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Archived: Heartlands Requires improvement

The provider of this service changed - see old profile

Inspection Summary


Overall summary & rating

Requires improvement

Updated 13 January 2016

This inspection took place on the 25 and 26 November 2015 and was unannounced.

We last inspected Heartlands on the 26 and 27 February 2015 where we found the provider had breached the Health and Social Care Act 2008 in two regulations. The provider sent us an action plan detailing the improvements they would make.

This was a planned comprehensive inspection that would have inspected the service under the five domains of Safe, Effective, Caring, Responsive and Well led. When we arrived, we were told by a representative of the organisation that the provider was in the process of selling Heartlands, which was subject to contract, with a possible date for the contracts be exchanged. As there would have been a change in the legal status of ownership of Heartlands, we changed our inspection to a focused inspection, looking at whether the service was Safe and Effective. Therefore, this report only covers the findings under Safe and Effective and in relation to the breaches; with regard to care and treatment being provided in a safe way and with the people’s consent. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Heartlands on our website at www.cqc.org.uk.

Heartlands is registered to provide accommodation and nursing care to up to 76 people. The home is purpose built and divided into four separate units across two floors. Broadstone and Yardley on the ground floor and Dovecote and Osbourne on the first floor. The home has a second floor that is not in use. Three of the four units provide nursing care to people with a form of advanced dementia and / or other health conditions. The fourth unit provides personal care, without nursing, to people suffering from mild to moderate dementia. On the day of our visits we were told there were 64 people living at the home.

The registered manager had recently resigned. 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. There was an acting manager, who at the time of this inspection, had been in the post for eight days. The acting manager has submitted their application to the Care Quality Commission to become the new registered manager. The acting manager was also being supported by an independent consultant.

There had been some improvements made to the safe way treatment and care was being provided to people. However, we observed that further improvements were needed in all four units to ensure people’s needs were well met.

There had been some improvement in the medicine management practices at the home; however there was still room for improvement.

Staff understood their responsibility to take action to protect people from the risk of abuse and harm because the provider had systems in place to minimise the risk of abuse. However, we saw that staff did not always follow the assessments to minimise the risks associated with people‘s care and this put people at further risk of injury. You can see what action we told the provider to take at the back of the full version of the report.

Referrals for people requiring support from other health care professionals; were not always made in a timely way to ensure risks to people were minimised.

The provider had not always recognised when the care being offered had put restrictions on people’s ability to choose and move around freely. Restricting people’s freedom to move around without the necessary authorisation meant that the provider was not meeting the requirements of the Mental Capacity Act and Deprivation of Liberty Safeguards. Therefore people’s human rights were not always protected. You can see what action we told the provider to take at the back of the full version of the report.

Staff knew about people’s needs but this was not consistent across the four units. Staff had received training but this had been ineffective to enable them to deliver care safely and effectively.

People were not always supported in a timely manner. Staff deployment was not sufficiently effective to ensure that people were adequately supervised, so that their care needs were met in the way people preferred.

People who needed support to eat and drink to prevent the risk of poor nutrition and dehydration had not always received this support effectively. People felt staff that supported them were caring and kind and they felt safe with staff.

Inspection areas

Safe

Requires improvement

Updated 13 January 2016

The service was not consistently safe

People were not consistently protected from the risk of harm because staff was not always aware of the processes they needed to follow.

Because the deployment of staff was not at all times efficient, support for people was not constantly provided in a timely way.

People received their medicines as prescribed, although improvement was still required to the management and recording of medicines.

People felt safe with the staff that supported them.

Effective

Requires improvement

Updated 13 January 2016

The service was not consistently effective

Peoples’ nutritional needs were assessed and monitored to identify any risks associated with nutrition and hydration; but these were not always effective as staff did not consistently follow guidance as required.

Peoples’ rights were not consistently protected. Staff did not understand the legal principles to ensure that people were not unlawfully restricted so care was not always provided in people’s best interests.

People did not consistently receive effective support. Staff did not always recognise when to request the involvement from other healthcare professionals where necessary.

People felt they were supported by staff that knew them.

Caring

Good

Updated 10 August 2015

The service was caring.

People and their relatives told us that staff were kind, caring and polite to them.

Responsive

Requires improvement

Updated 10 August 2015

The service was not consistently responsive.

Staff were not consistent in involving people about their care on a day to day basis.

People’s needs were assessed. Staff worked closely with people’s relatives to ask about their family member’s preferences.

Relatives told us they knew how to raise their concerns if they needed to and arrangements for listening and responding to complaints were in place.

Well-led

Requires improvement

Updated 10 August 2015

The service was not consistently well led.

Although the provider / acting manager had systems in place to monitor the quality of the service provided to people, these were not always efffective. Where actions were identified as needed to make improvements these were not always implemented in a timely way.

Staff felt supported in their job roles.