This inspection took place on 16 August 2016 and was unannounced. Heatherwood provides accommodation and personal care for up to eight older adults in Orpington, Kent. At the time of our inspection the home was providing support to five people.There was no registered manager in place at the time of this inspection although the current manager was in the process of applying to become the registered manager. The previous registered manager had left their role in November 2015. 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 our last comprehensive inspection on 20 and 21 August 2015 we found breaches of legal requirements because medicines were not safely managed, and risks to the health and safety of people had not always properly assessed. We also found a further breach because the provider’s quality assurance systems did not always correctly identify issues and because action had not always been taken where issues had been identified. The provider wrote to us following that inspection and told us the action they would take to address the breaches.
At this inspection we found that the provider had taken action to ensure people’s medicines were safely managed. Improvements had also been made to the provider’s quality assurance systems, although further improvement was required to ensure they identified all appropriate action was taken to address identified issues.
We also found that whilst improvements had been made to risk assessment processes, the malnutrition risk assessment tool used by staff had not always been completed correctly and therefore did not always identify when people were at risk of malnutrition. This was an issue we had identified at our previous inspection and was a continued breach of regulations. However, whilst there was a risk to people because of the incorrect use of the tool, we found that there had been no negative impact on people at the service at the time of our inspection, and action had been taken by staff in response to people's weight loss. Following our inspection we wrote formally to the provider and they provided us with details of the system they had put in place to ensure staff were aware of how to correctly use the malnutrition risk assessment tool, to prevent any further errors being made. This assured us that action had been taken to address our concerns and we will check on this at the next inspection
Additionally, we found a breach of regulations because one person had not consented to the use of bed rails following a fall from bed, despite having been assessed as having the capacity to make the decision about the use of bed rails for themselves. You can see the action we have told the provider to take in respect of both of these breaches at the back of the full version of this report.
People were protected from the risk of abuse because staff were aware of the action to take if they suspected abuse had occurred. There were sufficient staff deployed within the service to safely meet people’s needs and the provider undertook appropriate checks on new staff before they started work to ensure they were suitable for the roles they were applying for.
Staff had received training in areas considered mandatory by the provider and people told us they thought staff had the skills to support them effectively. Staff also received supervision although improvement was required to ensure all staff were supervised on a regular basis in line with the provider’s policy.
People were supported to maintain a balanced diet and were involved in choosing meal options for the menus. People had access to a range of healthcare services when needed. Staff were aware to seek consent from people when offering them support and told us people had capacity to make decisions about their care and treatment for themselves. Staff confirmed that none of the people living at the service were subject to a Deprivation of Liberty Safeguards (DoLS) authorisation, although improvement was required to ensure the manager understood the conditions under which a person may be considered to be deprived of their liberty.
People told us that staff were caring and considerate. Staff treated people with dignity and respected their privacy. People were involved in making day to day decisions about their care and treatment.
People had care plans in place which were regularly reviewed and which reflected their individual preferences. The service offered people a range of activities to encourage social interaction. The provider had a complaints policy and procedure in place and people told us they were aware of how to raise concerns if they needed to.
People and relatives spoke positively about the management of the service, although they told us the manager was not always a visible presence. Staff had mixed views about the leadership of the service but told us they worked well as a team. The provider sought feedback from people through residents meetings and an annual survey and we noted that people had fed back positively about their experience of living at the service. The provider also undertook checks and audits covering a range of areas, and took action to address any issues that were identified in audit findings, findings although some improvement was required to ensure that this was consistent.