Heaton House Care Home

Heaton House is a residential care home providing accommodation for people who require personal and nursing care to up to 21 people. The service provides support to older people some of whom had dementia. At the time of our inspection there were 18 people using the service.

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

People’s medicines were not always managed safely; record keeping and systems relating to the management, storage and administration of people’s medicines were inconsistent. The provider had recently lost a number of staff and had carried out rolling recruitment; however, in some cases there were gaps in references and the correct service was not recorded on staffs DBS certificates; we discussed this with the provider who addressed this immediately. Risks relating to the safety of the environment had been identified but not actioned for significant periods of time. The provider was unable to evidence any actions to address risk identified in relation to the building. We identified the provider had not always responded effectively to safeguarding concerns. We have made recommendations relating to risk assessments and safeguarding procedures.

The provider and registered manager had not maintained oversight of systems and processes. There was no evidence of audits being carried out by the provider or registered manager which had led to a number of issues we identified during this inspection not being addressed. Audits which had been completed by other members of staff identified similar actions for a number of months without action being taken. The provider were not always clear on when notifications to CQC were required; however, we were assured this was due to a lack of oversight and governance as safeguarding referrals had been made and the provider had liaised with CQC. Staff reported feeling supported by the management team and felt confident changes being made would improve the service. We have made a recommendation the provider ensures systems relating to duty of candour are robust and effective.

The provider had not implemented systems which ensured staff were suitably skilled, qualified and had the relevant experience to provide care and support. Training records provided during our inspection did not provide assurances staff received robust training in all areas required. Additionally, staff feedback relating to their induction varied significantly and we found evidence within records which further corroborated this Information relating to people’s mental capacity had been recorded in care records and support plans; however, occasionally this was inconsistent and capacity assessments were not always decision specific. Communication with external professionals was not always recorded. We have made a recommendation the provider ensures all correspondence and involvement with external professionals involved in people’s care is recorded.

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 did not always support this practice .

The provider had not implemented a meaningful and varied programme of activities. We observed little evidence of people being engaged in activities and people and relatives feedback corroborated our observations. The provider had not always worked in accordance with their complaints policy; prior to our inspection the provider was made aware of a number of complaints. During our inspection we found only one complaint had been logged which meant an audit trail to evidence what action the provider had taken and when, could not be reviewed. Additionally, lessons learnt from complaints could not be evidenced due to their being only one complaint recorded. People’s care plans and support plans had been improved since our last inspection particularly oral care and communication plans. We have made recommendations in relation to activities and end of life care training.

People and their relatives felt care was provided by staff who understood how to meet their needs, promote their independence and dignity and protect their privacy. Staff demonstrated a good understanding of person centred care and how to support people as individuals. Staff told us this culture was apparent across the staff team and people confirmed this by describing staff as “kind, “hardworking” and “beautiful”.

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 2022) and breaches of regulations were identified. The service remains rated requires improvement. Under the current provider this service has been rated requires improvement for the last two consecutive inspections.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found the provider remained in breach of regulations.

At our last inspection we recommended that the provider reviewed training compliance, activities, people’s communication plans and their duty of candour systems. At this inspection we found improvements had been made to people’s communication plans; however, further development was needed in the other areas.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

The inspection was prompted in part due to concerns received about the overall governance of the service, people’s safety and low staffing levels. A decision was made for us to inspect and examine those risks.

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

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, premises and equipment and good governance at this inspection.

We have issued warning notice's against the breaches relating to safe care and treatment and good governance. We issued a requirement notice against the breach relating to premises and equipment.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Glenhomes Care Home is a care home providing personal and nursing care to up to 21 people. The service provides support to older people, some of whom are living with dementia and/or physical support needs. At the time of our inspection there were 16 people using the service. The service while registered to provide nursing care was only providing support to people with residential support needs and didn’t employ any nursing staff.

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

People and their relatives felt care was provided safely. Staff had a good understanding of incidents which would require a safeguarding referral and who they could and should contact if they had any concerns. Medicines were administered safely; however, some issues were identified in relation to audits, paperwork and night time medicine arrangements. Dependency levels had not yet been fully completed and some staff felt staffing levels at night were not sufficient. However, the provider had implemented new systems including an electronic recording system which would support the assessment of how many staff were needed to meet the needs of people. The home was clean and hygienic .

The provider had recently purchased the home from the previous provider and had identified several areas where improvement was needed. This included staff training and all staff had been assigned a training programme they needed to complete within a realistic timeframe. The provider evidenced their oversight of this. Staff had a good understanding of the MCA and how this impacted their roles. Inconsistent record keeping was identified across a variety of records, with some records not being completed appropriately or fully. We discussed this with the provider who demonstrated their new recording system which will promote consistency in record keeping. Training for staff on how to use the system had been scheduled. We have made a recommendation the provider continues to monitor staff’s compliance with completing mandatory training courses.

The provider had changed the layout of communal areas within the home to accommodate a bigger office. However, the provider had failed to consult with people and relatives and we fed back to the provider our concerns about the communal space available to the 16 people living at the service being limited. The provider advised they were in the process of purchasing the neighbouring property and communal space would be considered a priority when using this space to extend the home. They were unable to give a timescale of when any work would be completed.

People received care which was warm, attentive and person centred. People and relatives consistently shared positive feedback with us about their experience of the care provided at the home. People’s preferences, likes and dislikes were recorded in their care plans. Further detail was needed in some people’s records though to ensure all records reflected the person centred care provided by staff.

Care plans and risk assessments were completed to varying levels of quality; some people had plans which reflected how they wished their care to be provided and how staff could do this safely. However, some plans and risk assessments lacked detail. The new provider had set up a ‘meet the management’ meeting when they took over the home and relatives reported this being useful to them. However, some relatives felt communication since then could improve. We identified activities needed development and the provider acknowledged this and advised they had included this as part of an internal action plan. We have made recommendations the provider develops activities and continues to work to address the issues they identified when developing their own action plan.

The provider and management team had identified auditing systems were not robust. They had begun to implement new auditing tools and quality assurance assessments and development of these was ongoing. The provider had identified they needed to recruit a new registered manager for the service to address issues, gaps and inconsistencies they had identified following their purchase of the home. A registered manager had been interviewed and was due to start following a notice period. Following this the current registered manager would de-register and continue to be involved at a provider level. Not all relatives knew who the registered manager was with some referencing the deputy manager as ‘the manager’ and some referencing one of the directors of the home.

Aside from the stated failings in communicating changes to communal space 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.

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

This service was registered with us on 11 May 2022 and this is the first inspection.

The last rating for the service under the previous provider was requires improvement, published on 12 November 2019.

Why we inspected

The inspection was prompted in part due to concerns received about neglect, people being administered medication incorrectly by untrained staff and of concerns relating to support provided during night shifts. 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 COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment and good governance 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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.