Archived: Heath House

In April 2015 we inspected the service and found the care being provided was Inadequate. We placed the service into Special Measures and commenced use of our enforcement powers. We inspected the service again in September 2015 and found that while some improvements had been made these had not been adequate or consistent to ensure people would always receive safe care. The improvements had not been sufficient for us to remove the service from Special Measures.

Since that inspection we have maintained regular contact with the registered provider and other organisations also responsible for monitoring the safety and quality of care people receive. The registered provider took action to reduce the number of people it was supporting at Heath House. This had given the registered manager chance to review, change and maintain new and improved ways of working to ensure people are safe and receive the care they require.

This inspection identified that significant improvements had been made to all areas of the service, and it was pleasing to receive feedback that supported this from people living at the home, their relatives, staff and other professionals. These improvements meant the service has not been rated as inadequate for any of the five key questions so we have removed the service from special measures. The service will be expected to maintain the improvements and this will be considered in future inspections.

There was a registered manager in post who was present for this inspection. 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.

People we spoke with told us they felt safe living at Heath House. Staff were aware of the actions they needed to take to ensure people stayed safe, and we observed them working in accordance with the written plans and risk assessments.

Medicines management had improved and people could be certain they would receive their medicines safely and as the Doctor had prescribed.

The number of staff and the management of staff had improved. We saw that this had resulted in people having to wait less time to have their needs met, and that people could more often attract the attention of staff when they needed to. However this was not consistent and we concluded that there were not always enough staff on duty, or available in the correct area of the home to ensure people's needs were met without an undue delay.

People were supported to attend a wide range of health appointments. Nursing and care staff undertook a range of activities every day to ensure people maintained the best possible health. This helped to maintain their physical and psychological well-being.

The quality and choice of food available to people had improved. People were offered a range of food, drinks and snacks that met their cultural, dietary and health needs. Some further work was required to ensure people always had the support they required at meal times, and that the dining experience was pleasant.

Staff had been provided with training about the Mental Capacity Act 2005 (MCA) and we observed staff seeking people's consent and working in ways that reduced the restrictions on people's liberty and independence.

Everyone we spoke with, and our own observations showed that staff worked with kindness and compassion. The staff provided people with the support and reassurance they required to help them stay calm and to feel settled.

People had been offered new and increased opportunities to undertake activities that were of interest to them, which provided stimulation, and which reduced the chance of people being socially isolated.

The registered provider and manager had introduced numerous ways to seek feedback from people, and had used this feedback to further improve and develop the service.

We received consistent information that the service was well led. People and their relatives told us about the confidence they had in the manager, deputy manager and people responsible for leading each shift.

The registered provider and manager had developed an action plan that had been effective at driving forward the quality and safety of the care provided to ensure people received a service that would meet their needs.

You can see what action we told the provider to take at the back of the full version of the report.

We gathered evidence against the outcomes we inspected to help answer our five key questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

At the time of the inspection there were 39 people living at the home. During this inspection we spoke to two people who used the service and spoke to the relatives of five people. We carried out observations of specific people who were unable to talk to us because of their health conditions. We looked at care records for eight people, spoke with eight staff and the management team of the home and two visitors. We also observed ten people using Short Observational Framework for Inspections (SOFI). After our inspection we spoke to two health professionals who supported people who lived at the home.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

People who used the service and relatives we spoke with told us they either felt safe when being supported with their personal care or their relative received safe care.

We spoke with care staff and looked at records. We saw that staff had the skills and knowledge to support a person if they suddenly became unwell.

The provider worked with other agencies to investigate issues of concern to ensure people were kept safe.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) under the Mental Capacity Act 2005. Applications to deprive a person of their liberty need to be made where a person does not have the mental capacity to understand that a decision to deprive them of their liberty is in the person's best interest. In this home when applications have needed to be submitted, proper policies and procedures were not always in place. We found that the provider had not always ensured that request for DoLS had been granted before depriving a person of their liberty and that they had not requested a review for a person's DoLS and the DoLS had lapsed. There was a risk that for this person they were not receiving care which kept them safe from the risk of harm.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring that the service meets the requirements of DoLS legislation and ensure care records contain sufficient and timely information to enable care staff to provide care which keeps people safe from the risk of harm.

Is the service effective?

People's health and care needs had been reviewed with them and their families. A relative of a person who used the service told us, 'He is always supported to attend hospital [appointments].' Another relative told us, 'They came and saw them in hospital and did a thorough check'.

Where necessary, risk assessments had been undertaken and were used to help staff provide appropriate, safe and consistent support to people who used the service. These included assessing individual nutritional needs to ensure people were supported to receive the necessary fluid intake to prevent dehydration.

Staff could not always provide care which met people's needs because care records were not always up to date or easily available to staff. People's daily records were not always completed and care staff were dependent on nursing staff reporting any changes in people's conditions. Therefore there was a risk that people would not receive care which met their needs.

Staff did not always have up to date knowledge about how to meet people's specific care needs because they did not always receive refresher training or follow good practice. A health professional who visits people in the home stated that they provided training to staff on several occasions in how to support people with a specific condition but staff had not always implemented what they had been shown.

We have asked the provider to tell us how they intend to ensure that care staff are aware of people's current care needs and have up to date knowledge and information to support them to meet people's specific care needs.

Is the service caring?

All the people we spoke to confirmed that staff were kind to them. Comments included, 'They will do anything you ask,' and 'The staff are lovely there. I am sure [my relative] is well looked after.' We observed staff respond promptly to people's individual care needs and wishes and saw that they promoted social interaction.

When speaking with staff it was clear that they genuinely cared and knew about the people they were supporting.

Is the service responsive?

We saw that people were regularly asked if there was anything they needed. Relatives told us that the provider made them feel comfortable to raise concerns.

The provider did not always respond to people's individual interests and experiences because activities did not reflect individual preferences and records of how people spent their time were not consistently kept. Therefore the provider was unable to review and identify which activities and task individual people had enjoyed doing.

The service did not always work well with other agencies and services to make sure people received care in a coherent and timely way. People were supported to attend doctors, dentists and other health appointments when needed however a health professional who visited people in the home told us, 'I leave instructions about how to care for people but when I go back some staff still don't know about them.' Another visiting health professional told us, 'We left detailed instructions [about how to care for somebody] but they were not followed until three days after our visit.'

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring that activities reflect people's personal preferences and that staff are aware and respond appropriately to instructions from other health professionals.

Is the service well-led?

After our last inspection, the provider had sent us a plan identifying what actions they intended to take in order to ensure the service was compliant with current health and social care legislation. At this inspection we saw that the provider had responded to our last report and some improvements had been made, examples included better fluid management recording and the use of an admissions checklist. However not all concerns had been addressed.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring that they carry out the actions identified in our previous report to meet the care and welfare needs of the people who use the service.

One of the named managers of the home as detailed at the beginning of the report no longer works at the location. The provider is aware that this person needs to apply to deregister.

People did not always experience care, treatment and support that met their needs. Planning of care was not always accurate or completed to guide staff to deliver the care people required. However, visitors we spoke to were happy with the care their relatives received. One visitor told us: 'The care staff are brilliant, they are so friendly, I can't believe it.'

People received a nutritious diet which supported their health needs. However where people had been identified as requiring support to take sufficient fluids, this was not always achieved. Monitoring of the records did not take place. This meant the opportunity to guide staff to encourage further fluids was lost.

People received care from staff who had received training to recognise and report suspected abuse. The provider had undertaken checks of their character to protect people from receiving care from staff that were unsatisfactory.

People were cared for by staff who were qualified, skilled and experienced to meet people's needs. The majority of staff held a care qualification. There were enough staff on duty to meet people's care and welfare needs.

People and their relatives were able to make complaints. The service supported people to make complaints. Complaints were investigated and resolved to the complainant's satisfaction where possible.

Records were managed so that important information if required could be accessed in a timely fashion. Furthermore, records were maintained to a good standard being signed and dated by the author for all additions. This enabled the provider to maintain an audit trail.

After the last inspection issues of non compliance were noted and the provider submitted an action plan with time-scales which detailed how they were going to become compliant.

At this inspection 38 people were in residence across both units of the home. We spoke to four staff and the manager. We looked at four care plans, which were records of how people liked to receive care. We spoke with one person who used the service and one visitor.

The visitor told us they were very happy with the level of care saying: 'I can't praise the place highly enough.'

The assessing and monitoring practices were not effective and failed to act upon issues that arose. We saw that auditing of care documentation took place, but action was not taken when shortcomings had been identified. This meant the provider missed the opportunity to make improvements.

There were some improvements relating to records, but further improvements were needed. Records did not contain all the information needed to deliver effective care and treatment to meet people's needs and could not be easily located to inform how care and treatment had previously been provided.

We used a number of methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us of their experiences. We spoke to the relatives of four people who told us that they were happy with the level of care and treatment that their relatives received. Some visitors advised that they had seen improvement in their relatives, stating the staff were very good. One visitor commented that, 'Staff are really wonderful and they really care'.

We saw that people were treated with dignity and respect and their individual needs and choices were met. They were spoken to with respect and empathy. Care and treatment was planned and delivered in a way to ensure people's safety and welfare.

The provider had ensured that staff had a good understanding of safeguarding and were clear of their role in protecting people.

The home manager had only been in post one month. The two named registered managers need to make notification to be removed from this location. The provider needs to ensure these individuals cancel their registrations.