Heatherside Care Home

Heatherside Care Home is a residential care home providing personal care to up to 34 people. The service provides support to people aged 65 and over. The care home accommodates people in one adapted building over two floors. At the time of our inspection there were 26 people using the service.

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

People told us they were happy and safe living at Heatherside Care Home. Relatives told us their relatives felt safe, had no concerns over medication, and that the home was clean and well maintained.

We found the provider ensured people were supported safely. There were sufficient numbers of suitable, motivated staff, and recruitment files met the requirements.

Processes and procedures were in place to store and administer medicines safely. We were assured appropriate infection prevention and control measures were in place to protect people against the risk of COVID-19 and other infections.

The service was well led. The staff team told us they felt supported by the registered manager. People who used the service and staff were involved in how the service was managed. The registered manager had processes in place to monitor and improve the quality of service people received.

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 10 December 2019) and there were breaches of regulation. 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 14 October 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve good governance.

We undertook this focused inspection to check they 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 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 COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to 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 Heatherside Care Home on our website at www.cqc.org.uk.

Follow up

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

Heatherside Care Home is a residential care home providing personal care to 24 people aged 65 and over at the time of the inspection. The service can support up to 34 people. The care home accommodates people in one adapted building over two floors.

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

The provider and registered manager had not monitored the safety of the building appropriately. We brought this to their attention and they took immediate action to improve the safety of the building. There was information missing in the recruitment records of some staff and therefore it was unclear if their suitability for the role had been appropriately assessed. Following the inspection, the registered manager sent us documentation that demonstrated sufficient checks had been undertaken and that employment checks would be more robust in future. Some improvements were identified in relation to medicines management and recording. Incidents and accidents were monitored and investigated to reduce the risk of re-occurrence.

The service was not always well-led. Previous managers, the provider and the registered manager had not identified or sufficiently acted upon the issues we found during the inspection. Auditing processes had not been effective. However, the provider and registered manager took prompt action in response to our concerns. The registered manager and staff promoted a positive, open and honest culture within the service and understood their regulatory responsibilities. People and relatives were appropriately involved in the service.

Staff received a variety of training and felt well supported by the registered manager. The service was following some current best practice guidance and involved the appropriate healthcare professionals in people’s care. People's hydration and nutritional needs were met.

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.

The registered manager and staff provided caring and compassionate support to people. People were encouraged to remain as mobile and independent in their daily lives as possible. We observed people to be treated with dignity and respect.

People's needs were holistically assessed and met by the care provided. People were treated equally and without discrimination. A variety of activities were available for people to participate in and enjoy. Complaints were well managed and responded to appropriately. End of life care was provided effectively and compassionately.

We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

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 17 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At this inspection we found improvements had been made in relation to all the requirements of the regulations identified however more time was needed to ensure people were receiving the social interaction and stimulation they required to lead interesting, full and meaningful lives.

Heatherside Care Home (referred to as Heatherside throughout this report) is a care home which provides residential care for up to 34 older people living with a range of medical conditions including Parkinson’s disease, diabetes and those living with sensory loss and dementia.

The home is situated in a village on the outskirts of Basingstoke. It comprises two floors, is situated within its own grounds and has a two acre secure rear garden. The home has 32 rooms, a communal lounge with a large television and doors leading through to a patio area and the grounds. There is a smaller quieter and more private seating area adjacent to the main lounge. There is also a dining room, bathroom and shower rooms and a lift for access to the first floor. Meals were served according to people's choice in their rooms or dining room. At the time of the inspection 28 people were living at the home. Throughout this report care staff will be referred to as 'staff'.

Heatherside does not have a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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. The home’s current manager was in the process of becoming registered with the CQC.

People using the service told us they felt safe. Staff understood and followed guidance to enable them to recognise and address any safeguarding concerns about people. People's safety was promoted because risks that may cause them harm had been identified and guidance provided to staff to help manage these appropriately.

People were supported by sufficient numbers of staff to meet their needs. The provider used a staffing tool to assess people’s dependency to identify the numbers of staff required in order to meet those needs.

Recruitment procedures were fully completed to ensure people were protected from the employment of unsuitable staff.

People received their medicines safely, staff had received the appropriate training to enable them to complete their role safely. Where people received medicines in a way other than prescribed by the GP advice had been sought and followed by the appropriate healthcare professionals to ensure it remained safe to be administered by an alternative method such as crushing for example.

Contingency plans were in place to ensure the safe delivery of people's care in the event of adverse situations such as a fire, flood or utilities loss. These were easily accessible to staff and emergency personnel such as the fire service, if required to ensure people received continuity of care in the event of an on-going adverse situation which meant the home was uninhabitable.

People were supported to eat and drink safely whilst maintaining their dignity and independence. We saw that people were able to choose their meals and were offered alternative meal choices where required. People's food and drink preferences were documented in their care plans and were understood by staff. People were supported to eat and drink enough to maintain a balanced diet.

Care plans and risk assessments contained detailed information to assist staff to provide care in a manner that respected each person's individual requirements and promoted their dignity. People were encouraged and supported by staff to make choices about their care including how they spent their day in the home.

People received care which was regularly reviewed to ensure contained the most up to date guidance for staff on how to effectively meet people’s needs. Care plans and risk assessments were reviewed monthly to ensure they remained accurate to enable staff to meet people’s needs.

People, where possible, were supported by staff to make their own decisions. Staff were able to demonstrate that they complied with the requirements of the Mental Capacity Act 2005 when supporting people. This involved making decisions in the best interests of people who lacked the capacity to make a specific decision for themselves. Staff sought people's consent before delivering their care and support.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager showed an understanding of what constituted a deprivation of a person's liberty and was able to discuss the processes required in order to ensure people were not deprived of their liberty without legal authority.

People told us that care was delivered by kind and caring staff who sought to meet their needs and ensure they were happy. We saw that people had friendly and relaxed relationships with staff who would stop and speak with them when they had the opportunity to do so.

People living with specific health conditions such as diabetes for example were supported to manage these conditions safely. Guidance regarding the management and monitoring of people’s blood glucose levels was sought and we saw this guidance was followed in practice.

Work was ongoing to ensure people were provided with the opportunity to participate in activities allowing them to live interesting and fulfilling lives. During this inspection people told us they felt there was a lack of opportunities for them to be able to participate in activities of their choice. The manager was already aware of people’s feelings and was taking positive action to address these appropriately.

People and relatives we spoke with knew how to complain and told us they would do so if required. One complaint had been made since the last inspection and effective procedures to monitor, investigated and respond were followed by the manager in an effective way. People and relatives were encouraged to provide feedback on the quality of the service through a number of quality control questionnaires.

The manager promoted a culture which focused on people receiving care in a relaxing environment. Staff, people and relatives felt the home had a homely and happy environment. Staff felt supported by their colleagues and the management team.

The manager had informed the CQC of notifiable incidents which occurred at the service allowing the CQC to monitor that appropriate action was taken to keep people safe.

The quality of the service provided was reviewed regularly by means of effective quality control audits. These were completed to identify areas where the quality of the service provided could be improved. We could see action had been taken to address where any shortfalls in the service provision had been identified.

At the last inspection on 7, 8 and 12 October 2015 we found that the provider had breached three regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (HSCA 2014) concerning suitable numbers of staffing, treatment of those living with diabetes and safe staff recruitment working practices. We had also made a recommendation regarding the implementation of a structured and recognised induction and training package for new staff which followed the Care Certificate Standards.

We told the provider they needed to take action and we received a report setting out the action they would take to meet the regulations. At this inspection we found that some improvements had been made with regard to one of the breaches identified. However during this inspection we identified two continuing breaches and a further two breaches of the HSCA 2014.

Heatherside Care Home (referred to as Heatherside throughout this report) is a care home which provides residential care for up to 34 older people living with a range of medical conditions including diabetes and dementia.

The home is situated in a village on the outskirts of Basingstoke. It comprises two floors, is situated within its own grounds and has a two acre secure rear garden. The home has 34 rooms, a communal lounge with a television and doors leading through to a patio area and the grounds. There is a smaller quieter and more private seating area adjacent to the main lounge. There is also a dining room, bathroom and shower rooms and a lift for access. Meals were served according to people’s choice in their rooms or dining room. At the time of the inspection 30 people were living at the home.

Heatherside does not have a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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. The previous registered manager had left Heatherside four months prior to this inspection and a new manager had been immediately appointed by the provider. At the time of the inspection they were in the process of becoming registered with the CQC. Throughout this report care staff will be referred to as ‘staff’.

There were not effective systems in place to identify whether there was sufficient staff deployed to meet people’s individual needs in a timely fashion. Where the need for additional staff had been identified, the provider did not ensure that these were made available. The provider had not ensured that regular reviews of people’s dependency needs were carried out to identify the correct number of staff required to meet people’s needs.

People were not always protected from the unsafe administration of medicines. Senior staff responsible for administering medicines had received training to ensure people’s medicines were administered, stored and disposed of correctly. However we could not see that appropriate advice had always been sought from healthcare professionals to ensure medicines were safe to be provided in a way other than prescribed.

Care plans and risk assessments contained detailed information to assist staff to provide care in a manner that respected each person’s individual requirements and promoted their dignity. People were encouraged and supported by staff to make choices about their care including how they spent their day in the home. However at the time of the inspection these care plans and risk assessments were not being reviewed monthly in accordance with the provider’s guidelines. This was required to ensure they contained the most up to date relevant information and guidance to assist staff in delivering safe and effective care.

People were not always supported to have their diabetes safely managed. When advice had been provided regarding the management and monitoring of people’s blood sugar levels this guidance was not always followed by staff to ensure people received the most appropriate medical treatment.

People, where possible, were supported by staff to make their own decisions. Staff were able to demonstrate that they complied with the requirements of the Mental Capacity Act 2005 when supporting people. This involved making decisions in the best interests of people who lacked the capacity to make a specific decision for themselves. Staff sought people’s consent before delivering their care and support. However records did not always show people’s decisions to receive care had been appropriately assessed, and documented.

People who were unable to make decisions regarding their care and treatment were not always supported by the relevant processes to ensure decisions made regarding their care were made in their best interests.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager showed an understanding of what constituted a deprivation of a person’s liberty.

People were not provided with the opportunity to participate in activities allowing them to live interesting and fulfilling lives. Recruitment of new activities staff was on-going at the time of the inspection however people told us they were bored as there were no opportunities available to them.

The provider had not always ensured that quality control audits had been completed in line with the provider’s policy to improve the quality of the service provided. The manager was aware of this and had started work to ensure appropriate actions were taken.

People were not always able to immediately recognise the new manager however had no hesitation in raising concerns with them if required. Staff did not feel that the manager was always a visible presence in the home.

Staff told us they felt supported by their colleagues and senior staff however they did not always feel this support from the manager.

People using the service told us they felt safe. Staff understood and followed guidance to enable them to recognise and address any safeguarding concerns about people. People’s safety was promoted because risks that may cause them harm had been identified and guidance provided to staff to help manage these appropriately. People were assisted by staff who encouraged them to remain independent.

Recruitment procedures were fully completed to ensure people were protected from the employment of unsuitable staff.

Contingency plans were in place to ensure the safe delivery of people’s care in the event of adverse situations such as a fire, floor or utilities loss. These were easily accessible to staff and emergency personnel such as the fire service if required to ensure people received continuity of care in the event of an on-going adverse situation which meant the home was uninhabitable.

People were supported to eat and drink safely whilst maintaining their dignity and independence. We saw that people were able to choose their meals and they enjoyed what was provided. People’s food and drink preferences were documented in their care plans and were understood by staff. People were supported to eat and drink enough to maintain a balanced diet.

People told us that care was delivered by kind and caring staff who sought to meet their needs and ensure they were happy. We saw that people had friendly and relaxed relationships with staff who would stop and speak with them when they had the opportunity to do so.

People and relatives we spoke with knew how to complain and told us they would do so if required. No complaints had been made since the last inspection but procedures were in place for the manager to monitor, investigate and respond to complaints in an effective way. People and relatives were encouraged to provide feedback on the quality of the service through annual questionnaires.

The manager promoted a culture which focused on people receiving care in a relaxing and homely environment. Staff and people felt that the home had a homely and happy environment.

The manager had informed the CQC of notifiable incidents which occurred at the service allowing the CQC to monitor that appropriate action was taken to keep people safe.

We found two continuing breaches and three new breaches 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.

Following the inspection the provider sent us an action plan stating what action they would take to ensure compliance with this regulation. The purpose of this inspection was to check that the provider had taken the required actions.

On the day of the inspection there were 34 people living at Heatherside Care Home. As part of this inspection we spoke with four people who use the service, the manager, the acting deputy manager, one member of the care staff and two kitchen staff. We reviewed four people's care records in relation to their nutrition and the management of the risk of pressure sores.

Since the last inspection there had been a change in the management of the service. The new manager has submitted an application to the Care Quality Commission to become the registered manager of the service. 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 and associated Regulations about how the service is run.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

The risks to people of developing pressure sores were managed. People had the correct equipment pressure relieving equipment in place to manage identified risks to them. People had written care plans to manage the risks from pressure ulcers and the manager took action to ensure these were available on people's files.

People's nutritional care plans and risk assessments had been reviewed and contained clearer information about nutritional risks to people and how to manage them. Staff had received relevant training to enable them to screen nutritional risks to people. The manager took action to ensure staff updated the screening tool monthly when people were weighed.

As part of this inspection we spoke with four of the 34 people who use the service, three people's relatives, one visiting professional, the manager and four staff. We also reviewed records relating to the management of the home which included, four care plans and daily care records.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made, and how to submit one.

The home was clean and there were processes in place to manage the risk of infection. People we spoke with and their relatives were satisfied with the level of cleanliness of the home. We noted that the service did not have a sluice to clean and wash commode pans. However, the provider was aware of the need for this and was making the necessary arrangements to provide one.

There were sufficient staff employed by the service to meet people's needs. One person told us 'There are enough staff' and another said 'Staff have time to spend with us.' We observed that staff were busy but people's care needs were met in a timely manner. The manager had sought people's views on staffing and was in the process of increasing the staffing on one shift in response to the feedback they had received.

Is the service effective?

People we spoke with felt confident in the provider's ability to meet their care needs. One person told us 'Staff understand my needs.'

The service had used risk screening tools to identify risks to people. However, we saw evidence that staff had not fully completed the form provided to assess the risk of malnutrition to people. There were not effective care plans in place to provide staff with guidance about how the risk of people becoming malnourished was to be managed. The risk of people developing pressure sores had been assessed and where people required pressure relieving equipment this had been provided. However, people did not have a care plan in place to provide staff with guidance on the management of this risk to people. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to people's care and welfare.

Is the service caring?

We observed that staff were caring in their interactions with people. We spoke with people and their relatives who were positive about the care provided by staff. One person told us 'Carers are very good' and another person's relative told us 'Staff are very good.'

We saw staff treated people with respect and dignity. One person told us 'They treat me with dignity.' Staff had consulted people about decisions in relation to their care. People were able to exercise choice in relation to how they wanted their care provided.

Is the service responsive?

We saw evidence that the service was responsive to changes in people's needs. We observed that the service responded promptly to the deterioration in one person's health on the day of the inspection. Staff ensured that people's needs for fluid in the hot weather had been met. The service had responded to issues raised by people. One person told us 'I complained about staff coming and doing checks on me at night so they no longer come in.' This person felt that staff had listened and responded to the issue they had raised.

Is the service well-led?

The home had been run for a period of time by an interim manager in the absence of the registered manager. However, from 16 June 2014 the service had appointed a new manager to run the service. The new manager informed us that they were in the process of submitting their application to the Care Quality Commission (CQC) to become the registered manager of the service.

We saw evidence that people's views about the service had been sought via meetings and surveys. People told us that the new manager was visible within the home and that they felt they could raise issues as required. One person told us 'We have meetings to say how things are going.' We saw evidence that where issues had been identified there were action plans in place.

People's nutritional needs were assessed and people told us they mostly enjoyed the quality of the food, and were provided with a choice of meals. Comments included, 'I wish they would change the menus occasionally' and 'meals are very good'.

There were procedures to protect people from abuse. Staff were knowledgeable of people's specific health and personal care needs and had received training. Further training was scheduled by the provider to update staffs skills and knowledge that included communication and person centred approaches.

People and their relatives told us they were kept informed, were listened to and given opportunities to give their view of the services provided. Comments included, 'sometimes staff come round with a list of questions, I'm sure if there was anything you wanted to say to staff they would listen'. The home had health and safety measures in place that promoted the safety of people and visitors to the home.

We found that the home's staff sought people's consent before they received any care or treatment and the staff acted in accordance with people's wishes.

The care plans we saw provided details of people's individual needs, wishes and preferences. The home sought advice from external healthcare professionals where necessary and this was recorded in people's care files.

The home had safe systems in place for the storing and administering of medicines and staff received appropriate training in this area.

We found that appropriate checks were undertaken before staff began work and there were effective recruitment and selection processes in place. Staff had also received appropriate induction training.

People had been made aware of the complaints procedure. People told us their comments and complaints were listened to and acted on, without the fear that they would be discriminated against for making a complaint.