The Heathlands Village

The Heathlands Village (known as Heathlands) is a residential care home providing personal and nursing care to up to 214 people. The service provides support to older people from both the Jewish and Non–Jewish community, some of whom were living with dementia. At the time of our inspection there were 137 people using the service.

Heathlands is divided into 7 units. Wolfson (nursing), Hamburger House (residential), Cedarwood (residential), Willow (residential), the Simon Jenkins unit (discharge to assess), Beach House (residential dementia), and Oakwood (nursing dementia).

People all have their own en-suite rooms. Each unit has a shared lounge, dining area and bathrooms. Heathlands also has extensive grounds, and the site includes an onsite synagogue, restaurant and atrium where people can meet their family and friends, as well as other facilities.

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

Assessments regarding people’s capacity to make their own decisions were not completed. Applications for a Deprivation of Liberty Safeguards were made when people moved to the home where applicable. This meant people were not always supported to have maximum choice and control of their lives. We have made a recommendation for formal capacity assessments to be completed and regularly reviewed.

From our observations, and feedback from people and relatives, staff supported people in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People said they were safe living at Heathlands. Brief risk assessments were in place and care staff knew people’s needs well. People received their medicines as prescribed. Guidance for when people needed an ‘as required’ medicine to be administered was not sufficiently detailed. The registered manager said they would ensure additional details were recorded across all units.

There were enough staff to meet people’s needs. Staff were safely recruited. Incidents and accidents were recorded and reviewed to ensure actions had been taken to reduce the risk of a reoccurrence. The home was clean throughout.

There was a quality assurance system in place. This was in the process of being improved. Additional clinical managers had been recruited who in future would complete regular audits, giving the team and shift leaders more time to manage their units. The clinical managers were now more visible on the units and able to provide more support for the staff teams.

Feedback from people and relatives was positive about the care and support they received. There was good communication with relatives. A medical professional was also positive about the home, with staff knowing people’s needs and following any guidance provided.

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 7 March 2019).

Why we inspected

The inspection was prompted in part due to an increase in notifications made by the home and the length of time since the last inspection. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. We found no evidence during this inspection that people were at risk of harm. Please see the safe and well led sections of this full report.

The overall rating for the service has remained good based on the findings of this inspection.

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.

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

Recommendations

We have made a recommendation for the service to follow best practice guidance for assessing and reviewing people’s capacity to make decisions.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Our last comprehensive inspection took place on 18, 19, 28 January and 1 February 2016. We found no breaches in the Regulations at that inspection.

The Heathlands Village is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided and both were looked at during this inspection.

The Heathlands Village provides a wide range of care services for up to 214 older people from both the Jewish and Non–Jewish community. The Heathlands Village is divided into six units. Beach House, residential dementia, Wolfson, residential, Unit 2 residential, First Floor residential, the Simon Jenkins nursing unit and Oakwood nursing dementia unit. The Heathlands Village is situated in extensive well-maintained grounds. At the time of our inspection visit the service was undergoing extensive restructure and design and only 121 people were using the service.

The service had a registered manager in place. A registered manager is a person who has registered with CQC 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 our last inspection in January 2016 we rated the service as ‘good’, with an ‘outstanding’ rating for the key question, ‘is the service responsive?’. At this inspection we found the evidence continued to support the rating of good and the service could demonstrate continuous improvement.

We found concerns about the safe control of substances hazardous to health (COSHH) on the new dementia unit, Beach House. The registered provider acknowledged that this was a result of people moving around the service. The registered provider’s maintenance team acted to rectify this issue immediately.

Overall, people’s medicines were safely managed. However, we raised some concerns about the storage of non-medicated creams and thickeners as well as the recording of thickeners that were not on the computerised medicines system. We were aware that the service was in the process of changing their supplying pharmacist and computerised medicines systems. The registered manager assured us that they would address the shortfalls we found with the new pharmacist and additional medicines cabinets would be provided. Minor issues were addressed immediately by the provider.

Recruitment procedures were sufficiently robust to protect people from the risk of unsuitable staff. However, improvements were needed to the registered providers application form to ensure a full employment history was maintained. This was addressed immediately by the provider during our inspection.

Staff had received training in safeguarding adults and knew the correct action to take should they witness or suspect abuse taking place. Improvements had been made to the security systems of The Heathlands Village.

We saw further improvements had been made to strengthen moving and handling procedures and health and safety training for staff in line with Health and Safety Executive (HSE) guidance.

The service was clean and tidy throughout and no malodours were detected.

We saw that the service had made changes to the site to make it more dementia friendly and provide a quieter area for people to live who were receiving end of life care. The registered provider had completed refurbishment of an existing area to create a new smaller dementia unit which was to a very high standard. This was to be the blue print for other areas of the home. It was recognised that these changes did not suit everyone. However, action had been taken by the registered provider to help minimise the impact.

There were adequate numbers of staff to support people safely and effectively. Staff had received or had access to training to help them support and care for people safely and effectively. Improvements had been made in staff training and more support was being offered to staff from human resources to improve staff retention.

People had access to health care professionals both on and offsite.

People enjoyed the food that was offered which was overseen by the Manchester Beth Din.

People’s religious needs were able to be met on site. Following requests from relatives we saw that Yiddishkeit (Jewish customs and way of life practices) had been further promoted with more work planned. Non Jewish people were also welcome to live at The Heathlands Village and their needs would be catered for and adapted to. For example, the provision of Asian meals.

We saw frequent and friendly exchanges between staff and people who used the service and the atmosphere was calm and relaxed.

There were a wide range of facilities to access and arrangements for social activities were wide ranging with additional support provided by volunteers if needed. The new exercise bikes had proved to be a hit with people who use the service.

The service had recently received the highest level of the gold standard framework to support people nearing the end of their life to receive compassionate and supportive care that met their cultural needs.

People were actively encouraged to give their views and raise concerns or complaints. The service saw concerns and complaints to help drive improvement and were discussed at a high level.

People told us and we saw that managers at all levels were visible, approachable and supportive. We saw that the service had recently appointed a care quality assurance manager. Part of this role was to maintain quality assurance in line with CQC regulations and Key Lines of Enquiry.

There was a strong emphasis on continually striving to improve and working in partnership with others. The service actively sought and acted on the views and opinions of people who used the service, relatives and staff. The service had developed a clear and visible code of practice that supported a positive culture and value base, which was expected to be followed by all people connected with The Heathlands Village.

This inspection was prompted by information we received about an incident following which a person using the service later died. This incident was subject to a police investigation and as a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC indicated potential concerns about how the service managed the risks of falls when moving and handling people using lifting equipment such as a hoist.

This report only covers our findings in relation to these concerns. The concerns raised form part of the two domains; is the service safe and is the service well led. Our findings are reported under these domains.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘The Heathlands Village’ on our website at www.cqc.org.uk.

The Heathlands Village provides a wide range of care services for up to 214 older people from both the Jewish and Non–Jewish community. The Heathlands Village is divided into six units and is situated in extensive well maintained grounds. It is close to the village of Prestwich and there is easy access to local shops, public transport and the motorway network.

At the time of our inspection, 129 were using the service and of those 33 people were being transferred by the use of a hoist or a stand aid.

There was a registered manager in place and they were available throughout this inspection. 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 were discrepancies between the policy and procedure in relation to the frequency of moving and handling people refresher training and the certificate validation, which was addressed following our inspection.

Care records, risk assessments and systems were in place to help direct staff to use the correct hoist and sling that people had been assessed to use.

Staff had received the moving and handling training they needed to help ensure the safe transfer of people. Refresher moving and handling people training was available and the majority of staff had undertaken this training. Competence checks were undertaken to check that staff practice was safe; however, there was no centralised system to enable us to confirm which staff had been assessed. We recommend that a central log of competency checks is maintained to help ensure and track that these important checks have been carried out.

Systems were in place to ensure that lifting equipment was maintained as specified by the legal requirements of the lifting operations and lifting equipment regulations (LOLER).

The registered provider had invested in a dedicated moving and handling people training room. The room and equipment cost over £6,000 and was set up in January 2017. A wide range of equipment was seen to have been made available for staff to use for moving and handling training purposes.

The service, where able, had followed the principles of the Duty of Candour, following the incident. The Duty of Candour sets out some specific requirements that providers must follow when things go wrong with care and treatment, including informing people about the incident, providing reasonable support, providing truthful information and an apology.

The provider had taken prompt action to help prevent a similar incident occurring. The board had commissioned an independent external advisor to undertake a root cause analysis of the incident.

The Heathlands Village provides a wide range of care services for up to 214 older people from both the Jewish and Non–Jewish community. The Heathlands Village is divided into six units and is situated in extensive well-maintained grounds. It is close to the village of Prestwich and there is easy access to local shops, public transport and the motorway network. At the time of our inspection visit 154 people were using the service. The low number was due to ongoing improvements being made to the site.

The service had a registered manager in place. A registered manager is a person who has registered with CQC 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 this inspection we found no breaches in the regulations that we reviewed.

People who used the service told us “I feel safe in here. There's plenty of people in here,” “I feel safe here because there's always somebody around,” and “If you arrive after hours I have a phone number to be let in. You don't have to wait. There's 24 hour reception” and “I've always felt safe in here.”

Staff we spoke with told us that, “All staff get safeguarding training,” “If someone complained to me I would write everything down and report it to the team leader immediately” and “There are eyes and ears everywhere at Heathlands.” Staff had received training in safeguarding adults and knew the correct action to take should they witness or suspect abuse taking place.

Recruitment procedures were sufficiently robust to protect people from the risk of unsuitable staff and there were adequate numbers of staff to support people safely and effectively.

People’s medicines were safely managed.

People who used the service and relatives said, “It's like a five star hotel,” “The home is clean and her bedroom is clean. It is always clean in here,” “They do clean the public areas and my bedroom every day. My bedding is also kept clean” and “Cleaners are around all the time.”

The registered manager had a good understanding of the Mental Capacity Act. Authorisations for non-urgent Deprivation of Liberty Safeguards were ongoing with the local authority. Improvements were in the process of being undertaken to clearly identify when people had given their consent and for what reason.

Staff had received or had access to training to help them support and care for people safely and effectively.

People enjoyed the food that was offered which was overseen by the Shomer for the service to ensure that religious and cultural requirements were met. People who used the service told us, “I like the food here. You get a good choice of food.” “The food is excellent. It is very nicely cooked. The food is pretty good,” “There's plenty of choice. I like the evening meal best. It's a good end to the day,” “The food is excellent. Its Kosher” and “We get enough fruit and vegetables. There is a reasonable choice of food.”

One person told us, “If I'm poorly a doctor will come to see me. I have seen a doctor when I ask for one. I saw the doctor yesterday. There is a surgery on the premises. You can use the emergency doctor otherwise. I have access to other medical professionals when needed.

We saw frequent and friendly exchanges between staff and people who used the service and the atmosphere was calm and relaxed.

People who used the service told us, “The staff treat me with respect. They are very kind to me.” “On the whole they are decent. They do knock before coming into my room. Staff are kind to my relative and sometimes offer them a drink” and “Staff do know what I like and don't like.”

Staff members we spoke with told us, “I have worked here for seven years now and I know all the people here individually. I know all about them” and “I would be more than happy to have a family member or friend living here. The people here do get very well looked after.”

People nearing the end of their life received compassionate and supportive care.

The arrangements for social activities were wide ranging with additional support provided by volunteers. The service took a key role in the local community and was actively involved in building further links.

People were actively encouraged to give their views and raise concerns or complaints. The service saw concerns and complaints as a means to drive improvement.

The service had a manager who was registered with the Care Quality Commission and was qualified to undertake the role. People told us and we saw that managers at all levels were visible, approachable and supportive.

The service actively sought and acted on the views and opinions of people who used the service, relatives and staff. The service had developed a clear and visible code of practice that supported a positive culture and value base, which was expected to be followed by all people connected with Heathlands Village.

There was a strong emphasis on continually striving to improve and working in partnership with others, for example, members of the community, music therapy and the local university.

We focused our inspection on one of the residential units of the home in Eventhall House. This was because of information we had been given several weeks prior to the inspection, by the home's registered manager. Our inspection identified that the allegations were not substantiated. The provider was meeting the essential standards of quality and safety in the outcomes areas that we inspected.

We found that arrangements were in place to ensure that people using the service were cared for, and supported by, sufficient skilled and experienced staff. A relative told us they felt the staffing levels had improved recently and that their relative was well cared for.

Inspection of documentation and a discussion with newly appointed staff showed that arrangements were in place to ensure that people using the service were cared for by staff that were safely recruited and were properly trained, supported and supervised.

We found that adequate equipment and adaptations were available to promote people's independence and comfort and assist in their safe moving and handling.

'Very happy here, the staff are very good' and 'No problems here, well cared for'.

The design, layout and maintenance of Heathlands Village ensured that people using the service, staff and visitors, were kept safe.

People's care records contained enough information to show how they were to be supported and cared for.

Suitable arrangements were in place to help protect people using the service from abuse.

People were cared for by staff that were properly trained, supported and supervised.

Regular monitoring of the service and facilities provided was in place to help protect people against the risks of inappropriate or unsafe care.

We saw that staff took appropriate action when any weight loss was identified. We also saw that the care records contained detailed information about the care, treatment and support needs that people had.

People's care records contained detailed information to show how they were to be supported and cared for. People told us they were well looked after. They told us; 'All very nice' and 'I am well looked after'. A relative told us; 'I have no concerns, the care is very good and the staff are very kind'.

The medication system was safe and one person told us they received their medicines when they needed them. We were told; 'Yes, they know I need them and they do not forget'.

An effective complaints procedure was in place and people knew how to make a complaint.