and had been involved in the care planning process.

People told us they enjoyed the activities, but they were limited at times. Prior to the inspection, the designated activity coordinator had left which meant some people’s access to activities was dependent on staff availability. Recruitment of a replacement activity person was underway. People could raise any complaints or concerns if they needed to and had access to a complaint’s procedure.

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

Rating at last inspection

The last rating for this service was Good (published 17 January 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Healey Lodge Nursing Home provides accommodation and care and support for up to twenty four people older and younger people including people living with a dementia or learning disability. There were 23 people accommodated in the home at the time of the inspection.

The service was also registered to provide nursing care but at the time of our visit nursing care was not being provided due to difficulties recruiting suitable nursing staff. An application had been forwarded to Care Quality Commission (CQC) to remove this activity and to change the name of the service to reflect this.

Healey Lodge Nursing Home is located on the outskirts of the town of Burnley, Lancashire and is on a main bus route. Accommodation is provided on two floors. Shops, pubs, churches, the library and other amenities are within walking distance. There are surrounding gardens with a patio and seating areas. A car park is available for visitors.

The service did not have a registered manager in post. The previous registered manager left the service in April 2015. A registered manager is a person who has registered with CQC 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. A manager had been in post since May 2016 and an application to register her with the CQC had been forwarded in November 2016.

At the previous inspection on 24 and 25 June 2015 we found the service was not meeting all the standards assessed. We found shortfalls in the management of medicines, maintaining the environment, provision of induction and training for staff, responding to people’s concerns and operating effective quality assurance and auditing systems. We also made recommendations regarding the provision of supervision and support for staff, recruitment processes, infection control practices and obtaining people’s consent. We asked the provider to take action to make improvements and to send us an action plan. The provider complied with our request. During this inspection we found the required improvements had been made.

From December 2015 a number of safeguarding concerns had been raised about the care people were receiving, the management of the home, cleanliness of the home, the lack of suitable nursing staff and the high reliance on agency staff. At that time a decision was made by the provider to cease providing nursing care. The service worked with local commissioners until care reassessments were completed or until alternative suitable placements could be found for people that could meet their needs. The medicines management team, infection control team and local authority commissioners have worked with management and staff to support them to make improvements. In October 2016 we were told they were satisfied sufficient improvements had been made.

During this inspection people told us they did not have any concerns about the way they or their relatives were cared for. They were happy with the care and support provided and told us they felt safe and well cared for.

Staff could describe the action they would take if they witnessed or suspected any abusive or neglectful practice and had received training on the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS). This meant they had knowledge of the principles associated with the legislation and people’s rights.

People considered there were enough suitably skilled staff to support them when they needed any help and they received support in a timely and unhurried way. The manager followed a robust recruitment procedure to ensure new staff were suitable to care for vulnerable people. Arrangements were in place to make sure staff were trained and supervised at all times.

Medicines were managed safely and people had their medicines when they needed them. Staff administering medicines had been trained to do this safely.

We found people lived in a clean, pleasant and homely environment and appropriate aids and adaptations had been provided to help maintain people’s safety, independence and comfort. People had arranged their bedrooms as they wished and had brought personal possessions with them.

Each person had an individual care plan that was sufficiently detailed to ensure they were at the centre of their care. People’s care and support was kept under review and they were involved in decisions and discussions about their care. Risks to people’s health and safety had been identified, assessed and managed safely. Relevant health and social care professionals provided advice and support when people’s needs had changed.

We found staff were respectful to people, attentive to their needs and treated people with kindness and respect in their day to day care. We observed good relationships between people. From our observations it was clear staff knew people and their visitors well and were knowledgeable about people’s individual needs, preferences and personalities. The atmosphere in the home was happy and relaxed; we overheard friendly banter and laughter during our visit.

Activities were appropriate to individual needs and people were happy to participate in activities both inside and outside the home. People told us they enjoyed the meals. They were provided with a nutritionally balanced diet that catered for their dietary needs.

People were encouraged to be involved in the running of the home and were kept up to date with any changes. People had no complaints, were aware of how to raise their concerns and were confident they would be listened to.

People using the service, relatives and staff considered the service was managed well and they had confidence in the manager. There were effective systems in place to monitor the quality of the service to ensure people received a good service that supported their health, welfare and well-being.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

During this inspection we spoke with four people using the service and with one visitor. We spoke with three care staff, a cook, a housekeeper and the manager. We also spoke with the local authority and a visiting health professional. We viewed records which included, three care plans and daily care records, maintenance and servicing records, recruitment and induction records, menus and records of meals served, customer surveys and quality monitoring records

We considered the evidence we had gathered under the outcomes. This is a summary of what we found:

Is the service safe?

Staff had undertaken training in the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). This should help staff to understand their responsibilities with supporting people to make their own decisions. Policies and procedures were also available for staff to refer to if needed. There had been no applications made under DoLS since our last inspection visit.

Assessments of any risks were recorded, managed and kept under review. This would help to keep people safe from harm.

Updated recruitment policies and procedures had recently been introduced. We saw pre-employment checks had been sought to verify new staff were of good character. However record keeping in this area needed to be improved. Staff had undertaken training that gave them the skills and knowledge to meet peoples' needs.

We found all areas of the home to be bright, clean, safe and comfortable. People had commented that the d'cor in some areas of the home needed improving. We found improvements were ongoing although there was no formal plan to support this. People had access to a range of appropriate, well maintained equipment to safely meet their needs and to promote their independence and comfort. Staff had received training to ensure they were competent to use the equipment safely and properly.

People were supported to eat and drink sufficient amounts to meet their needs. People told us they enjoyed the food. Comments included, "The food is very nice; I get a choice", "We get plenty to eat and drink and it is all very good". The meal time was not rushed and people were able to eat at their own pace.

Is the service effective?

Regular reviews were carried out to respond to any changes in people's needs and to ensure the level of care was appropriate. People who we spoke with told us they were involved in discussions about their care and said they were kept up to date with any changes. However, records did not clearly show people's involvement which meant they may not receive the care and support they wanted.

People's health and well-being was monitored and appropriate advice and support had been sought in response to changes in their condition. We found the service had good links with other health care professionals to make sure people received prompt, co-ordinated and effective care.

Is the service caring?

People told us they were happy with the care and support they received. Comments included, "I have my own routine and staff are ok with that; they ask if I need any help" and "Staff are here to help me; I am very well looked after'. Comments from visitors included, 'Care has been first class' and 'It appears to be a very caring and compassionate home'.

We observed staff interacting with people in a pleasant and friendly manner and being respectful of people's choices and opinions. One person said, 'The staff are great; I can have a laugh with them'.

Is the service responsive?

We found people's needs were assessed by suitably experienced staff, prior to admission to the home. Care, treatment and support was planned and delivered in line with people's individual care plan.

The care plans contained information about people's preferred routines and likes and dislikes. This information would help staff to look after people properly and ensure they received the care and support they needed and wanted. We found the quality of information in people's care plans varied and was not always reflective of the care people received. We were told a new care plan system was being introduced with clear timescales for completion.

There were opportunities for involvement in suitable activities. People told us they were involved in discussions and decisions about the activities they would prefer and activities were arranged for small groups of people or on a one to one basis.

People told us they were happy with the service they received. They said they could raise their concerns with the staff or managers.

Is the service well-led?

A manager was responsible for the day to day management of the service. The manager had forwarded an application to register with the Care Quality Commission (CQC). The manager was supported by the owner and by managers from the other homes within the organisation.

People had been encouraged to express their views and opinions of the service through meetings, customer satisfaction surveys and during day to day discussions with staff and management. People told us they were kept up to date about how the service was run.

There were systems in place to monitor the quality of the service with evidence that shortfalls had been identified and improvements made. This should help protect people from poor care standards and to identify any areas of non-compliance.

Any incidents and/or safeguarding concerns had been reported to the appropriate agencies. Staff were aware of the procedures for reporting any concerns about poor practice.

We found people's medicines were managed safely. Records were clear and accurate and medicines were stored safely and appropriately.

People told us about the different activities they had participated in. One person said, "I've had so much fun doing different things; it helps to pass the day". A visitor said, "There are plenty of interesting things going on".

During this visit, people told us they were happy with the staff team. Comments included, "They are very accommodating" and "The staff are very good; very kind". However, they also told us that 'at times' they had to wait until staff were available. We reviewed the staffing rotas and found there were times when some people may be left unsupervised for short periods of time. Following our visit adjustments were made to the rotas to ensure people were not left unsupervised.

Systems were in place to encourage people to express their views of the service and involved with any decisions about how the service was run.

We found staff had been updated and involved in discussions about any planned changes. There was a plan of training, support and supervision for staff. This would provide them with the skills and knowledge they needed to look after people properly and help to identify any shortfalls in staff practice. Most of the care staff had achieved a recognised qualification in care, which would help them to look after people properly. Staff were observed interacting with people in a pleasant and friendly manner and being respectful of people's choices.

We were told a new manager was due to start work this month. We were confident this would provide some continuity for people who lived at the home, their relatives and for staff.