Heliosa Nursing Home

Heliosa Nursing Home is a residential care home providing personal and nursing care to 38 people at the time of the inspection. The service can support up to 40 people in one adapted building across two separate areas, each of which had separate adapted facilities.

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

Required improvements identified at our last inspection had been made, sustained and built upon. Safety and leadership had improved significantly. People received safe and effective care and outcomes were good.

Risks to people’s health, safety and welfare, were identified and managed safely with the involvement of the person or their representatives.

Safeguarding systems, policies and procedures ensured people were safe and protected from abuse.

People told us they felt safe and well cared for and made positive comments about the staff and standard of care. Comments included “They look after me 200% nothing too much trouble”. “I am so well looked after in every way”. A visiting relative said, “We have no doubt (relative) is safe, overall if I were to rate the quality of the care I'd say excellent”.

We were assured by the additional measures in place to help prevent the spread of COVID-19. Risks relating to infection prevention and control (IPC), including in relation to the COVID-19 pandemic were assessed and managed. Staff followed good IPC practices. Safe visiting was supported and enabled. Visitors were invited to take rapid COVID-19 test just before their visit, were provided with appropriate personal protective equipment as in accordance with government guidelines and best practice.

Medicines were safely managed, and systems were in place for reporting accidents and incidents and learning from them.

There were sufficient numbers of suitably trained and experienced staff on duty and safe recruitment procedures were followed. Staff presented as well trained, caring professionals.

The management team and staff were clear about their roles and responsibilities and they promoted a positive, person-centred culture. Staff worked well together as a team, and there was good partnership working with others to meet people's needs.

Effective systems were in place for checking on the quality and safety of the service and making improvements where needed.

Rating at last inspection and update

The last rating for this service was requires improvement (published 22 November 2019) and there were two breaches 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 we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

The provider notified us of concerns relating to the management of people’s finances. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well led sections of this full report.

Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires improvement to Good. This is based on the findings at this inspection.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Heliosa is a residential care home providing personal and nursing care to 40 people at the time of the inspection. The service can support up to 40 people in one adapted building across three separate areas, each of which had separate adapted facilities. One secure nursing unit specialising in dementia care and one mixed nursing unit.

We found that improvements were required in the way the service identified, assessed and reduced the risk of injury presented to people who used the service. Whilst pressure relieving equipment had been provided for people at risk of developing pressure ulcers this was not always being used effectively so people had remained at increased risk of injury. A sensor mat had been provided to alert staff when a person assessed at high risk of falls was attempting to mobilise, but this was not in place, so risk of injury was not always mitigated. Care plans had not always been updated when a person’s needs changed, and care records did not always reflect the level of care provided.

The systems in place to monitor the quality of the service were not always effective and had not highlighted the concerns identified during this inspection. Records needed for the safe management of the home were not always in place or kept up to date

The provider and registered manager were open and transparent and took immediate action to make necessary improvements and ensure people received safe and effective care.

Effective safeguarding systems, policies and procedures ensured people were safe and protected from abuse. People living at Heliosa and their relatives told us that their experience of using the service was good. People told us that they felt safe and their relatives and friends told us that they were confident that their loved ones were safeguarded from avoidable harm. Safeguarding concerns were responded to and managed effectively.

People told us they were supported and treated with dignity and respect. All people and their visiting relatives and friends had something positive to say about the home, the staff and the standard of care provided.

The atmosphere in the home throughout our inspection was warm welcoming and friendly. People had access to a range of activities that interested them and felt they were supported to maintain relationships with people that were important to them.

There was enough suitably trained and experienced staff who had good relationships with the people who used the service.

Medicines were managed safely and effectively.

Staff understood their role and responsibilities for maintaining high standards of cleanliness and hygiene in the premises.

New staff were recruited safely and received induction training before they could provide care and support. They benefited from ongoing training including the nationally recognised qualifications in health and social care.

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.

People were supported to maintain a balanced diet and were able to access health care services as and when needed.

A visiting health care professional spoke highly of the staff and management team, reporting that they worked in partnership with them to ensure that people’s health care needs were met.

Morale amongst the staff team was good. Staff told us that they appreciated support, guidance and direction of the management team.

The provider and management team demonstrated a commitment to improving the service and delivery of person-centred, high quality care by engaging with everyone using the service and stakeholders.

Concerns and complaints were responded to effectively and managers and staff learned from experience.

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 August 2018) and there were two breaches of regulations on Safe Care and Treatment and Good governance. 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 made or sustained and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

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

The provider took effective action to mitigate these risks during and after the inspection.

Enforcement

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Heliosa Nursing Home (Heliosa) is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Heliosa can accommodate 42 people who require support with nursing needs. The home has two separate units with one providing care and support for people who are living with dementia and may display behaviour that is challenging. The second unit provides care and support for people who may be living with dementia or require nursing care. At the time of our inspection there were 33 people living in the home.

The service was last inspected in January 2017 when we found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. On this inspection we looked to see if improvements had been made and these breaches of regulations had been met.

We found improvements had been made and four of the previous breaches had been met. Although we highlighted areas for further improvement we found that people living at Heliosa were receiving safe care which also enhanced their quality of life. The management and leadership of the service was more established and consistent.

The home had a manager who was in the process of being registered at the time of our inspection visit. Following the inspection the manager was registered. 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 mostly good systems in place for monitoring peoples medicines. However, we were concerned that insufficient safeguards were in place for people with swallowing difficulties who required ‘thickening’ agents to be added to drinks to reduce the risk of choking. There were also some recording issues with medicines which made it difficult to make an accurate check of medicines in stock. Some people who required extra administration and support plans for their medicines did not have these in place.

There was an internal quality assurance system in place to review systems and help to ensure compliance with the regulations and to promote the welfare of the people who lived at the home. This had been further developed by the manager since the last inspection and evidenced ongoing improvement to the service. We found however they did not fully identify or effectively monitor some of the issues we found. Some clinical records were not fully completed or were confusing.

You can see what action we told the provider to take at the back of this report.

Staff members we spoke with confirmed that they received regular training throughout the year and that this was up to date. The managers kept training statistics which confirmed this. We reviewed the induction training for staff and saw this did not meet the standards in the ‘Care Certificate’ which is the governments blue print for induction of staff working in care.

We made a recommendation regarding this.

At the last inspection we found a breach of regulations because risk assessments had not been completed in relation to environmental hazards which put people at potential risk of harm. We found improvements had been made to the assessments and monitoring of these risks. We did find two-bedroom fire doors propped open which had not been noted on the daily safety audit. This was addressed on the inspection. Daily audits were changed to include this check. There were a number of maintenance checks being carried out weekly and monthly. These included water temperatures as well as safety checks on the fire alarm system and emergency lighting. The previous breach had been met.

Previously there was breach of regulations as there were insufficient qualified, competent, skilled and experienced staff deployed to meet the needs of the people living in the service. We found this had improved and staffing numbers were now sufficient. Staff numbers were matched to the dependency levels of people living in the home. We found the staffing levels overall were consistent. Observations of routine care evidenced people getting appropriate support. We noted a continued high use of agency staff which also made communication difficult at times as they did not have English as a first language. There were plans in place to recruit more permanent staff on-going. The breach had been met.

At the last inspection we had found a breach of regulations because there were instances where safeguarding procedures were not followed when the manager was absent. This had improved. The service had a safeguarding policy in place. This was designed to ensure that any safeguarding concerns that arose were dealt with openly and people were protected from possible harm. All the staff we spoke to confirmed that they were aware of the need to report any safeguarding concerns and had received ongoing training regarding this. The manager had effectively liaised with safeguarding authorities to investigate any concerns. The breach had been met.

At the last inspection there had been a breach of regulations because staff were not seeking consent for day to day tasks and always giving people choices in relation to their care. Staff were not treating people with dignity and respect. We found improvements. Our observations and feedback we received from people living at Heliosa and their relatives was positive about this aspect of care. The breach had been met.

There were people being supported on a Deprivation of Liberty [DoLS] authorisation. DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom and ensures that any restrictions are appropriate and in the person’s best interests. We found these were being monitored by the manager of the home.

People told us they enjoyed the food. We saw that there were sufficient food and drinks and anybody at risk of malnutrition was appropriately supported. There was a flexible menu in place which provided a good variety of food to people using the service. People living there told us that the food was good. The staff worked with dieticians to consider supporting people with additional needs.

People we spoke with said they were satisfied living at Heliosa. They spoke about the nursing and care staff positively. When we observed staff interacting with people living at the home they showed a caring nature.

Activities were organised in the home. There was a designated member of staff employed to support this who was motivated to provide meaningful activities and these continued to be developed. We observed that more activities could be devised which linked to peoples past interest and hobbies.

We looked at how staff were recruited and the processes in place to ensure staff were suitable to work with vulnerable people. We saw checks had been made to help ensure that staff employed were ‘fit’ to work with vulnerable people.

People had care plans which were personalised to their needs and wishes. Most care plans contained information to assist support workers to provide care in a manner that respected the relevant person’s individual needs.

Heliosa Nursing Home (Heliosa) is a 42 bed home with nursing for older people: 39 of which are en-suite. The home has two separate units with one providing care and support for people who are living with dementia and may display behaviour that is challenging. The second unit provides care and support for people who may be living with dementia or require nursing care. The property is detached and set in substantial gardens and is two miles away from Congleton town centre.

The service was last inspected in October 2015 when we found the provider was meeting all the regulations and the service was rated as good.

The home has a registered manager. 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. At the time of our inspection there were 37 people living in the home.

We found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the back of this report.

Risk assessments had not been completed in relation to the pond and we found that fire doors were propped open putting people at potential risk of harm. The provider had not considered the potential risk that these issues presented.

Sufficient numbers of suitably qualified, competent, skilled and experienced staff were not deployed to meet the needs of the people living in the service. We observed that people were left in bed as they were not sufficient staff to assist people out of bed and staff did not have time to respond appropriately to people living in the home.

We saw that the service had a safeguarding policy in place. This was designed to ensure that any safeguarding concerns that arose were dealt with openly and people were protected from possible harm. All the staff we spoke to confirmed that they were aware of the need to report any safeguarding concerns; however we found instances where safeguarding procedures were not followed when the manager was absent.

The service had a range of policies and procedures which helped staff refer to good practice and included guidance on the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. We saw that applications had been made appropriately and consent to care was considered in the written documentation, however staff were not seeking consent for day to day tasks and always giving people choices in relation to their care. Staff were not treating people with dignity and respect.

We asked staff members about training and they all confirmed that they received regular training throughout the year and that this was up to date, however some staff did not feel that the standard of the training always provided them with knowledge and skills to do their jobs effectively. Our observations confirmed that staff members did not always have the appropriate knowledge to carry out their jobs effectively.

People living in the home and their relatives gave us mixed feedback about the staff and the home. Some felt that the standard of care they received was good, whereas others felt that the care and compassion shown by staff was not consistent across the staff team.

People had care plans which were personalised to their needs and wishes. Most care plans contained information to assist support workers to provide care in a manner that respected the relevant person’s individual needs; however we found that the care given did not always reflect what was recorded in the care plan. People told us and we observed that there were very few activities taking place in the home that reflected people's preferences.

There was an internal quality assurance system in place to review systems and help to ensure compliance with the regulations and to promote the welfare of the people who lived at the home. This included audits on care plans, medication and accidents. However, despite these being in place, they did not identify many of the issues highlighted within this inspection.

There were a number of maintenance checks being carried out weekly and monthly. These included water temperatures as well as safety checks on the fire alarm system and emergency lighting.

We looked at recruitment files for the most recently appointed staff members to check that effective recruitment procedures had been completed. We found that appropriate checks had been made to ensure that they were suitable to work with vulnerable adults.

There was a flexible menu in place which provided a good variety of food to people using the service. People living there told us that the food was good. The home were working closely with dieticians to consider portion sizes as well as supporting people with additional needs.

The registered manager was working hard to make improvements to the service. Staff members, relatives and people living in the home were positive about how the home was being managed and felt that the manager was supportive and approachable and that things had improved since she had been in place.

The people using the service who were able to tell us said that they were happy living in the home. Comments included; 'it is lovely here', 'I am happy with the home, happy with the staff and happy with the manager' and 'beautiful, I can have a cup of tea at any time, day or night'.

We also received positive comments about the home and staff members from the visitors we spoke with. Comments included; 'Brilliant, staff are very friendly and they always keep me informed' and 'things get passed on if raised, staff seem to be very caring'.

The home had an adult protection procedure [now called safeguarding] that complied with all of the relevant legislation and good practice guidelines.

Information about the safety and quality of service provided was gathered on a continuous and on-going basis from feedback from the people who used the service and their representatives, including their relatives and friends, where appropriate.

We told the provider to make improvements and they sent us a satisfactory action plan followed by information that a new boiler had been installed and improvements made to the plumbing.

We visited on 21 June to check that the hot water system was satisfactory. Staff told us that since the remedial work they now had enough hot water to carry out their duties.

We spoke to a person who lived there who said the water took a 'while to run through' but that it was hot and their radiator was 'now OK'.

We ran taps in several locations including those from which we had not been able to obtain hot water during our last visit and found that they all provided hot water.

Another person told us that things were 'fine' and when we asked if they were treated decently they said 'yes'.

We looked at a sample of four care plans and noted that they were appropriately completed although some were in transition to a new system that was being introduced.

We looked at the home's arrangements for protecting people from the risk of abuse and found them to be satisfactory.

We found the home to be clean, tidy and hygienic and the provider had appropriate arrangements in place to protect people from the risks of infection.

The home had made arrangements for the maintenance of the buildings and we saw evidence that these were adhered to and that the work was carried out by appropriately qualified contractors. However there was a problem with the inconsistent supply of provision of domestic hot water in some parts of the home that had an impact on the care provided.

We looked at the home's procedures for the recruitment of staff and found them to be satisfactory with checks on staff carried out to the requirements of the regulation.