Archived: Heeley Bank Care Home

Heeley Bank Care Home is a nursing and residential home, which at the time of this inspection was providing personal and nursing care to 59 older adults, some were living with dementia. The home comprises of three units, one for residential care, one for nursing care and one for people with dementia related conditions. The service can support up to 67 people.

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

The service had made some improvements since the previous inspection but not all feedback had been robustly addressed before we came to inspect. We found improvements were still required in key areas including the management of medicines, staff support and the homes auditing and quality monitoring processes.

People had not always received their medicines safely. We identified issues with documentation and record keeping. The home was responsive to feedback and took steps during and after the inspection to address these concerns.

A new manager was appointed at the home in May 2019 and they had relevant experience in how to run a service effectively. The service had quality assurance process in place which monitored all aspects of the services provided, however more work was required to ensure they were identifying the types of issues we found during inspection.

Staff were recruited safely and there were enough of them to keep people safe and to meet their care needs. People and relatives acknowledged there had been a number of personnel changes at the home over the last 12 months. Permanent staff knew people and their needs well, and we saw caring interventions throughout our inspection, albeit some people told us these interventions were sometimes task-led.

Staff were receiving appropriate training which was relevant to their role and people's needs. However, staff were not properly supported by the management team through regular formal supervisions where they could discuss their on-going development needs.

People told us they felt safe living at the home. Relatives we spoke with also raised no concerns about the safety of their loved ones. Staff were knowledgeable about how to identify and report any safeguarding concerns, which had been reported to the local authority as per the reporting procedure. Accidents, incidents and falls were documented, with lessons learned discussed as a staff team to help prevent a reoccurrence.

People's needs were assessed, and care was planned and delivered in a person-centred way, in line with legislation and guidance. We have made two recommendations about advance care planning and support plans for people who display behaviours which may challenge.

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 spoke positively about the food and drink provided, confirming they were offered choice and received enough.

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 18 July 2018) and there were multiple breaches of the 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 enough improvement had not been made/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 inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the management of medicines, the support staff received and governance systems and processes.

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 request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Heeley Bank 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. Heeley Bank is a purpose built care home that provides both residential and nursing care for up to 67 people. There are three separate units within the home divided into residential care, general nursing care and nursing care for people living with dementia. At the time of this inspection there were 49 people living at Heeley Bank.

The manager had been at Heeley Bank for approximately six months at the time of this inspection. They were in the process of registration with CQC. 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

Medicines were stored safely and securely, however the systems in place to ensure people received their medicines as prescribed were not always followed.

Not everyone we spoke with thought there were enough staff available to ensure people’s care and support needs were met in a timely way. Some people also told us there was a high use of agency staff which meant they did not always receive consistent care and support. We saw the manager had plans in place to recruit to the vacant posts. We recommend they consider the deployment of care staff during busy times, such as meal times and take into consideration what people have said regarding agency staff.

We saw the premises were clean and well maintained and the registered provider had systems in place to reduce the risk of the spread of infections. However, we saw these were not always observed by staff. The manager agreed to remind staff of the importance of wearing personal protective equipment (PPE).

Staff were provided with relevant training to make sure they had the right skills and knowledge for their role. However staff did receive appropriate supervision and regular appraisals to enable them to carry out their role effectively.

We saw staff delivering appropriate care to people even though this wasn’t always reflected in the person’s care record. People’s care records needed updating to reflect their current care and support needs. We saw plans were in place to do this.

People, their relatives and staff were not regularly asked for their views on the service or given opportunities to suggest any improvements.

The quality assurance and audits systems in place to monitor and improve service delivery were not always effective.

The service had up to date policies and procedures which reflected current legislation and good practice guidance. Some of these needed amending to include local contact details.

Staff understood what it meant to protect people from abuse. They told us they were confident any concerns they raised would be taken seriously by the manager.

The registered provider had effective recruitment procedures in place to make sure staff had the required skills and were of suitable character and background.

Staff understood the requirements of the Mental Capacity Act 2005. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The registered provider’s policies and systems supported this practice.

People were assisted to maintain their health by being provided with a balanced diet and supported to access a range of health and social care professionals.

Positive and supportive relationships had been developed between people, their relatives, and staff. People told us they were treated with dignity and respect.

Staff we spoke with were enthusiastic about their jobs, and showed care and understanding both for the people they supported and their colleagues.

There was a range of activities available to people living at Heeley Bank, which people told us they enjoyed.

There was an up to date complaints policy and procedure in place. We saw people’s comments and complaints were taken seriously, investigated, and responded to.

People, their relatives and staff told us the manager and the senior carer were supportive and approachable.

Safety and maintenance checks for the premises and equipment were in place and up to date.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were a breach of Regulation 12, Safe Care and Treatment, Regulation 18, Staffing and Regulation 17, Good governance.

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

Heeley Bank Care home is a nursing service that provides care for up to 67 people. It is a purpose built care service. At the time of our inspection 62 people were living at the service.

There was a registered manager at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People told us they felt safe and were treated with dignity and respect. Relatives spoken with felt their family member was in a safe place.

Our discussions with staff told us they were aware of how to raise any safeguarding issues and were confident the senior staff in the service would listen.

People we spoke with told us they were satisfied with the quality of care they had received and made positive comments about the staff. Peoples comments included: “We can always have a good laugh with the staff. I love them,” and “The staff always knock on my door and give a shout before they come in,” and “The staff keep a really close eye on me. It's lovely here.”

Relatives we spoke with made positive comments about the care their family members had received and about the staff working at the service.

Our observations during the inspection told us people’s needs were being met in a timely manner by staff. People told us staff responded to their call for assistance when they used their call bells.

At the last inspection we found the service did not have appropriate arrangements in place to manage medicines, so people were not protected from the risks associated with medicines. We saw that improvements had been made.

Since the last inspection the provider had introduced an electronic medication administration record system in place. We saw that some staff were still adjusting to using the new electronic system and would benefit from additional support and training. We shared this feedback with the registered manager; they assured us that appropriate action would be taken to provide additional support and training to staff.

People and relatives spoken with did not express any concerns regarding the cleanliness of the service. The service was clean and had a pleasant aroma.

We observed staff giving care and assistance to people throughout the inspection. They were respectful and treated people in a caring and supportive way.

Robust recruitment procedures were in place and appropriate checks were undertaken before staff started work. This meant people were cared for by suitably qualified staff who had been assessed as safe to work with people.

There was evidence of involvement from other professionals such as doctors, dentists, opticians, tissue viability nurses and speech and language practitioners in people’s care plans.

Individual risk assessments were completed for people so that identifiable risks were managed effectively. We saw one person’s care plan needed to be more prescriptive and give staff clear guidance on what do if the person was getting agitated. We shared this information with the registered manager, they told us the person’s risk assessments and care plan would be reviewed.

People’s nutritional needs were monitored and actions taken where required. People made positive comments about the food. Preferences and dietary needs were being met.

Staff told us they enjoyed caring for people living at the service. Staff were able to describe people’s individual needs, hobbies and interests, life history, likes and dislikes.

At the last inspection we found the provider had not ensured that staff were supported appropriately to make sure their competence was maintained. We found that sufficient improvement had been made.

The service promoted people’s wellbeing by providing daytime activities and trips outside the service had been organised for people to participate in.

The provider had a complaint’s process in place. People and relatives told us that concerns and complaints were always taken seriously, explored thoroughly and responded to in good time.

Resident and relatives meetings were held at the service and the service produced a regular newsletter. This meant people and their relatives or representatives were kept informed about information relevant to them.

Accidents and untoward occurrences were monitored by the registered manager and provider to ensure any trends were identified.

There were regular checks completed by the provider to assess and improve the quality of the service provided.

We considered all the evidence against the outcomes we inspected to help answer our five key questions; is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

This is a summary of what we found-

Is the service safe?

People spoken with told us staff treated them with dignity and respect. All the people told us they felt 'safe' and did not have any concerns. One person commented: 'I feel safe when the carers are here'.

We found people were protected from the risk of infection because appropriate guidance had been followed.

The manager operated an effective recruitment procedure and carried out the relevant checks when they employed staff.

Staff had received training in the Mental Capacity Act 2015 and Deprivation of Liberty Safeguards (DoLS).

Is the service effective?

We reviewed five people's care plans across the three units in the home. There was some variation in the quality of the finer detail in care plan documentation, both between and within the units but we found evidence that care plans and risk assessments had been reviewed regularly. We saw evidence of involvement from other professionals such as doctors, opticians, district nurses, tissue viability nurses and speech and language practitioners.

Is the service caring?

During the inspection we were not able to speak with some people using the service because we were unable to communicate verbally with them in a meaningful way. Therefore we used a formal method to observe people in one of the lounge areas. Staff were respectful and treated people in a caring and supportive way. Staff also explained their actions to people and gained consent.

People told us they were satisfied with the quality of care they had received. They also made positive comments about the staff. Their comments included: 'I haven't any complaints about anything, they [the staff] are very good about everything', 'the staff are very good at looking after you' and 'they [the staff] are kind'. People told us that they had choice which included choosing what to eat and where to have their meals.

We spoke with two relatives who were very satisfied with the quality of care their family member had received. They also made positive comments about the staff. Their comments included: 'I think they're [the staff] marvellous, they look after [family member] perfectly, they're very kind' and 'they [the staff] look after every aspect of her care'.

Is the service responsive?

We looked at the service complaints log and we found a comprehensive system in place to respond to complaints. People spoken with told us that they felt 'safe' and did not have any concerns about the care they had received or staff. They told us if they had any concerns they would raise these with the staff or the manager or speak to a relative.

People told us that staff responded promptly when they used their call buzzer's to call for assistance during the day or night. Peoples comments included: 'I don't have to wait long for staff to come when I use the buzzer' and 'I ring my buzzer and they [the staff] come very quickly'. However, we found one person did not have a call buzzer in place. We spoke with the quality team manager who told us that all the people living at the home should have access to a call buzzer unless it presented a potential risk to them and assured us this would be put in place.

Is the service well led?

We saw there was a range of quality monitoring checks in place to make sure the manager and staff learned from checks. The manager also completed a monthly accident and incident analysis. This enabled the service to look for any trends or causes.

The provider's quality team manager regularly visited the home to carry out an audit and produced an action plan for the manager to complete.

The home held regular staff meetings. This helped ensure that key information from all aspects of the service was shared with staff to enable the service to continually improve and reduce the risk of unsafe care and support.

The home held regular resident and relative's meetings. This showed the home actively sought the views of people or their representatives to improve the quality of service provided.

We spoke with one relative and they told us they were very satisfied with the quality of the care that had been provided to their family member.

All the people we spoke with made positive comments about the staff and were satisfied with the quality of care that they had received. Their comments included: 'they (staff) are all very different ages and in their own way smashing', 'I feel confident when they move me in the hoist' and 'the new manager joins in with everything'.

We found that staff were clear about what their roles and responsibilities were and what action they would take if they saw or suspected any abuse. People told us that they felt "safe" and that they had no worries or concerns. They all said that if they had any concerns or worries they would speak to staff or a family member.

We saw that the service had processes in place to assess and monitor the quality of service provision.

In this report the name of the registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.