Archived: Heartlands

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

At the time of our November 2016 inspection, Heartlands was undergoing a major modernisation project. At this inspection the work had been completed and the service was registered to accommodate 62 people in one adapted, three story building comprising of three separate units. The ground and first floor units provided support to people requiring residential and dementia care. The second floor unit provided support to people that required nursing care and lived with more complex needs. At the time of our inspection 34 people lived at the home. The home provides care and support to people from a range of ages, gender, ethnicity and physical abilities.

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 and associated Regulations about how the service is run.

At the last inspection in November 2016, the provider had not met all the legal requirements because mental capacity assessments were not specific decision based, consent was sought solely from family members who were not authorised to do so and best interests meetings were not consistently recording the decisions required to be made. This meant the principles of the Mental Capacity Act 2005 had not been followed. At this inspection, we found there had been an improvement because the provider had taken appropriate action when they had identified people who did not have capacity to consent to their care or treatment. Best interests processes had been followed, mental capacity assessments were time relative and decision based and applications had been made to authorise restrictions on people's liberty in their best interests.

Although the service employed sufficient numbers of staff, improvement was required to ensure staff levels were assessed, where appropriate to ensure people’s needs were consistently met. There was also some improvement required to ensure there was a consistent approach from staff to support people that presented with behaviours that challenge. Improvement was also required to ensure medicines were stored at a constant, safe room temperature. The provider had governance systems in place to monitor the quality of the service being delivered to people. However, improvement was required to ensure audits identified areas for improvement for example, medicine wastage and expired DoLS applications to make sure people were not being unlawfully restricted.

People felt safe living at Heartlands. The provider had processes in place to protect people from risk of abuse and staff knew what action to take to report any suspicion of abuse. Risks to people were appropriately assessed and staff knew how to keep people safe from the risk of avoidable harm. People were supported to take their medicines safely. The home environment was clean and people were protected from risk of infection. The provider had processes in place to share information with staff when things had gone wrong so learning could take place to reduce risk of reoccurrence.

People were supported by staff that received training. People’s needs were assessed and staff knew people well. The provider ensured people’s nutritional needs were met with good quality food, regular drinks and snacks and where appropriate referrals were made to healthcare professionals for people at risk of losing weight. Staff followed advice given by healthcare professionals to support people’s wellbeing. The provider had designed the home environment to consider people living with dementia with large spacious areas, dementia friendly signage and colour schemes.

People were supported by staff that were kind and caring and they treated people with respect. People and their relatives were involved in the planning and review of their care and support. Staff encouraged people to, where possible, maintain their independence.

When people’s needs changed, they were referred quickly and appropriately to healthcare professionals. There were a range of individual and group activities available for people to enjoy although some felt there could be more done with individual based interests to maintain people’s hobbies. People and their relatives had no complaints but knew how and who to complain to if they needed to. The provider had appropriate processes in place to ensure people at the end of their life were treated with respect and had their final wishes followed.

People and relatives told us they thought the service was well managed and staff felt supported by the management team.

Heartlands is a care home which provides accommodation and nursing care for up to 36 older people. At the time of our inspection 35 people were resident at the home.

Heartlands is currently undergoing a major modernisation project. Half the home has been demolished and was is the process of being rebuilt. When the first part of the project has been completed, people living at the home will be relocated into the new build and the remaining section of the home will also be demolished and rebuilt.

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 and associated Regulations about how the service is run.

We found mental capacity assessments completed for people who lacked the mental capacity to consent to their care and welfare, were not decision based. There were issues with consent being sought solely from family members who were not authorised to do so. Best interests meetings were not consistently recording the decisions required to be made, how the decision was agreed and who was involved in best interest discussions. Staff told us if a person could not consent, they would ask a family member to consent for the person. This does not follow the principles of the Mental Capacity Act 2005 and required improvement.

The provider had taken suitable action when they had identified people who did not have capacity to consent to their care or treatment. Applications had been made to authorise restrictions on people's liberty in their best interests. However, staff members were not always clear on what could constitute a restriction on somebody’s liberty and required improvement.

Staff felt the change over from the previous provider to the new provider had been smooth. We were told by staff, people living at the home and visitors that the registered manager was approachable and everyone was complimentary about the way they were managing the home through the rebuilding project. There were audit systems in place to monitor the quality of the care people received, however they were not always effective at identifying some of the issues we had raised with the registered manager and required some improvement.

People and relatives told us they felt the home was a safe environment for people to live in. Staff spoken with could confidently identify the different types of abuse and explained how they would report abuse. People were protected from the risk of harm and abuse because staff knew what to do and were effectively supported by the provider’s policies and processes. Risks to people were being managed although there was some inconsistency with risk assessments being completed. However, staff identified risks people faced and explained how those risks should be managed. Staff had a good understanding of the risks and the action that was required. The plans and risk assessments were reviewed and updated on a monthly basis and/or when people's needs changed.

Staffing levels had been reviewed because the size of the home had been significantly reduced due to the modernisation project. Everyone spoken with felt there was a requirement to increase care and domestic staffing levels and maintain current nursing staff levels. We saw all staff were busy but were available to provide support to people when needed. This included support for people to eat, drink and move around the home safely. Requests for assistance from people were responded to promptly. The provider’s recruitment processes ensured suitable staff were recruited.

People received appropriate support to take their prescribed medicines and nursing staff maintained accurate records of the medicine they administered to people. Medicines were stored securely and consistently at the recommended temperature given by the manufacturer and were safely disposed of when no longer required.

People were supported by suitably trained staff that told us they received training and support which provided them with the knowledge and skills they needed to do their job effectively. People and relatives felt staff were knowledgeable on how to support people effectively and that staff possessed the necessary skills.

People were able to choose what they ate and drank and were supported to maintain a healthy diet with input from dietary specialists. People were supported to receive care and support from a variety of healthcare professionals and received appropriate treatment if they were unwell.

People's records contained care records relating to their specific needs and there was evidence that the plans were updated when people's needs changed. People and relatives told us they were involved in developing and reviewing care records. People were supported by caring and kind staff who demonstrated a positive regard for the people they were supporting. Staff understood how to seek consent from people and how to involve people in their care. We saw staff interacting with people in a friendly and respectful way and that staff respected people's choices and privacy.

People were supported to lead active lives and, where appropriate, to access the local community. In addition, people were supported by staff that provided activities on a daily basis. People and relatives told us they had no complaints but were confident it they did, that the registered manager would deal with it effectively.