Heatherdale Healthcare Limited

Heatherdale Healthcare Limited is a care home providing nursing and personal care. The service can support up to 43 people. There were 36 people were living at the home at the time of the inspection. The service supports people aged over 65 years some of whom are living with dementia and a range of health needs. Accommodation is provided over two floors with a communal lounge, dining room and activity room on the ground floor.

People’s experience of using this service

People and their relatives said their experiences of the service were positive. One person told us, “Staff are always on training, so I think they always know what they are doing. I would trust my life with them.” A relative said, “The staff seem to love him(person living at the service). He gets on really well with the staff. They support him mentally and emotionally, as well as physically. They are really good”.

There had been a number of improvements since the last inspection which benefitted people. People could be assured their complaints would be responded to; nurses had the knowledge and skills to support and monitor people’s health conditions; the service was monitored to ensure people received a quality service.

This included systems for monitoring the quality of the service, the handling of complaints, nurses clinical training, the monitoring of clinical risks and the management of 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 understood how to apply the principles of the Mental Capacity Act 2005.

There were systems to recruit suitable staff and enough were available to meet people’s needs. The provider had ensured staff were deployed where they were most needed at the service.

People told us they felt safe and staff understood their roles in safeguarding people from harm. Risks to people had been identified, assessed and staff knew how to manage these risks safely. There was a process to identify learning from accidents, incidents and safeguarding concerns.

People’s nutritional needs were assessed and met, people had access to health and social care professionals as required. The environment was suitably adapted to their needs.

People told us staff treated them with care and kindness. They had a personalised plan for their care that reflected their needs. An activity coordinator was employed, and people were offered a range of in-house and external activities. People’s wishes relating to their end of life care needs had been discussed with them or their relatives, where appropriate.

People and their relatives were positive about the manager and the way the home was run. In a survey of people who used the service the overwhelming majority of people said they would recommend the service to others. A relative said, “I think the manager is open and transparent and has a good reassuring background. I know they are looking at involving the relatives and the residents in making improvements to the home.”

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 24 October 2018) and there were three breaches of regulation with regards to risk management, handling complaints and the governance of the service. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We carried out a targeted inspection on 13 August 2020 to check on specific concerns we had about management of risks, infection control and the governance of the service. We carried out an additional targeted inspection on 9 December 2020 to check on a specific concerns we had about infection control and staffing. We did not find any additional breaches of regulation during these targeted inspections. 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 focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective, Responsive and Well-led which contain those requirements.

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.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service is Good. This is based on the findings at this inspection.

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

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.

Heatherdale Healthcare Limited is a residential care home providing personal and nursing care to 34 older people at the time of the inspection. Some of the people living at the service were living with dementia. The service can support up to 43 people. The service is provided in a purpose built building over two floors.

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

People told us they were happy living at the service. One person said, “They are very pleasant. I feel well looked after and am happy to be here.”

There were suitable measures in place to reduce the risk of infection. For example, staff had access to personal protective equipment (PPE). Staff were using PPE correctly and in line with current guidance. Some policies and risk assessments needed updating However this was addressed during the inspection.

There were enough staff to support people. Staff had been recruited safely to ensure they were suitable to undertake their role supporting vulnerable people.

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 20 February 2020).

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about infection control and staffing. 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 Warning Notices 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.

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.

Heatherdale Nursing Home is a nursing home providing personal and nursing care to 34 people aged 65 and over at the time of the inspection. The service can support up to 43 people.

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

People’s relatives told us they were safe and well cared for at the service. There was a new manager at the service who was receiving a handover from the outgoing registered manager. Some documents such as care plans were not fully completed or contained generic information. Information was not always updated when people’s needs changed or was difficult to find. The impact on people was reduced by staff’s knowledge and understanding of people’s care needs.

The new manager had completed a full audit of the service and had identified the shortfalls found at this inspection. Relatives and staff told us the manager was approachable and communicated effectively.

The service was clean and odour free, additional cleaning had been carried out due to the pandemic. This was not always recorded. Staff had been given information about guidance for managing infection control in relation to COVID 19, however not all staff were fully up to date with guidance. These are areas for improvement.

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 20 February 2020).

Why we inspected

We undertook this targeted inspection to check on specific concerns we had about management of risks, infection control and good governance. 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 Warning Notices 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.

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.

People’s experience of using this service

At this inspection we found there was no effective system for the handling of complaints. Some nurses’ training was out of date and the processes to assess nurse competency were not always effective. Agency nurses’ clinical training was not checked. The system for monitoring the quality of the service needed improvements to ensure it was effective in identifying shortfalls.

Some risks had not been identified and improvements were needed to the way some clinical risks were monitored to ensure there were accurate records. Aspects of the management of ‘as required’ medicines needed improvement to ensure people received all medicines as prescribed.

Some improvement was needed to ensure people were consistently supported to have maximum choice and control of their lives and that staff supported them in the least restrictive way possible and in their best interests.

Prompt action was taken to address these areas during and after the inspection. We will check progress on these at our next inspection.

There were enough staff to meet people’s needs, although our observations suggested staff could be deployed more effectively at times. The provider agreed to review staff deployment across the home.

People told us they felt safe and staff understood their roles in safeguarding people from harm. Most risks to people had been identified, assessed and staff knew how to manage these risks safely. There was a process to identify learning from accidents, incidents and safeguarding concerns.

People’s nutritional needs were assessed and met and they had access to health and social care professionals as required. The environment was suitably adapted to their needs.

People told us staff treated them with care and kindness and their needs in respect of their protected characteristics were assessed and supported. People were consulted about the support they received and told us staff treated them with dignity and respect and encouraged their independence.

People had a personalised plan for their care that reflected their needs. They had access to a range of activities. People’s wishes relating to their end of life care needs had been discussed with them or their relatives, where appropriate.

People and their relatives were positive about the registered manager and the way the home was run. Staff told us the registered manager had an open-door policy and was visible as a leader. Some aspects of the quality monitoring system worked to identify where improvements were needed.

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 21 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the handling of complaints, staff training and the system to monitor the quality of the service.

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 for the provider to understand 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.

The home provided accommodation, personal and nursing care for older people. The accommodation spanned two floors and a lift was available for people to travel between floors. There were 38 people living in the home when we inspected. Nursing staff and care staff assisted people to manage chronic and longer term health issues associated with aging or after an accident or illness.

There was a registered manager employed at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

At our last inspection 25 May 2016, we gave the home an overall rating of, ‘Good’, but found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This breach was in relation to Regulation 12, Safe Care and Treatment. Medicine’s records were not always accurate. We asked the provider to take action to meet Regulation 12. The registered manager sent us an action plan telling us the actions they had taken to meet the regulation.

At this inspection, there had been some improvements, but we found recording errors were still occurring. We made a recommendation about this.

Staff received training that related to the needs of the people they were caring for and nurses were supported to develop their professional skills maintaining their registration with the Nursing and Midwifery Council (NMC).

There were policies in place for the safe administration of medicines. Nursing staff were aware of these policies and had been trained to administer medicines safely.

Nursing staff assessed people’s needs and planned people’s care. They worked closely with other staff to ensure the assessed care was delivered. General and individual risks were assessed, recorded and reviewed. Infection risks were assessed and control protocols were in place and understood by staff to ensure that infections were contained if they occurred.

The provider and registered manager ensured that they had planned for foreseeable emergencies, so that should emergencies happen, people’s care needs would continue to be met. Equipment in the home had been tested and well maintained.

Decisions people made about their care or medical treatment were dealt with lawfully and fully recorded. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Restrictions imposed on people were only considered after their ability to make individual decisions had been assessed as required under the Mental Capacity Act (2005) Code of Practice. The registered manager understood when an application should be made.

The registered manager had ensured that they employed enough nursing and care staff to meet people’s assessed needs. A robust agency back up system was in place. The provider had a system in place to assess people’s needs and to work out the required staffing levels. Nursing staff had the skills and experience to lead care staff and to meet people’s needs effectively and the registered manager provided nurses with clinical training and development.

People were supported to eat and drink enough to maintain their health and wellbeing. They had access to good quality foods and staff ensured people had access to food, snacks and drinks during the day and at night.

We observed safe care. Staff had received training about protecting people from abuse and showed a good understanding of what their roles and responsibilities were in preventing abuse. Nursing staff understood their professional responsibility to safeguard people. The registered manager responded quickly to safeguarding concerns and learnt from these to prevent them happening again.

Incidents and accidents were recorded and checked by the registered manager to see what steps could be taken to prevent these happening again. The risk was assessed and the steps to be taken to minimise them were understood by staff.

People had access to qualified nursing staff who monitored their general health, for example by testing people's blood pressure. Also, people had regular access to their GP to ensure their health and wellbeing was supported by prompt referrals and access to medical care if they became unwell.

Recruitment policies were in place. Safe recruitment practices had been followed before staff started working at the home. This included checking nurse’s professional registration.

We observed staff that were welcoming and friendly. People and their relatives described staff that were friendly and compassionate. Staff delivered care and support calmly and confidently. People were encouraged to get involved in how their care was planned and delivered. Staff upheld people’s right to choose who was involved in their care and people’s right to do things for themselves was respected.

If people complained they were listened to and the registered manager made changes or suggested solutions that people were happy with.

The registered manager of the home, nurses and other senior managers were experienced and provided good leadership. They ensured that they followed their action plans to improve the quality of the home. This was reflected in the changes they had already made within the home.

Heatherdale Nursing Home provides accommodation for up to 40 people who need nursing and personal care. Communal areas, such as the lounge and dining room are on the ground floor. Bedrooms are over three floors accessed by stairs and a passenger lift. There is a garden to the rear of the building. At the time of our visit, there were 39 people who lived in the home. People had a variety of complex needs including dementia, physical health needs and mobility difficulties.

There was a registered manager at the home. 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.

Medicines were not being administered safely to all people living at the home. Clear and accurate medicines records were not maintained in all instances.

The registered manager had systems in place to manage safeguarding matters and make sure that safeguarding alerts were raised with other agencies. All of the people who were able to converse with us said that they felt safe in the home; and said that if they had any concerns they were confident these would be quickly addressed by the registered manager.

The home had risk assessments in place to identify risks that may be involved when meeting people’s needs. The risk assessments showed ways that these risks could be reduced. Staff were aware of people’s individual risks and were able to tell us about the arrangements in place to

manage these safely.

There were sufficient numbers of qualified, skilled and experienced staff to meet people’s needs. Staff were not hurried or rushed and when people requested care or support, this was delivered quickly. The provider operated safe recruitment procedures.

Staff knew each person well and had a good knowledge of the needs of people who lived at the home. Training records showed that all staff had completed training in a range of areas that reflected their job role. Nurses were given training suitable for them to validate their ongoing registration as a nurse. Staff told us that they had received supervision and appraisals were on-going.

Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 to ensure any decisions were made in the person’s best interests. We found the home to be meeting the requirements of Deprivation of Liberty Safeguards.

The food menus offered variety and choice. They provided people with nutritious and a well-balanced diet. The cook prepared meals to meet people’s specialist dietary needs.

People were involved in their care planning, and that staff supported people with health care appointments and visits from health care professionals. Care plans were amended immediately to show any changes, and care plans were routinely reviewed every month to check they were up to date.

People were treated with kindness. Staff were patient and encouraged people to do what they could for themselves, whilst allowing people time for the support they needed. Staff encouraged people to make their own choices and promoted their independence.

People knew who to talk to if they had a complaint. Complaints were managed in accordance with the provider’s complaints policy.

People’s needs were fully assessed with them before they moved to the home to make sure that the home could meet their needs. Assessments were reviewed with the person and their relatives. People were encouraged to take part in activities and leisure pursuits of their choice, and to go out into the community as they wished.

People spoke positively about the way the home was run. The management team and staff understood their respective roles and responsibilities. Staff told us that the registered manager and the deputy manager were very approachable and understanding.

There were effective systems in place to monitor and improve the quality of the service provided. We saw that various audits had been undertaken.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Is the service safe?

The service was kept clean and free from infection because the manager ensured that the home was cleaned in a planned way. Staff were trained in infection control and they understood their role in minimising infection risks. People told us that the home was kept clean. People confirmed that staff followed guidance about wearing gloves and other protective equipment when providing personal care.

We spoke with three people who lived at the home, one relative and a visiting professional. They told us they were happy with the care provided by the home. The visiting professional said they had been coming to the home for a number of years and felt the physical health of people living in the home was promoted. The relative we spoke with told us that the care was "Very good really" and they did not have any concerns. One person said "The staff are good to me".

We looked at how the home was meeting the nutritional needs of the people living at the home. We saw people had access to plenty to eat and drink. They were able to make requests if they wished to have an alternative meal. Referrals were made to appropriate professionals if people had difficulty with their swallowing.

We looked at cleanliness and infection control at the home. We found there were some measures in place to ensure infection control was maintained, such as a system for managing laundry appropriately. However some of the bins used for disposing gloves were not suitable, this meant that used gloves were left in open bins. Some staff had recently attended infection control training but other staff had no record of attending this training. Others had not completed the training for several years.

People told us that staff understood their individual needs and said they felt well cared for. People said they liked the staff. One person said 'I am very well cared for here'.

People spoke highly of the quality of the meals at Heatherdale. Comments made included 'The food is good, there is always a choice'.

Medicines were handled appropriately and people were protected against the risk of unsafe management through effective procedures and practices.

We found that the service carried out the appropriate checks on new staff and had effective recruitment procedures in place to protect people living at the service.

We found evidence that when people made a complaint, their complaint was taken seriously and investigated thoroughly. People said they were confident that if they raised a concern it would be dealt with.

We found that whilst records were accurate and kept up to date, they were not stored securely.

Questionnaires about the home had been distributed and the results were being acted on. Staff had talked to people living at the service about their 'perfect day' which included people's personal preferences such as times for getting up and their preferred daily routines. Information about people's interests and hobbies had also been gathered and documented. The manager has stated that this information is now being used to plan the activities on offer.