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Archived: Heartlands Requires improvement

The provider of this service changed - see old profile

Reports


Inspection carried out on 25 and 26 November 2016

During a routine inspection

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 carried out on 26 and 27 February 2015

During a routine inspection

The inspection took place on 26 and 27 February 2015 and was unannounced. The last inspection carried out on 4 March 2014 was a follow up to check that the provider had implemented actions to improve the service provided. We found that the required action had been taken and the provider was meeting the requirement of the regulation inspected.

The home is registered to provide accommodation and nursing care to up to 76 people. The home is split into four units over two floors; Broadstone and Yardley on the ground floor and Dovecote and Osbourne on the first floor. The home has a third floor that is not in use. Three of the four units provide nursing care to people suffering from 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 66 people living at the home.

The location is required to have 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. The provider registered the service with us in 2011. There has been no registered manager in post from the date of registration. As a result of this breach we issued a fixed penalty fine of £4000. which the provider has paid. An acting manager has been recruited and in post since December 2014. They told us they intended to submit their application to us to become the registered manager of the home. Following our inspection, the acting manager commenced the process to become registered with us.

Although staff were trained to administer people's medicines, we found that suitable arrangements were not in place to ensure that people received their medicines as prescribed.

Some staff involved people in making choices about their day to day needs. However, this was not consistent across all of the four units of the home. Where people did not have the capacity to make certain decisions, due to their dementia, we found that staff did not understand the requirements of the Mental Capacity Act (2005) or the Deprivation of Liberty Safeguards. No formal assessments of people's mental capacity had been completed in line with the requirements of the law. We saw restraints were in place, such as key-coded locked doors to units which meant some people's liberty was deprived but they had no deprivation of liberty safeguard in place. The provider told us that the requirements of the law had been overlooked and they would take action to rectify this oversight.

Some people that we spoke with were able to verbally express to us that they felt safe living at the home and were, overall, happy living there. Relatives told us that overall they were satisfied with the service provided to their family member.

Relatives told us that they felt staff were caring and kind toward their family member and were responsive to their needs. However, during our inspection we found that there was not consistently sufficient and suitable numbers of staff to meet people's needs when required. We observed that this led to delays in some people's needs being met on one of the units.

We found that risks to people had been identified and actions put into place to reduce the risk or harm or injury to them.

Staff told us that they were pleased that the home now had an acting manager in place. Staff said that they were still getting to know the acting manager but overall felt that they were approachable and supportive.

Although systems were in place to monitor and improve the quality of service people received,  these were not always effective. We saw that when improvements had been identified as needed, actions were not taken in a timely way.

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

Inspection carried out on 4 March 2014

During an inspection to make sure that the improvements required had been made

At our last inspections in May and October 2013 we found non- compliance with one of the essential standards for quality and safety: Care and welfare of people who use services. We did this inspection to check what progress had been made and we had also received some concerns about the home. These were that the manager had left and a new manager had not been recruited, handovers between care staff and nurses did not include sufficient information about people’s needs and some nurses had left which meant there was a reliance on agency staff who did not know people who lived there. The contact who raised these concerns alleged that staff had a lack of information about people’s health needs and how to monitor these.

Fifty four people lived at the home on the day of our inspection. We spoke with ten people who lived there, five of their relatives, two health care professionals who visited during our inspection, 14 members of staff, the deputy manager, project manager and operations manager.

Since our last inspection the fourth unit of the home Dovecote had been opened. The deputy manager told us that three people lived on that unit who had moved in during the last week. During this inspection we visited Broadstone, Yardley and Osbourne units.

We saw that staff were being recruited to ensure that people were cared for by an adequate number of staff who knew them and how to support them to meet their needs. We saw that staff interacted well with people and treated each person with respect. One person said, “I like it here. They look after us. I would be a liar if I said anything else.” Another person told us, “It’s a decent home, decent people. It really is very good.”

We found that improvements had been made to the support people had with their personal care. Staff knew how to support individuals to meet their health and personal care needs. This helped to promote people’s self – esteem and wellbeing.

People were offered activities that they enjoyed, however, more staff employed to support people with activities would ensure that people were offered regular, meaningful activities.

We observed that the environment needed improvement so that people were cared for in a pleasant and comfortable surroundings to promote their health and wellbeing.

Inspection carried out on 8 October 2013

During an inspection to make sure that the improvements required had been made

Fifty one people lived there on the day of our inspection and one person was in hospital. We spoke with five people who lived there, three of their relatives, one visiting healthcare professional, ten members of staff, the manager and the project manager. Several people who lived there were unable to tell us their experiences of living there so we spent time observing how staff interacted with people.

At our last inspection in May 2013 we found that improvements were needed so that people were offered opportunities to take part in meaningful activities. At this inspection we saw that some improvements had been made but that not all people were offered these opportunities.

We saw good interactions between people who lived there and staff. A visitor told us, “The staff treat my relative very well; they offer care that is personal, gentle and considerate.”

We saw that people's needs were assessed by a range of health professionals and their healthcare needs had been monitored and met.

At this inspection we found that improvements had been made and people were encouraged to eat a healthy and nutritious diet. People told us that they had a choice of what to eat and liked the food provided. One person said, “Staff know what types of food I like and I get a choice.”

We found at this inspection that people were asked for their views about the home and these were listened to. We saw that audits were completed and action was taken to make improvements where needed.

Inspection carried out on 2 May 2013

During a routine inspection

We visited two of the three units - Osbourne and Yardley during this inspection. There were 48 people living in the home on the day of our inspection. We spoke with six of the people living there and five of their relatives. We spoke with eight members of staff and the manager and looked at four people’s records. Staff knew how to support people to meet their needs and ensure their health needs were met. One relative told us, “My relative is happy and safe here.”

People told us and we saw that there were not regular activities organised to meet the needs of all the people living there. One person’s relative said, “There is no stimulation or activities offered here.”

We saw that people were not always well supported to eat their meals and drinks were not always within people's reach. This could mean they were at risk of not receiving a balanced diet or sufficient hydration to ensure their health and well being.

People had their medicines as prescribed to ensure their health and well being.

There were enough staff to support the people living there to meet their needs and ensure their safety.

People were asked for their views about the home and audits of the quality of care that people received were completed. However, it was not clear what was done to make improvements as a result of these.

Inspection carried out on 22 May 2012

During a routine inspection

There were 52 people living there when we visited. Nobody knew we would be visiting that day. The home was split into four units, although one of these had been closed for refurbishment. Since we last visited the provider of the service had changed.

Some of the people living at the home had dementia and other conditions which meant that they were not able to tell us about their experiences. To help us to understand the experiences people have, we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences. Some people living there were able to tell us about their experiences. We also spoke with the manager, deputy manager,eight members of staff and five relatives who visited during the day. We looked at the records of four of the people living there and sampled the provider's records.

People told us they were asked for their views and could make choices about what they wanted. One person said, "I can have a bath or a shower but I prefer to have a shower."

People told us that staff supported them to meet their needs. One person said, "Staff look after me, they are very good." Another person told us, "Staff don't mollycoddle you, but as soon as you need or want anything, they are there." This showed that staff supported people to promote their independence and do what they could for themselves.

We saw that care plans did not always detail how staff were to support individuals. However, staff spoken with knew how to meet individual's needs.

We saw that some staff interacted well with people, which promoted their well being. However, we also saw that some staff only concentrated on what they needed to do for people and did not always spend time talking with them, which impacted on their well being.

People told us that they felt safe living at the home. Staff knew how to safeguard the people living there from harm.

Staff told us that since the new manager had been in post they had been well supported. They were now having more training so they would know how to support the people living there to meet their needs.

People told us that they knew how to complain if they were unhappy. They said that they could talk to the staff and they would always be listened to.