This inspection was unannounced and took place on the 6, 20 and 21 September 2016. At the last inspection on 7, 8 and 12 October 2015 we found that the provider had breached three regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (HSCA 2014) concerning suitable numbers of staffing, treatment of those living with diabetes and safe staff recruitment working practices. We had also made a recommendation regarding the implementation of a structured and recognised induction and training package for new staff which followed the Care Certificate Standards.
We told the provider they needed to take action and we received a report setting out the action they would take to meet the regulations. At this inspection we found that some improvements had been made with regard to one of the breaches identified. However during this inspection we identified two continuing breaches and a further two breaches of the HSCA 2014.
Heatherside Care Home (referred to as Heatherside throughout this report) is a care home which provides residential care for up to 34 older people living with a range of medical conditions including diabetes and dementia.
The home is situated in a village on the outskirts of Basingstoke. It comprises two floors, is situated within its own grounds and has a two acre secure rear garden. The home has 34 rooms, a communal lounge with a television and doors leading through to a patio area and the grounds. There is a smaller quieter and more private seating area adjacent to the main lounge. There is also a dining room, bathroom and shower rooms and a lift for access. Meals were served according to people’s choice in their rooms or dining room. At the time of the inspection 30 people were living at the home.
Heatherside does not have a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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. The previous registered manager had left Heatherside four months prior to this inspection and a new manager had been immediately appointed by the provider. At the time of the inspection they were in the process of becoming registered with the CQC. Throughout this report care staff will be referred to as ‘staff’.
There were not effective systems in place to identify whether there was sufficient staff deployed to meet people’s individual needs in a timely fashion. Where the need for additional staff had been identified, the provider did not ensure that these were made available. The provider had not ensured that regular reviews of people’s dependency needs were carried out to identify the correct number of staff required to meet people’s needs.
People were not always protected from the unsafe administration of medicines. Senior staff responsible for administering medicines had received training to ensure people’s medicines were administered, stored and disposed of correctly. However we could not see that appropriate advice had always been sought from healthcare professionals to ensure medicines were safe to be provided in a way other than prescribed.
Care plans and risk assessments contained detailed information to assist staff to provide care in a manner that respected each person’s individual requirements and promoted their dignity. People were encouraged and supported by staff to make choices about their care including how they spent their day in the home. However at the time of the inspection these care plans and risk assessments were not being reviewed monthly in accordance with the provider’s guidelines. This was required to ensure they contained the most up to date relevant information and guidance to assist staff in delivering safe and effective care.
People were not always supported to have their diabetes safely managed. When advice had been provided regarding the management and monitoring of people’s blood sugar levels this guidance was not always followed by staff to ensure people received the most appropriate medical treatment.
People, where possible, were supported by staff to make their own decisions. Staff were able to demonstrate that they complied with the requirements of the Mental Capacity Act 2005 when supporting people. This involved making decisions in the best interests of people who lacked the capacity to make a specific decision for themselves. Staff sought people’s consent before delivering their care and support. However records did not always show people’s decisions to receive care had been appropriately assessed, and documented.
People who were unable to make decisions regarding their care and treatment were not always supported by the relevant processes to ensure decisions made regarding their care were made in their best interests.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager showed an understanding of what constituted a deprivation of a person’s liberty.
People were not provided with the opportunity to participate in activities allowing them to live interesting and fulfilling lives. Recruitment of new activities staff was on-going at the time of the inspection however people told us they were bored as there were no opportunities available to them.
The provider had not always ensured that quality control audits had been completed in line with the provider’s policy to improve the quality of the service provided. The manager was aware of this and had started work to ensure appropriate actions were taken.
People were not always able to immediately recognise the new manager however had no hesitation in raising concerns with them if required. Staff did not feel that the manager was always a visible presence in the home.
Staff told us they felt supported by their colleagues and senior staff however they did not always feel this support from the manager.
People using the service told us they felt safe. Staff understood and followed guidance to enable them to recognise and address any safeguarding concerns about people. People’s safety was promoted because risks that may cause them harm had been identified and guidance provided to staff to help manage these appropriately. People were assisted by staff who encouraged them to remain independent.
Recruitment procedures were fully completed to ensure people were protected from the employment of unsuitable staff.
Contingency plans were in place to ensure the safe delivery of people’s care in the event of adverse situations such as a fire, floor or utilities loss. These were easily accessible to staff and emergency personnel such as the fire service if required to ensure people received continuity of care in the event of an on-going adverse situation which meant the home was uninhabitable.
People were supported to eat and drink safely whilst maintaining their dignity and independence. We saw that people were able to choose their meals and they enjoyed what was provided. People’s food and drink preferences were documented in their care plans and were understood by staff. People were supported to eat and drink enough to maintain a balanced diet.
People told us that care was delivered by kind and caring staff who sought to meet their needs and ensure they were happy. We saw that people had friendly and relaxed relationships with staff who would stop and speak with them when they had the opportunity to do so.
People and relatives we spoke with knew how to complain and told us they would do so if required. No complaints had been made since the last inspection but procedures were in place for the manager to monitor, investigate and respond to complaints in an effective way. People and relatives were encouraged to provide feedback on the quality of the service through annual questionnaires.
The manager promoted a culture which focused on people receiving care in a relaxing and homely environment. Staff and people felt that the home had a homely and happy environment.
The manager had informed the CQC of notifiable incidents which occurred at the service allowing the CQC to monitor that appropriate action was taken to keep people safe.
We found two continuing breaches and three new breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.