Heathside Residential Home is based in Leigh and is owned by Wigan Council. The home can accommodate up to 30 older people living with a diagnosis of dementia. All the bedrooms are single accommodation with 15 providing en-suite facilities. Communal space within the home included two dining rooms, three lounges and a conservatory. A separate hairdressing room is also available. There are two secure central garden areas that are easily accessible from the main building.
There was no registered manager in place at Heathside Residential Home when we undertook our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. We were subsequently informed that the acting manager had been successful in their application to be manager at the home and that an application to register with CQC would be submitted.
On the 2 July 2014, we conducted an annual scheduled inspection at the home and found the service was not meeting the essential standards. We judged the service had not taken appropriate steps to ensure the care and welfare needs of people living in the home had been effectively met. We issued a compliance action and told the provider to take action to make improvements. We also served a warning notice on the provider as we found people were at risk, because the service did not have appropriate arrangements in place to manage the safe administration of medicines.
During this inspection we reviewed how medication was administered and found people were protected against the risks associated with medicines, because the home had appropriate arrangements in place to manage medicines. However, some improvements were required, as the minimum and maximum temperatures of the medicine refrigerator were not monitored so staff could not be certain that medicines in the fridge were safe to use. Additionally, some people who had been prescribed a painkiller to be taken ‘when required’ were given the medicine regularly. The inspector saw staff give two people a painkiller (prescribed ‘when required’) with their other medicines, without asking if they were currently experiencing pain. This meant people potentially received a medicine they didn’t need.
The service did not have effective management systems in place to monitor the quality of services provided. This was demonstrated by the failure of the auditing process used by the service to identify concerns we established during the inspection. These included the effectiveness of the medication and monthly meal time audits. The service was also unable to demonstrate how they responded effectively to any concerns raised by people who used the service or their representatives. We found no records were maintained of the interaction between management and people or their relatives in response to any concerns raised or of what if any improvements had been made to the service as a result.
This was a breach of Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, because the registered provider did not have effective systems in place to monitor the quality of service delivered.
During this inspection, people told us they felt safe and secure living at Heathside Residential Home. Throughout the inspection we observed staff treating people with respect and dignity. We saw staff supporting people in a sensitive and respectful manner, smiling and encouraging people when undertaking routine tasks such as supporting people with eating and drinking.
We found there were a range of risk assessments in place to keep people safe from harm. These included nutrition; falls; bathing; fire safety and moving and handling. Staff were aware of risks to people and what action was required to keep people safe from harm.
On the whole, we found there were sufficient numbers of trained staff on duty to provide appropriate levels of care and support for the current numbers of people staying at the home on the day of our inspection. Staff and team leaders told us that staffing levels were inconsistent varying from suitable numbers of staff to low levels of staffing. Improvements were required to ensure consistency with suitable staffing levels were maintained on a regular basis.
We found care plans reflected the current health needs of each person. Staff we spoke to were able to demonstrate a good understanding of each person’s needs and the care and support required.
We spoke with staff to ascertain their understanding of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards. We found all staff demonstrated a good understanding of the legislation and had received training which we verified from looking at training records.
We found people who used the service and their relatives were prevented from entering bedrooms at will as doors were permanently locked from the outside. This meant people and relatives had to be escorted to bedrooms and a staff key used to allow entry. One of the implications of continuing to adopt this practice was that people who used the service including their relatives were not able to enter their bedrooms without being unnecessarily restricted.
We discussed our concerns with the acting manager about the restrictive nature of this practice for people who lived at the home. The acting manager assured us that for people who had capacity they would review the policy by consulting with them and their relatives to ensure people fully approved and consented to the arrangement. In respect of people who lacked capacity, we were told that consultation would take place with the Local Authority Lead on the Deprivation of Liberty Safeguards (DoLS) to ensure the suitability of this practice was reviewed.
Improvements were required as both supervision and appraisal were undertaken inconsistently. While most staff confirmed that they had received recent formal supervision, one member of staff stated that had not received any formal supervision for at least eight months.
Improvements were required to ensure people’s needs were effectively met and managed during meal times and that a well organised, calm and relaxed experience was achieved for each person who used the service.
Most of the people who used the service suffered from varying degrees of dementia and were at times confused and disorientated. We found the home did not have the design and signage features that would help to orientate people with this type of need.
We observed staff supporting people in a kind and sensitive manner, laughing, joking and smiling with people who used the service. This included routine tasks such as when toileting and personal hygiene. We noted this was done in a sensitive and discreet manner which respected the person’s dignity and choice. This interaction was typical of the many positive interactions we saw during the inspection.
Care files provided clear instructions to staff on the level of care and support required for each person and included detailed instructions on hygiene and personal appearance, toileting and continence, communication and respect, and mobility and falls. Relatives were able to confirm to us that they were involved in determining and reviewing the care needs of loved ones.
We found no set activity programme in the home on the day of our inspection or very little in the way of mental or physical stimulation for people. We observed people sitting in one of the lounges where the TV was on but none of the residents seemed to be paying attention. We found improvements were required in the way people were stimulated both mentally and physically in order to meet their individual needs.
People told us they thought the home was well run and managed. They were able speak freely to staff and the acting manager about any concerns or issues they had and were confident these matters would be addressed. Improvements were required as it was not clear to us how the home responded to people’s concerns about the service and how improvements were made and recorded.