Heathside Retirement Home

Heathside Retirement Home (known as Heathside) is a residential care home providing personal care to 30 people aged 65 and over at the time of the inspection. The service can support up to 30 people.

All bedrooms are single occupancy with the majority having an en-suite toilet. There are two lounges, a new conservatory and an accessible garden to the rear of the property.

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

Quality assurance systems had been improved. A sample of care plans and night records were checked each month. Action plans agreed with the local authority and medicines optimisation team had been implemented.

Risks were identified and guidance provided for staff to manage these risks. Summaries of people’s risks and support needs had been written and were reviewed each month. Checks made by the night staff were fully recorded. Procedures were in place if a person did not want staff to check them during the night.

The medicines round had been reviewed with the medicines trolley being taken to the lounge where people were located when administering their medicines.

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.

Staff participated in the CIVOD-19 testing programme and visiting arrangements were safe. We signposted the service to the government advice on the correct wearing of masks as we observed some staff wearing their masks below their nose.

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 16 September 2020) and there was one breach of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this targeted inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this targeted inspection to check whether actions had been taken to address the breach identified at the last inspection in relation to Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on breaches of regulations or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

Heathside Retirement Home is a residential care home providing personal care to 30 people aged 65 and over at the time of the inspection. The service can support up to 30 people.

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

At this inspection we only looked at the key questions safe and well led.

The quality assurance system was not robust. The registered manager was not pro-active in communicating with senior staff members about the audits they had completed.

Staff had not always received the necessary support and training to be able to effectively write risk assessments and care plans. One person's care plan had not been reviewed in a timely manner after they had moved to the service, resulting in the care plan not being reflective of their needs.

Accidents and incidents were recorded and reviewed by the registered manager. However, the staff had not recognised the seriousness of one incident, which meant it was not correctly recorded. The registered manager, partner and training and development manager said they were not aware of a change in one person’s support needs, which meant risks for this person had not been adequately assessed and managed.

People received their medicines as prescribed. We have made a recommendation about reviewing how the medicines round is managed.

Staff felt able to speak to the registered manager and regular staff meetings and supervision meetings were held.

People and relatives said they felt safe living at Heathside.

There were sufficient staff on duty to meet people’s identified needs. Infection prevention and control measures had been reviewed in light of the Covid-19 pandemic.

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 good (published August 2018).

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about the risk management and quality assurance systems in place at the service. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with the governance and quality assurance at the service, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

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

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Heathside Retirement Home on our website at www.cqc.org.uk.

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 a breach in relation to the quality assurance and oversight of the service at this inspection.

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

Follow up

We will request an action plan and will meet with the provider to discuss 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.

Heathside is registered to provide accommodation with personal care for up to 30 people. At the time of our inspection there were 27 people living at the home. All rooms are single occupancy with the majority having an en-suite toilet. Since our last inspection in May 2017 the dining room had been moved to the first floor, which reduced the need for people to queue for the lift at meal times and had consequently reduced the number of falls occurring. There are two lounges and an accessible garden to the rear of the property.

At our last inspection in May 2017 the home was rated as requires improvement; there were no breaches of the regulations found. At this inspection we found improvements had been made and the home was now rated as good.

Heathside had a registered manager, who was registered with the CQC in February 2018. 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.

The quality assurance system used to monitor the service had been strengthened since our last inspection. This helped to improve the performance of the service. Additional monitoring had been introduced including weight monitoring, equipment checks and call bell responses. Weekly and monthly audits were completed. Accidents and incidents were reviewed to assess if there were any patterns across the home. Actions and recommendations, for example from the fire risk assessment or local authority audit, had been implemented.

Infection control measures had been improved and included the management team carrying out daily walk rounds to check the cleanliness of the home.

We observed staff engaging with people throughout the inspection. Staff sought people’s permission before providing support and explained to people the support they were about to provide. People told us the staff treated them with dignity and respect.

We observed safe moving and handling techniques being used; however, on one occasion the available equipment was not used in a timely manner when one person was struggling to stand up.

People’s medicines were administered as prescribed. Care staff added thickeners to people’s drinks to reduce the risk of choking. The registered and assistant managers told us they would introduce a recording chart for this.

Care plans and risk assessments were in place which provided guidance and information about people’s support needs, their likes, dislikes and preferences and how to mitigate the identified risks. Staff we spoke with knew people and their needs well. Care files were reviewed every six months or when people’s needs changed.

Heathside used a care planning system called CareDocs. This added standard prompts to the assessments which were not person centred. The registered manager said they would add the action taken for each individual to the assessments so it was clear what had been done to mitigate the assessed risk. The care plans already included this information.

A pre-admission assessment was completed before people moved to Heathside and initial care plans written. Staff said they received sufficient information about new people’s support needs before they moved in.

Relatives told us they were involved in providing the information for the care plans and the home kept them very well informed of any changes in their relatives’ health or wellbeing.

People were supported with their health and nutritional needs. Health professionals were complimentary about the support provided at Heathside, although one told us there was a higher than expected number of skin tears at the home. There was no known pattern for this.

People said they enjoyed the food and they always had a choice of meals. A cooked breakfast was now available every day.

People and relatives told us they felt safe living at Heathside. They said there were always enough staff on duty and they didn’t have to wait long for support. Additional time was now on the rota at the staff cross over in the afternoon and the registered manager was trying to have a member of morning staff working until 5pm each day to assist with the teatime meal.

The home had added more dementia signs and photographs to people’s doors to assist people to orientate themselves within the home. Moving the dining room to the first floor from the basement level had reduced the queue for the lift at meal times and consequently the number of falls occurring in the home.

A safe recruitment system was in place. New staff completed an induction and shadowed experienced staff before working as part of the rota. Staff who were new to care were enrolled on the care certificate; however, they were not completing this within the recommended 12 week timescale. Staff completed refresher training and this was seen to be up to date.

Staff said they enjoyed working at the service, felt well supported by the management team and reported that they were open and approachable. Regular supervision meetings and staff meetings were held.

Relatives also said they could talk to the management team or staff if they needed to. Residents meetings were held to gain feedback from people about the service. A survey had been completed in February 2018 for residents, relatives, professionals and staff. The feedback was positive and any suggestions made had been implemented.

A part time activities officer was employed by the service. They arranged a variety of in house activities and trips out. People and relatives were very positive about the trips they had been on.

People’s wishes at the end of their life and in the event of their death were recorded in advanced care plans.

A complaints policy was in place. Complaints had been investigated and responded to appropriately.

People’s cultural and religious needs were being met by the service.

The service was working within the principles of the Mental Capacity Act (2005). People’s capacity was assessed and applications made for a Deprivation of Liberty Safeguard (DoLS) where a person was found to lack capacity.

The home was visibly clean throughout. One of the lounges and the new dining room had been re-decorated and new carpets purchased.

Heathside is a care home registered to provide personal care with accommodation for a maximum of 30 people. The home has 28 single rooms and one double room. Most rooms have an en-suite toilet. At the time of our inspection 30 people were living at Heathside. The home has three lounges and a dining room. There is a large accessible garden area to the rear of the property.

One of the owners / providers is also the registered manager for Heathside. 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.

The registered manager was supported by a manager who managed the service on a day to day basis. They had been promoted from deputy manager one month before our inspection. There had been two other managers at the service since our last inspection, but both had left. A training consultant was also employed for four days per week whose role was to arrange staff training and complete staff supervisions and audits of the service.

At the last inspection we found two breaches of the Health and Social Care Act 2008 as not all risks had been assessed and guidance to staff had not always been updated when people’s needs changed. At this inspection we found some improvements had been made.

The new computer system, Care Docs, had been implemented since our last inspection. We saw risks were identified and guidance given to staff to mitigate these risks. Care plans were written in a person centred way and identified the support required to meet people’s health and social are needs. The manager was in the process of reviewing all care plans and risk assessments at the time of our inspection. They then planned to review them every six months or when people’s needs changed.

However we found that action had not been taken when one person was weighed and had lost weight. When the person’s weight was re-checked during our inspection it was found the last reading had been incorrect. A senior carer had now been given the responsibility for ensuring people were weighed, entering the weights into Care Docs and ensuring appropriate referrals are made if people lose weight and their care plans are updated. This should help ensure that action is taken if people lose weight in future.

We also saw that a plan of care for one person who had a skin tear had not been updated when the district nurse and GP had visited. These visits had been noted in the daily record, which meant staff reading the plan of care may not be aware of the visits and any advice provided to the home.

Staff received a handover at the start of each shift. This provided information about any changes in people’s health and wellbeing.

People told us they felt safe living at Heathside and their relatives agreed. People and their relatives said there were enough staff on duty to meet their needs; our observations confirmed this. People said the staff treated them with kindness and respect and knew their needs well. We heard and saw positive interactions between people and staff members throughout the inspection.

A safe system of recruitment was in place. We saw one person had commenced work before the second reference had been received. The registered manager said they had been completing their training and induction by shadowing experienced staff until the second reference had been obtained.

Staff received a range of training, included distance learning through a national college, to meet people’s needs. Staff who were new to care were enrolled on two distance learning courses which met the requirements of the care certificate as part of their induction.

The care consultant completed staff supervisions every three months. The manager planned to complete some supervisions in the future. Regular staff meetings were held. This meant the staff received the training and support to meet people’s health and social care needs.

People received their medicines as prescribed and the medicine administration records were fully completed. Guidelines were in place for any medicines prescribed ‘as required’. Creams and eye drops were dated on opening. We have made a recommendation that liquid medicines are also dated when opened. A senior carer was responsible for auditing the medicines every week.

All accidents and incidents were recorded and the Care Quality Commission and local authority notified when required. The manager analysed the accidents and incidents each month to look for any patterns.

Systems were in place to meet people’s health and nutritional needs. People were regularly weighed in line with the assessed risk and referrals made to the Speech and Language Team (SALT), district nurses and other medical professionals as needed. Medical professionals told us the service made appropriate referrals and followed any advice they were given.

Mental capacity assessments and best interest decisions had been completed and applications for a Deprivation of Liberty Safeguards made to the local authority where required. People confirmed the staff gave them choices over day to day decisions and supported them to complete the tasks they could do for themselves so that they maintained their independence. We have made a recommendation that the service requests copies of any Lasting Powers of Attorney that are in place.

An activities officer had been recruited to work two days per week since our last inspection. A weekly plan of activities was in place, including external entertainers. Regular trips were arranged.

A range of audits was in place; however we saw that the management audit and health and safety audit had not consistently been completed to monitor the service.

People’s wishes for their care and support at the end of their lives had been sought. If people wished to remain at Heathlands at the end of their lives the service worked with health professionals to provide the support they required.

All areas of the home were clean. Procedures were in place to prevent and control the spread of infection.

Systems were in place to deal with any emergency that could affect the provision of care, such as a failure of the electricity and gas supply. Regular checks were in place of the fire systems and equipment. However the fire risk assessment had not been updated since 2014. We have made a recommendation that a fire risk assessment is completed by a suitably qualified person.

Regular resident meetings were held where people were asked for their feedback on the service. Relatives told us the staff and manager were approachable and they would raise any concerns they had directly with the staff. They said their concerns were acted upon by the staff team. Surveys had been undertaken, which we saw were overwhelmingly positive.

Heathside Retirement Home was last inspected in February 2015 when it was found to be meeting all the regulations we reviewed.

Heathside is a care home registered to provide personal care with accommodation for a maximum of 30 people. The home has 28 single rooms and one double room. Most rooms have an en-suite toilet. At the time of our inspection 29 people were living at Heathside. The home has two lounges and a dining room. There is a large accessible garden area to the rear of the property.

One of the owners / providers is also the registered manager for Heathside. 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.

A manager was also employed to manage the service on a day to day basis. We were told the manager was in the process of applying to become the registered manager; however at the time of our inspection CQC had not received an application for this.

During this inspection we found breaches of Regulations 9 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because not all risks had been assessed. Guidance for staff to follow had not always been updated when people’s needs had changed. You can see what action we told the provider to take at the back of the full version of the report.

A process was in place to recruit suitable staff; however records of staff recruitment did not fully evidence that the people who used the service were protected from the risks of unsuitable staff being recruited. We found the reasons for gaps in three people’s employment history had not been recorded. The manager told us they would record this information in future.

People told us they felt safe in the service and had no concerns about the care and support they received. Staff had received training in safeguarding adults and knew the correct action to take if they witnessed or suspected abuse. Staff were confident that the provider and manager would act on any concerns raised.

Care staff received the induction, training and supervision they required to be able to deliver effective care. We saw that a training consultant had recently been employed to support the staff with their training requirements. We saw, and were told, the staffing levels were sufficient to meet people’s needs.

We saw that medicines were managed safely. People told us that they received their medicines as prescribed. Protocols were in place to guide staff as to when ‘as required’ medicines were to be administered. We found there were discrepancies in the stock of two PRN medicines. Weekly audits were completed and any issues found were acted upon.

All areas of the home were clean. Procedures were in place to prevent and control the spread of infection. Systems were in place to deal with any emergency that could affect the provision of care, such as a failure of the electricity and gas supply. Regular checks were in place of fire systems and equipment.

People told us they received the care they needed. Care records we reviewed showed that people’s needs had been identified. However, it was not always clear what changes had been made when people’s needs had changed. Records had not been dated to show the most current information for staff to follow. We noted a new computerised care record system was being introduced.

Systems were in place to help ensure people’s health and nutritional needs were met. Records we reviewed showed that staff contacted relevant health professionals to ensure people received the care and treatment they required.

People we spoke with told us that the staff at Heathside were kind and caring. During the inspection we observed kind and respectful interactions between staff and people who used the service. Staff showed they had a good understanding of the needs of people who used the service. Some staff had completed training regarding end of life care; although they would like additional training in this area. One of the visitors we spoke with during the inspection told us the end of life care their relative had received in Heathside Retirement Home had been excellent.

We noted capacity assessments were completed for all people moving to Heathside to assess whether people were able to consent to their care and support. The provider and manager were aware of the actions to take to ensure any restrictions in place were legally authorised under the Deprivation of Liberty Safeguards (DoLS). We found the front door of the home was locked and required a fob to open; meaning people could not leave unescorted if they wanted to. The manager has contacted the local authority for advice as to whether their initial capacity assessment covers the fact the door is locked as this was known when people agreed to move to the home.

A programme of activities was in place for people at Heathside. We were told a new activities officer had been employed to increase the activities available for people.

Staff told us they enjoyed working in the service and received good support from the provider, manager and senior care workers. Regular staff meetings took place and staff said they were able to make suggestions and raise any concerns they had at the meetings.

There were effective systems in place to investigate and respond to any complaints received by the service. A system of residents’ meetings and surveys was in place for people and their relatives to comment on the care provided at the home. All the people we spoke with told us they would feel confident to raise any concerns they might have with the manager.

We noted there were a number of quality audits in the service; these included medicines, care records and the environment. Action plans were completed following the audits.

As part of this inspection we observed people who use the service, the registered manager, and three care staff. We also reviewed four care records, daily care records and medication administration records.

Below is a summary of what we found. The summary describes what the staff told us, what we observed and the records we looked at.

Is the service safe?

There was a staffing rota in place and staff told us they felt there was enough staff on duty at any time. All staff felt they received plenty of training and felt competent to do their job. A member of staff told us 'Yes there are enough staff here.' Medication was managed and administered in a safe and effective manner.

Is the service effective?

People's needs were being met at the home. We found that people's needs were assessed in a timely manner and care files included information about people's diagnosed health conditions and also their preferences.

Is the service caring?

We observed that staff providing people's care were kind and encouraging and spoke to people in a friendly manner.

People appeared to be treated with dignity and the staff could tell us what they were able to do to maintain a person's dignity. One member of staff told us "I always knock on people's door." One person who lives at the home told us "The staff here are lovely, very friendly."

Is the service responsive?

People's needs had been assessed before they moved to the home. People's records identified personal preferences and choices and the support that needed to be provided.

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Is the service well-led?

Staff felt listened to and supported by their manager. One member of staff told us "The manager is very supportive, you can go to her about anything."

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask; 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?

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Suitable policies and procedures were in place and staff had been trained to understand their responsibilities under the DoLS Codes of Practice. Care plans and our observation of staff provided evidence of good practice in applying the least restrictive options to promote each person's autonomy.

Risks relating to care, treatment and support had been appropriately assessed and were being managed well to keep people safe from accidental harm.

Care plans provided evidence of good risk management. For example, information in records provided evidence of staff taking prompt action to prevent people living in the home from accidental injury due to falls.

The home's equipment had been subject to servicing and maintenance at regular intervals.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines. We will revisit Heathside to check that suitable improvements have been made.

Is the service effective?

Staff understood and respected the people they cared for as individuals and provided their care and support in line with each person's choices and preferences.

Systems for dealing with complaints, suggestions and compliments made sure that the views of people using the service and their representatives were responded to by making improvements where appropriate. We saw evidence of this in the action taken to prevent people's clothes going missing in the laundry.

Is the service caring?

People living in the home were provided with stimulating and interesting activities, and care and support was in line with good practice guidelines. We saw staff treating people with respect and compassion. A relative told us, "I have seen them (staff) stop what they are doing to help people who are distressed or upset about something."

The two relatives we spoke with expressed positive feedback about the care provided to people living in the home. One of the relatives told us staff communicated well and were always pleasant and helpful.

Is the service responsive?

People living in the home had their needs assessed and their care plans showed us how staff would provide care and support to meet their needs. Care plans also contained some information about individuals' choices and preferences. One person's health and welfare was placed at risk, because no care plan had been written to tell staff how to provide care and support according to the person's preferences.

People living in the home said that staff were good at responding to their requests for help. Two relatives told us, 'There is always a member of staff around if we need to speak to them. We have got no problems with the staff here. They're very pleasant and extremely helpful.'

Is the service well-led?

The provider told us systems were in place to monitor, audit and review the quality of the service provided by Heathside, although written evidence was not available during our visit.

The management took a positive approach in responding to feedback from people who used the service and their representatives. We saw evidence of the action being taken to learn from incidents and identify where improvements should be made in the best interests of people using the service.

The staff we spoke with said they received good support from the manager. One member of night staff said, "The registered manager always responded in an emergency or if we need assistance or guidance during the night."

We spoke with six people who lived at the home who were complimentary about the care and the support they received from staff. Comments included: 'They asked me what my preferences were.' 'I was asked about my likes and dislikes.' 'They are lovely, very kind.' 'I am really happy here they are marvellous.'

We saw staff using appropriate personal protective equipment (PPE) such as; aprons and gloves. We spoke with staff who told us they always had access to PPE.

We looked at a sample of staff supervision records and saw topics such as policies and procedures, personal development and training, attitude, appearance, safeguarding and dignity were discussed.

We saw the provider used a variety of methods to obtain feedback about the service they offered. These included regular resident meetings and a questionnaire sent to relatives. We spoke with two relatives who told us: 'I have completed a questionnaire about what we think of the home.'

People who used the service told us that they were treated in a dignified and private manner and that their rights to choice and decision making was maintained. One of the people we spoke with said, "I decide when I go to bed and get up, what I have to eat and what I do during the day" "I can choose where I see my visitors."

People living in the home said that they received the right amount of care and support to meet their needs. They confirmed that they were provided with activities to interest and stimulate them and that their medication was given to them in accordance with their doctor's instructions.

We found that sufficient staff had been provided to ensure that people received the care and support they needed. The people accommodated described staff as kind, caring and considerate and they told us that they got on well with the providers and care staff. One person commented "The staff are very good. They know us well and they work very hard to make sure we get the support we need. They always find time to have a laugh and a joke with us."

The provider had a robust system in place for managing risks in the home and for continually improving the quality of the service provided. A visitor told us "I don't have to worry about my X any more. I know they are in good hands."