Heartwell House Residential Care Home

About the service

Heartwell House Residential Care Home is a residential care home providing personal and nursing care to 13 people at the time of the inspection. The service can support up to 13 people. This service is also a domiciliary care agency to provide personal care to people living in their own homes but no one was receiving care at home.

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

Based on our review of key questions of Safe and Well-led. The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right Support

The provider made sure people were provided with care and support in a safe and clean environment. The provider was responsive and made safe the staircase used by people to access the upper floor. The areas with ongoing building works had been secured to protect people from the risk of hazards.

Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcome. Staff made sure people received information about medicines in a way they could understand.

Staff supported people to have the maximum possible choice, control and independence so they had control over their own lives. Staff encouraged people to take part in activities of interest to have a fulfilling and meaningful everyday life.

Right Care

People's dignity and human rights were promoted, and people were encouraged to make day to day decisions about the activities and events they wished to participate in. People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs.

Staff understood how to protect people from poor care and abuse. The service worked with other agencies to do so.

Staff recruitment processes promoted safety. Staff had training on how to recognise and report abuse and knew how to apply it. Staff turnover was very low, which supported people to receive consistent care from staff who knew them well. People were supported by skilled staff who provided one-to-one support for people take part in activities, and visits and when they wanted.

Staff restricted people’s freedom based only on their individual needs and in line with the law.

Right culture

The provider was responsive to our feedback and assured us they would strengthen the systems used to monitor the quality of service in relation to people’s care plans and staffing. The provider told us they were in the process to recruit a manager for the service. They also assured us the reporting procedures would be revised to ensure staff notified CQC promptly about significant events that affects people’s safety.

People’s quality of life was enhanced by the service’s culture. Staff respected people’s rights and acted upon people’s views. The provider sought the views of people individually, in house meetings and through surveys.

Staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing.

Staff were committed to reviewing people’s care and support on an ongoing basis as people’s needs and wishes changed over time. People and those important to them were involved in planning their care. The service enabled people and those important to them to work with staff to develop the service. Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity.

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 7 December 2021). At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this inspection to check whether enough improvements had been made to meet the regulations. We also checked the service is applying the principles of Right support Right care Right culture.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Heartwell House Residential Care Home is a residential care home, providing personal or nursing care to up to 13 people, some of whom are living with mental health support needs. At the time of inspection, 13 people were living at the service.

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

Staffing levels were not always sufficient to meet people’s needs. On the day of inspection, staffing was below the usual numbers due to staff sickness. People were left in communal areas without staff attention for long periods of time. The usual daily staffing numbers were not always adequate to provide people with good care.The registered manager told us that extra staff were required at particular times, but this was not arranged, leaving the service short staffed.

The environment was not always safe. Window restrictors were not always in place on the first floor, to ensure people’s safety. A back door was open and accessible to people, which opened out on to a building site where several hazards were present.

Audits were conducted, but prompt action was not always taken to resolve any issues found including staffing shortage and the environment.

Medicines were managed effectively. Storage and administration of medicines was safe, and staff were trained in this area.

Staff recruitment procedures ensured that appropriate pre-employment checks were carried out.

Infection control procedures were followed and the service was regularly cleaned.

Staff treated people with kindness, dignity and respect. We observed positive interactions between people and staff, and feedback from people about staff relationships were good.

Staff felt well supported by the registered manager.

The management notified CQC of specific events, as and when required.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Requires improvement (published 21 January 2021)

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels and ongoing management of the service

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safety and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

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.

Heartwell House is also registered to provide domiciliary care, though currently has not commenced providing this service.

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

People were not always provided with safe care. People were exposed to the risk of acquiring infectious diseases including COVID-19 because infection control procedures were not managed safely. The service has had a number of outbreaks of COVID-19. Despite this, lessons were not learned and, government guidance not followed to minimise the risk of further outbreaks. Personal protective equipment (PPE) was not always worn correctly, and some staff did not follow the providers dress code and travelled to and from work in their uniforms.

There were some medicines that were not managed properly, however, we did not find anyone had been harmed. Environmental risks were not addressed. An electrical socket had remained unrepaired since February 2020, there were other areas of maintenance which the staff had recorded were in need of repair, but these had not been followed up or made safe. Cleaning mops and buckets were not stored properly and flooring and walls were not adequate that would allow proper cleaning and disinfection. By the second day of the inspection a number of the above areas had been improved.

Staff were not supported in their roles and, when they raised concerns they were not always listened to. Supervisions, appraisals and team meetings were undertaken and staff were recruited safely.

The service was not always well-led. Leadership and oversight of the service was poorly coordinated and records to support effective quality assurance of the service were not in place. Information in some documents was inconsistent and staffing numbers did not allow for people to be supported properly. Management communication with staff was inconsistent, where staff did not feel well informed or valued.

Relatives we spoke with had mixed opinions about the home in relation to communication, and questionnaires and newsletters were distributed periodically.

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 Good (published 15 January 2020).

Why we inspected

The inspection was prompted in part due to whistle blowing concerns received about infection control and staffing. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this report for details.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to people’s safe care and treatment and poor governance. Please see the action we have told the provider to take at the end of this report.

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 to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Hartwell House Residential Care Home is a residential care service providing personal care and accommodation to people with mental health needs. At the time of the inspection the registered manager confirmed the service was providing personal care to nine people.

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

People felt safe with staff from the service. Staff understood how to protect people from the risk of harm and understood potential signs of abuse. Care plans provided guidance for staff to follow. Risk assessments reduced risk for people.

People received their medicines as prescribed and they were protected from the risk of infections through staff working practices. There were enough staff to meet people’s needs.

Staff went through a recruitment process so that the provider only employed suitable staff, though this needed to be more robust to include relevant past care references.

Staff had received training to provide knowledge and skills to do their job well and effectively meet people’s needs.

People were provided with care and support that ensured they had good nutrition and hydration. They had access to healthcare that maintained their health and wellbeing. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible.

Staff knew people well. People had developed positive relationships with staff which helped to ensure good communication and support. Staff respected people’s privacy and dignity. They supported people to be independent.

People were involved and consulted when deciding how support was provided. Staff knew and understood the needs of the people using the service and care was provided based on their assessed needs. Staff were responsive to changes in people's needs to ensure they received help to maintain their health and well-being.

People knew how to raise concerns or make a complaint. The provider had a system in place to respond to complaints to put things right. The updated complaints policy provided information about how these would be managed and responded to.

People and staff spoke positively about the management and leadership of the service. They said staff were friendly and caring, and they had built good relationships with them.

The service worked in partnership with external agencies to ensure people achieved good outcomes from their care and support.

Systems were in place to monitor the quality of care and support people experienced through quality assurance systems and processes to improve the service, though more systems needed to be checked to always ensure a quality service.

Rating at last inspection

The last rating for this service was good (published 13 December 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per out re-inspection programme. If we receive any concerning information we may inspect sooner.

Heartwell House Residential Care Home is a care service providing accommodation and support for up to 13 people with learning disabilities or mental health conditions. Accommodation is on three floors with a staircase for access. There are 11 single bedrooms and one double bedroom situated on the first and second floors with stairs for access. There are two lounges and a dining room at the service.

At the time of our inspection there were 12 people using the service.

Heartwell House had 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 2008 and associated Regulations about how the service is run.

At the last inspection on 7 January 2016 the service was rated Requires Improvement in Safe and Effective. At the follow up inspection in June 2016 we returned and saw these two areas had improved and were rated as Good.

At this inspection we found the service remained Good.

People had their support needs assessed and were involved in the development of their care plans. Staff had access to people’s care plans and received regular updates about people’s changing needs. Care plans were updated and included changes to people’s support needs. People attended routine and specialist health checks.

People felt staff were kind and caring. People felt their privacy and dignity was respected in the delivery of care and their choice of lifestyle. People were aware of their care plans and were involved in care plan reviews. Staff prompted people to make choices and respected their decisions.

People were provided with a choice of meals that matched their dietary and cultural needs and choices. Staff ensured people were able to maintain contact with their family and friends and visitors were made welcome at the service. There were sufficient personalised and culturally appropriate activities provided on a regular basis. People felt they could raise any issues or concerns with the registered manager or staff.

Staff were subject to a thorough recruitment procedure that ensured they were qualified and suitable to work with the people using the service. All the staff received an induction and then on-going training for their specific job roles. Staff were informed about, and were able to explain, how to keep people safe from abuse. Staff were aware of whistleblowing procedures and how to report suspected abuse to external bodies and follow up alleged incidents. Staff were available in adequate numbers to meet people’s support needs.

Staff told us they had access to information about people’s care and support needs and what was important to people. People and staff felt they could make comments or raise concerns with the management team about the way the service was run and were confident these would be acted on.

The service promoted equality and diversity and management followed the provider’s policy on delivering a culturally appropriate service. The staff team was made up of people with a range of skills including the ability to cook culturally appropriate food and speak a number of local languages.

There was a clear supportive management structure within the service and staff knew who to contact for advice out of hours. The provider undertook quality monitoring of the service and was supported by the registered manager and staff. Staff were aware of the reporting procedure for faults and repairs and had access to maintenance services to manage emergency and other repairs.

The provider had developed opportunities for people to express their views about the service. These included the views and suggestions from people using the service, their relatives and health and social care professionals. We received positive feedback from a health professional with regard to the support offered to people.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach.

We undertook this focused inspection unannounced on 10 June 2016 to check that the provider had followed their plan and to confirm that they now met legal requirements.

This report covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting ‘all reports’ link for Heartwell House on our website at www.cqc.org.uk

Heartwell House Residential Care Home provides care and support for up to 13 people with learning disabilities or mental health conditions. It is situated in a detached house in Leicester City. The home has two lounges and a dining room. There are 11 single bedrooms and one double bedroom situated on the first and second floors with stairs for access.

On the day of our inspection visit there were 13 people using the service.

The service has a registered manager. This 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.

Since out last inspection visit many improvements had been made to this service. The people using it were enthusiastic about these changes and enjoying the benefits of receiving more personalised care and support.

Heartwell House had a calm atmosphere and people using the service told us they felt safe. They knew their rights and who to tell if they had any concerns. Staff had been trained in safeguarding and understood their responsibilities to protect people from harm.

People’s risk assessments had been re-written and improved. They identified areas where people might be at risk and what staff needed to do to minimise this. Staff followed risk assessment guidance in order to keep people safe.

The provider had made a number of improvements to the premises to make them safer. A paved garden area at the rear of the premises was in need of clearing and upgrading and the provider had agreed for this to be done.

There were enough staff on duty to meet people’s needs. Staffing levels at night had been increased to meet the needs of people who preferred later bedtimes. A new staff recruitment and retention policy had been introduced to help ensure the staff employed were suitable to work with people who use care services.

Improvements had been made to how people’s medicines were managed. These included the re-training of staff and new policies for staff to follow to help ensure these medicines were administered safely.

People told us they were happy with the staff team. The staff provided effective care and understood the importance of offering people choice. They followed the principles of the Mental Capacity Act when supporting people to make decisions.

People using the service and staff told us the choice of food served had improved. A new cook had been employed and they provided a varied menu in line with people’s dietary preferences.

The staff had a good understanding of people physical and mental healthcare needs. They supported people to see healthcare professionals to help ensure they got any treatment they needed.

People we spoke with told us they were satisfied with the care and support being provided and that their choices were respected. Staff had a good understanding of the needs of people who used the service and demonstrated a good rapport with people. Staff were able to communicate with people in their own language.

Our observations showed that people were comfortable and confident with staff. We saw that people had a choice about when to eat their lunchtime meal and people's individual preferences, religious and cultural needs had been catered for. The meal had been freshly prepared and looked appetising.

We looked at the records of three people who used the service and found care plans were detailed and thorough and provided clear guidance to staff about how the persons' care should be delivered.

Staff had been appropriately screened to ensure they were suitable to work with vulnerable people.

There were appropriate arrangements were in place for the obtaining, recording and administration of medicine.

Records were accurate and fit for purpose.

We found that the service was compliant with the essential standards of quality and safety that we inspected.

At out last visit of 2 July 2012 we found that people were not fully protected from the risk of abuse by staffs' lack of up to date knowledge and training around safeguarding vulnerable adults. We followed this up at this visit and found that the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.