Heathfield Residential Home

Heathfield Residential Home is a residential care home providing accommodation and personal care to up to 35 older people in a large adapted building. At the time of our inspection there were 32 people using the service.

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

People told us they felt safe living at the service. Potential risks to people’s health and welfare had been assessed, there were risk assessments and guidance for staff in place to mitigate the risk. Accidents and incidents had been recorded and analysed to identify any patterns or trends and to assess if action taken had been effective. Checks had been completed on the environment and equipment people used to make sure people were as safe as possible.

People were supported by staff who had been recruited safely. There were enough staff to meet people’s needs, staff had received training appropriate to their role and received supervision to develop their practice. There were effective systems in place to monitor the quality of the service. Action had been taken when shortfalls had been identified.

Medicines were managed safely. People were referred to healthcare professionals when their needs changed, and staff followed the guidance provided. People were supported to express their end of life wishes, staff worked with healthcare professionals to support people at the end of their lives.

People were supported to eat and drink a balanced diet to stay as healthy as possible. People were supported to be as independent as possible. Staff supported people to take part in activities they enjoyed, spend time with their relatives and take trips out.

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 treated with kindness and compassion and encouraged to be as independent as possible.

There were systems in place to protect people from abuse and discrimination. People, relatives and staff were asked for their opinions of the service and action was taken to make improvements. Complaints were recorded and investigated. The registered manager had apologised when things had gone wrong.

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 15 July 2021). 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

This inspection was prompted by a review of the information we held about this service showing the service may have improved.

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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Heathfield Residential Home is a care home which provided accommodation and personal care to 22 people aged 65 and over at the time of the inspection. The service can support up to 35 people in one adapted building.

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

Improvements had been made since the last inspection which meant people had a better experience of care. Further improvements were still needed to make sure a culture of continuous improvement was maintained and sustained.

Records of people’s assessments and care needs were not always accurate to ensure a consistent service was provided. Monitoring systems to make sure peoples medicines were managed safely were not robust and effective and we found discrepancies. We were only somewhat assured about COVID-19 infection control procedures and how isolation procedures following a hospital visit were followed by staff.

Monitoring procedures needed further work to make sure the improvements made could be enhanced further and action was taken to sustain improvement. Provider oversight had improved but issues were not always picked up and actioned to maintain a good service.

A better oversight of accidents and incidents had been introduced so people could be assured staff had measures in place to prevent repeat occurrences. The recruitment of new staff was now more safely managed although one area needed further work. Staffing levels had improved as the provider had deployed more staff at night. People told us there were enough staff.

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 with their eating and drinking needs and healthcare advice was sought when needed. Advice recommended by healthcare professionals was followed by staff to maintain people’s health.

People and their relatives were asked their views of the service and were involved in their care. An open culture was evident, and people, staff and relatives were overwhelmingly positive about the management of the service and the quality of care and support provided.

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 Inadequate (published 1 December 2020) and there were four continued breaches of regulation.

We served a Notice of Decision to impose conditions on the provider’s registration for this location following an inspection in April 2020. This included requiring the provider to update CQC on improvements made through monthly reporting and to keep CQC informed of any admissions to the service with assurances of their ability to provide people’s care. The provider continued to comply with conditions.

This service has been in Special Measures since 8 January 2020. During this inspection, the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating. We carried out an unannounced focused inspection of this service on 29 July 2020. Breaches of legal requirements were found. After the last inspection, the provider completed a monthly action plan as required to show what they would do and by when to improve safe care and treatment, staffing, need for consent and good governance.

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.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to requires improvement. 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 Heathfield Residential Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a continued breach in relation to accurate record keeping and monitoring of quality and safety at this inspection.

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.

Heathfield Residential Home is a care home which was providing personal and nursing care to 19 people aged 65 and over at the time of the inspection. The service can support up to 35 people in one adapted building.

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

Few improvements had been made since the last inspection. There continued to be many shortfalls in the service provided to people.

Individual risks were not always assessed and managed to keep people safe. People could not be sure their prescribed medicines were always managed in a safe way. When people had accidents and incidents, action was not always taken to learn lessons to reduce the risk of a re-occurrence.

People could not be assured new staff were asked to provide the robust information needed to make sure they were suitable for their role providing care and support to people.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Although people had an assessment of their care needs before moving into the service, this did not always capture the important detail needed to develop an individual care plan to ensure their safety.

People could not be assured there were enough staff on duty at night to make sure they could be evacuated safely if an emergency such as a fire took place. We have made a recommendation about this.

Although staff training had improved, there were still areas for concern where people may not have skilled staff on duty to provide their care.

Infection control practice in relation to the latest COVID-19 government guidance for the use of PPE in care homes was not always followed to keep people and staff safe.

People who needed their food and fluids monitored could not be sure this was happening consistently or that areas of concern were noticed. Timely referrals to healthcare professionals were sometimes not made to make sure people were not in discomfort.

The management and oversight of the service was still not robust enough to identify areas of concern and put actions in place to continuously improve quality and safety. Only few improvements had been made since the last inspection and this was a cause for concern. This was the fourth inspection where the provider had not achieved a rating of good and the second consecutive rating of inadequate.

Staff had regular individual support meetings and the registered manager held regular staff meetings to keep staff up to date.

The registered manager now made sure they alerted the appropriate authorities if there were allegations of abuse.

The service was clean, pleasant and well maintained. People’s individual rooms had personal items and furnishings to help them to feel at home. The provider asked for and listened to people’s views, and their relatives.

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 Inadequate (published 10 April 2020) and there were multiple breaches of regulation. We served a Notice of Decision to impose conditions on the provider’s registration for this location. This included requiring the provider to update CQC on improvements made through monthly reporting and to keep CQC informed of any admissions to the service with assurances of their ability to provide people’s care.

At this inspection insufficient improvement had been made and the provider was still in breach of regulations.

Why we inspected

We received concerns about staffing levels and safeguarding concerns in relation to people leaving the service unaccompanied when not safe to do so. As a result, we undertook a focused inspection to review the key questions of safe, effective 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. Ratings from the previous comprehensive inspection for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained inadequate. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the safe, effective and well led sections of this full report.

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

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.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe, and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Heathfield Residential Home is a care home providing personal and nursing care to 29 people at the time of the inspection, some of whom lived with dementia. The service can support up to 35 people.

The service was provided across two floors of one adapted building. Most of the people living at the service were permanent residents. However, the service also provided respite care to people who required it for short periods of time. At the time of the inspection no one was staying there for respite.

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

Feedback from people and their relatives was mixed. Although most people were happy with their care they did raise some concerns. One relative said, “If I was assessing them I would give them seven out of 10.”

Some measures to keep people safe were not always in place. Risk assessments had not been fully completed. This meant there was a lack of information for staff on how to keep people safe. Where there were risks, the actions planned to keep people safe were not always monitored. For example, where people were at risk of dehydration, records on how much the person had drunk were poor.

The service had systems and processes in place to safely administer, record and store medicines. However, these were not followed, and people were not getting their medicines as prescribed. Internal audits by the provider had identified several of the issues the inspection team saw on the day, but had not managed to rectify these and embed good practice around the safe and effective management of medicines.

Safeguarding incidents were not always reported to the local authority to review and investigate. Staff had not always completed safeguarding training to ensure they understood how to keep people safe from abuse. When incidents had occurred, they were not always reported and there was a lack of information about actions that had been taken to keep people safe. This meant opportunities to prevent these concerns from arising again were missed.

Staff had not always been recruited safely. For example, records did not include a full employment history, or a written explanation of any gaps in employment. On the first day of the inspection there was insufficient staff to support people and people had been left waiting for support. However, staffing levels were increased on the second day after we raised concerns.

When people moved to the service their needs were assessed. However, the assessment had not been used to effectively plan people’s support and ensure that there were sufficient staff with the skills they needed to support people. People’s emotional support needs had not been adequately considered and there had been no recorded efforts made to reduce anxious or emotional based behaviour.

Staff had not completed the training or induction they needed to provide people with effective support. There were times where staff had not provided good support to people. Staff were not well supported or supervised.

People’s capacity had been assessed. However, some people had variable capacity, and this had not been taken in to account. Legal safeguards were not always in place where people were not safe to leave the home unsupported. This meant some people were being deprived of their liberty without an appropriate assessment to determine if this was lawful or appropriate. Some people had been recorded as having capacity to make their own decisions, however decisions had also been recorded as having been taken on their behalf. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Support to maintain nutrition and hydration was not as effective as it could have been. Where people had been unwell and lost a significant amount of weight action had not been taken to support the person with nutrition. People had access to healthcare services. However, some people would have benefited from more support from health and social care professionals such as the occupational therapist to improve their care. There was a lack of support to maintain dental hygiene and people’s dental needs had not been fully assessed.

The service was clean, and the decoration well maintained. However, a number of people were living with dementia and there were areas where the decoration could be more dementia friendly.

There were areas where people could be treated with more dignity and respect. For example, some people would benefit from more support when they were eating. People’s privacy was not always well maintained as staff accessed people’s records on a computer in a public space and the screen was visible to people and their relatives. We made a recommendation about this.

There was a lack of person-centred information about what people could do for themselves. This meant there was a risk that people’s independence would not be promoted or maintained. We made a recommendation about this. There was a lack of information about people’s preferences and we saw some incidents were their preferences were not met. Care plans including end of life plans lacked detail. Care plans were confusing and difficult for staff to read and staff relied on verbal information. This meant there was a risk that changes to people’s care would not be identified by staff.

The service was not well managed. Communication between staff and management needed to be improved and staff were not regularly or effectively supervised. Checks on the quality of the service had not identified concerns and opportunities to improve people’s care had been missed.

The provider had not met their legal obligations to report notifiable events to CQC. Prior to the inspection the management team had recently started working with local authority and health professionals to make improvements. However, there had not been sufficient time for this to have impact.

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 on 28 January 2019). At the last inspection there were two breaches of the regulations.

At this inspection the service had deteriorated, and the provider was still in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about a number of areas including staffing levels, medicines management, non-reporting of concern and safeguarding incidents. A decision was made for us to inspect earlier than planned to examine those risks.

We have found evidence that the provider needs to make improvements in all sections of this full report.

Enforcement

We have identified breaches in relation to safe care and medicines, governance, person centred care, safeguarding people, consent, staff training, recruitment and notifying CQC.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Heathfield Residential Home 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. Heathfield Residential Home accommodates 34 older people, some of who were living with dementia in one adapted building. Accommodation is arranged over two floors and there is a lift to assist people to get to the upper floor. There were 33 people living at the service at the time of our inspection.

At the time of our inspection, there was a registered manager in post. 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.

Heathfield was last inspected 14 November 2017. At that inspection it was rated as 'Requires Improvement’ overall. One breach of Regulation was identified during that inspection. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question(s) Safe, Effective, Responsive and Well-led to at least good.

At this inspection we found some improvements had been made, however we found one continued, and one new breach of the regulations.

Audits and checks were regularly carried out; however, they did not identify the shortfalls we found during our inspection. These included health and safety checks, which were regularly completed, however action had not been taken to reduce the water temperature within the service when it was identified as being too hot, and placing people at risk of scalding.

Medicines were not consistently safely managed. Records associated with medicines administrations were not consistently up to date containing the relevant information, and body maps were not in place to indicate the site application for Transdermal patch. Prescribed creams and ointments had not been dated on opening to ensure they did not exceed the manufactures expiry date.

People were supported to engage in activities to reduce the risk of social isolation, however people’s feedback about the quality and consistency of the activities was mixed.

Staff received training in safeguarding adults, and showed a good understanding of how to protect people from potential harm and abuse. Risks associated to people and the environment had been assessed and mostly mitigated. People told us staff understood how to deliver the care they needed. When things went wrong, staff discussed learning and how to prevent the accident or incident in team meetings.

There were sufficient numbers of staff deployed to meet people’s needs and keep them safe. Provider recruitment records confirmed that they followed staffing process to ensure the staff employed had the relevant experience and were of good character. New staff completed the providers induction programme which involved shadowing more experienced staff to get to know people. Following this there was an ongoing training and supervision programme for staff to ensure they had the skills to support people’s needs.

People’s needs were assessed by the registered manager, using recognised tools and good practice guidance. People were complimentary about the food, and received sufficient amounts to eat and drink. Staff worked within and externally to ensure people had access to healthcare services and on-going care and support. Suitable arrangements had been made to obtain people's consent to the care and treatment they received.

Since our last inspection there had been some improvements to the service. There was a new decking area to the rear of the property, which people told us they enjoyed in summer months. The service was clean and well maintained.

People told us staff were compassionate, and we observed kind and caring interactions between them and staff. People were able to describe to us how staff promoted their independence, and maintained their dignity. People were encouraged to be involved in their care and support planning.

People received person-centred care specific to their needs. Staff told us how they adapted their approach to support each person as an individual.

People told us they knew how to complain, but had not have cause to. There was a complaints policy in place which was accessible to people and their loved ones.

At the time of our inspection the service was not supporting anyone at the end stages of their life.

People, relatives, staff and healthcare professionals told us the service was well lead. We received positive feedback about the registered manager, and the culture of the service. Staff understood their roles and responsibilities, and told us they received the support needed to complete their roles from management. Quality assurance was carried out to identify and action any shortfalls, alongside regular staff and resident meetings.

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

Heathfield Residential Home 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. Heathfield Residential Home accommodates 34 people in one adapted building. Accommodation is arranged over two floors and there is a lift to assist people to get to the upper floor. There were 32 people living at the service at the time of our inspection.

A registered manager was leading the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the care and has the legal responsibility for meeting the requirements of the law. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Potential risks to people’s health had been identified and assessed. However, there was not always clear, detailed guidance for staff to follow to mitigate the risks to people. This did not impact on people, as staff knew people and took action to keep them as safe as possible.

There were no environmental risk assessments available for us to see at the inspection. Following the inspection, the provider sent us environmental risk assessments. Potential risks to people posed by the environment had not always been managed to keep people safe. Staff had not identified that people were at risk where a bath had been removed in a bathroom people used leaving pipes exposed. The area had not been cordoned off by staff. During the inspection, action was taken to reduce risk; the bathroom was locked to prevent people entering the room.

Staff completed regular checks and audits on equipment and all areas of the service. The audits had not identified shortfalls found at this inspection, for example, in care plans and risk assessments. When shortfalls had been identified, action plans had not been put in place, with who was responsible and when the action should be completed. Some shortfalls had been rectified but there was no record of how or when this had been completed.

Each person had a care plan, the person’s profile contained information about their life, choices and preferences. However, the care plans did not always contain details about how to support people in the way they preferred and reflect the care being given. Staff knew people’s preferences and people told us they received support in the way they preferred.

The registered manager met with people before they came to live at the service and carried out an assessment, to ensure staff were able to meet the person’s needs. The assessments did not include information about people’s equality and diversity needs, this was an area for improvement.

People’s care was planned following best practice guidelines. Staff monitored people’s health and people were referred to specialist healthcare professionals when needed. People had access to professionals including opticians, dentists and chiropodist to support them to be as healthy as possible. Staff worked with health and social care professionals to ensure people received the support they needed. People were supported to eat and drink enough to maintain a balanced diet.

People were protected from abuse and discrimination. Staff knew how to report concerns and felt confident that action would be taken. Staff knew how to keep people safe and understood their responsibilities for reporting accidents and incidents. The registered manager analysed accidents and incidents, to identify any patterns or trends and took action to mitigate the risk of them happening again. People’s medicines were managed safely and people received them on time.

Staff ensured people were protected from the risk of infection, they wore protective clothing and kept the building and equipment clean. The building had been adapted to meet the needs of the people living at the service. However, there were no signs for people to know where the bathrooms and toilets were. This was an area for improvement.

People were supported by sufficient numbers of staff, who had been recruited safely. Staff completed regular training to keep them up to date with guidance and best practice. Staff received supervision and appraisal to discuss their performance and personal development. The registered manager worked with staff to ensure they were competent; however, this had not been recorded.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People were treated with compassion and kindness. Staff had developed caring relationships with people and their relatives. People’s confidentiality, privacy and dignity were promoted and maintained by staff. Some people had not discussed their end of life wishes with staff, so everyone may not be aware of people’s wishes.

People were encouraged to air their views and were involved in making decisions about their care, support and treatment. People were supported to take part in activities; people told us they would like more activities. The registered manager told us that they had recognised this and would be employing an activities organiser. People told us that they knew how to complain and that any concerns they had would be dealt with immediately.

People, relatives and staff were encouraged to provide feedback on the quality of the service. Regular meetings were held for people to give their views and suggestions, these had been acted on and changes made.

There was an open and transparent culture within the service. Staff told us that they felt supported by the registered manager and they would deal with any concerns they may have. People and relatives knew the registered manager well and told us they were approachable. The registered manager was visible within the service; their office was by the dining room, so people could see them.

The provider had policies and procedures to give staff guidance about how to perform their role, this included equality and diversity. Staff understood their roles and responsibilities, and understood the vision that the registered manager had for the service. The registered manager was changing the staff structure within the service to improve the communication and lines of responsibility for both staff and people. Staff told us this was a positive step and would improve the support they gave people.

Services that provide health and social care to people are required to inform CQC of important events that happen in the service. CQC check that appropriate action had been taken. The registered manager had submitted notifications in an appropriate and timely manner and in line with guidance. The registered manager attended forums and worked with care specialists to ensure that they were up to date with best practice.

Providers are required by law, to display their CQC rating to inform the public on how they are performing. This was the first inspection of the service under the provider and a rating had not been given.

At this inspection a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 was identified. You can see what action we have asked the provider to take at the end of the report.