07 April 2015
During a routine inspection
The inspection visit was carried out on 07 April 2015 and was unannounced. The previous inspection was carried out in September 2013, and there were no concerns.
Heathfield Residential Home provides accommodation and personal care for up to 34 older people, all in single rooms. There were 32 people in residence on the day of the inspection.
The service is run by a registered manager, who was present on the day of the inspection visit. 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 Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). No applications had been made to the DoLS department for depriving people of their liberty for their own safety.
Staff had been trained in safeguarding adults, and discussions with them confirmed that they understood the different types of abuse, and knew the action to take in the event of any suspicion of abuse. Staff were aware of the service’s whistle-blowing policy, and were confident they could raise any concerns with the registered manager, or with outside agencies if they needed to do so.
The service had policies and procedures in place in the event of emergencies such as fire. A fire risk assessment had been carried out by an authorised fire officer. Each person had individual risk assessments in their own care plans which identified if there was a risk of falls, or a risk of coming down the stairs from a first floor room. Other risks included risks of bathing, walking independently, self-medicating and being unable to use a call bell. Processes had been put in place to minimise risks, such as thermostats to control hot water temperatures, and frequent checks for anyone who could not use a call bell.
The premises were well maintained throughout, and were clean and free from unpleasant odours in all areas.
There were sufficient numbers of staff to meet people’s individual needs without rushing them. People spoke highly of the staff and said they were “Always there for me”, “Caring”, and “Helpful”. The service had robust recruitment procedures in place to check that staff were suitable for their job roles.
Staff were given a detailed induction, and the probationary period included essential training such as fire safety and infection control. Staff training records showed that staff were kept up to date with these subjects with refresher training, and were able to receive training in additional subjects such as dementia care. Most care staff had completed formal qualifications, or were in the process of doing so. Records of supervision and appraisals confirmed that staff were working to appropriate standards and were supported by the registered manager and the deputy managers. Staff were encouraged to attend meetings, and to take their part in the development of the service.
People were given clear information about the service during their pre-admission assessment and as part of the admission process. Each room was provided with a file of documents so that people could look up any information they required. Staff discussed people’s care planning with them, and care plans were reviewed monthly. People or their representatives signed their consent to their care plans and risk assessments to confirm their agreement.
People were asked for their food and drink preferences, and said that the menus were varied, and were often discussed with them. They said that the food was good, and they had plenty of choice. People knew that they could request a snack at any time, and were actively offered hot and cold drinks throughout the day.
The registered manager and care staff maintained good links with the local GP practices, and contacted the GPs and district nurses as needed. Referrals were made to other health professionals such as dieticians and dentists when necessary. Care plans included a pre-prepared information sheet to go with people to hospital in the event of an emergency. Medicines were safely stored, and were administered by senior care staff who had been trained in this.
Staff attended to people quickly in response to their call bells. They had friendly and caring attitudes, and treated people with dignity and respect. People said that the staff were “Very good” and looked after them well. People felt that staff “Went beyond” what they expected. Staff were informed about people’s previous lifestyles, their families and their hobbies and interests, and knew if people liked to join in with social gatherings, or if they preferred to sit quietly on their own. They were encouraged to follow their own preferences and to retain their independence. Daily activities were carried out by care staff, and included games, singing, quizzes and individual attention.
People were confident that the staff listened to them, and that they could raise any concerns. They knew that they could speak with the registered manager at any time, and that she would deal with any ‘niggles’ as well as any serious complaints. The complaints procedure was accessible in each person’s room.
The registered manager had a visible presence in the home, and people were invited to express their opinions at any time. Quality assurance processes included the use of questionnaires for people, relatives and staff. The registered manager analysed these and followed up any comments. This included informing staff of positive comments, as well as taking action to manage any negative comments. People were invited to attend residents’ meetings as a further opportunity to share their feelings and ideas. Changes were made in accordance with people’s views, giving them confidence in the process, and an assurance that their voices were heard.
The registered manager kept up to date with changes in legislation and attended events with other registered managers to keep her own practice up to date.
Records were appropriately maintained, and were stored so as to protect people’s confidentiality.