Heathwood Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We assessed all quality statements within the key question of Safe. The service had a system for recording and reporting safeguarding. The provider was in the process of implementing a new system to track safeguarding. There were gaps in some mental capacity assessments and best interest decisions which required specific decisions for people. People had Deprivation of Liberty Safeguards (DoLS) when needed. The service encouraged people to maintain their independence and as a service focused on providing person centred care for people. However, the quality of some risk assessments was variable and there were some gaps in the risk assessments we viewed. The registered manager started to address these areas of concern during the assessment process. Recruitment records we viewed were not fully completed. Not all staff providing care to people were suitably skilled and trained. This was a breach of Regulation 18, Staffing.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and their relatives told us they knew how to report any concerns. A relative told us, “They communicate well, and keep me up to date, they let me know about any falls, and their low blood pressure.”

Staff told us they knew how to report accidents and incidents. One staff member told us, “We always escalate falls to the senior who assesses the situation, we have a new policy in place if anyone has an injury and is on blood thinners we call an ambulance.”

The registered manager promoted an open culture within the home. The service kept records of accidents and incidents. Accidents and Incidents were reviewed monthly by the registered manager to determine any themes and actions needed. The provider had started to implement a new system to improve the effectiveness of accident reporting and analysis. Staff we spoke with told us the registered manager discussed learning from accidents and incidents with them. Feedback from professionals working with the service told us the registered manager knew when to escalate concerns and worked with staff to review and support their care and development. One professional working with the service told us the registered manager was, “Very knowledgeable about safeguarding issues, knows when to escalate issues and will work with staff to review and support their care and development.” The registered manager tested staff knowledge on specific areas of care such as the Mental Capacity Act and on injuries to people who may be on blood thinners.

One relative told us, “They [Staff] have been very good with [Name] chest infections, they contact me straight away.” Another relative told us, “[Name] of has improved since they have been in the home” and another told us, “[Name] had to go into hospital, Heathwood took them back. They have now put a pressure mat besides their bed.”

Staff supported people to attend medical appointments and seek support from the GP where needed. One member of staff told us they had recently reassessed a person’s needs following a hospital admission, “We could see [Name] would need more support initially coming back to Heathwood, but this could work, 2 carers to begin with now supported with 1 carer, the person has greatly improved.”

Professionals spoke highly of the service. One professional told us, “The manager seems to be receptive to advice and support offered by mental health services. They are in regular contact with GPs about concerns regarding residents.” Another told us, “They adapt well to patients changing needs and will support them right through to end of life care with support from District Nurses as required.”

People were accepted into the service safely. The service had good relationships with health and social care professionals. A member of the local care home hub visited fortnightly. Information we viewed showed staff recorded concerns to be raised with visiting professionals and the outcome of visits from professionals were recorded, adapting care plans to reflect this.

People and their relatives told us they felt safe. One relative told us, “I’m perfectly happy where she is, she is safe and gets care and support.” Another relative said, “There are several day rooms, and easy access to the garden, they are not sat in the same old chairs, looking at the same old wall, staff have been there quite a while.”

Staff had been trained in safeguarding, they told us they knew how to keep people safe from avoidable harm and abuse. One staff member told us, “I am completing new learning in safeguarding so I can complete safeguarding referrals and support staff.”

During the assessment we observed positive interactions between staff, people who live there, relatives, the registered manager and visiting professionals. The home was relaxed and had a homely feel.

The service completed Mental Capacity Assessments for people who could not make a decision about their care. However, there were some gaps in people’s records for decisions specific to Mental Capacity Assessments. For example, where one person had a sensor mat in their room, and another person was prescribed a controlled medicine for as required use. The registered manager acted on this feedback during the inspection. The provider told us they were introducing a safeguarding tracker as part of a new governance package. This had been included on the service action plan. Where people were being deprived of their liberty, referrals had been made to the local authority. The manager monitored people’s Deprivation of Liberty Safeguards (DoLS) authorisations.

People and their relatives told us they felt any risks were managed well. One relative told us, “The staff know me, and know [Name of person] well. They have had had a few falls, slides to the floor, they have put a pressure mat besides their bed. They get their medicines.” Another told us, “Home from home, they can make their own drinks, a member of staff is present” and “unsteady on their feet, gets disorientated and confused, has a rollator, the staff are lovely and very good, they have regular staff. If [Name] falls they let me know, what’s going on.”

Staff told us risks to people were managed well and information about people was available in their care plans. One staff member told us, “If someone has an unwitnessed fall we try to talk to them, carry out observations. We try to find out how the fall happened and look at where it happened. Sometimes people do not know what to do when they fall, we sometimes write things down for people, to help. If a person is in pain and cannot always say, we will move limbs slowly or apply a bit of pressure. We record everything on a form.”

We observed people moving freely around the home and garden, some people were involved in washing up and carrying out jobs in the kitchenette area, others were involved with activities.

The service had a range of risk assessments for people, these were reviewed regularly. However, there were gaps in some peoples care records. For example, where 1 person presented with behaviours that challenge and was prescribed a medicine to support as required. The quality and detail in risk assessments varied. The registered manager acknowledged this during the assessment process and had started to improve this process.

People lived in a well maintained and safe environment. A relative said, “The place is clean, well maintained and in good repair.” Where people used mobility aids these were in good condition. Actions were taken to make the environment safer for people, for example one relative told us, “They moved [Name] bed beside the wall and put a pressure mat near the bed,” when their loved one had experienced falls. This was to alert staff to the person getting out of bed so they could be safely supported. Bedrooms were personalised and well-kept. One relative told us, “The rooms are tastefully done, and not institutionalised.”

Staff told us there was an effective process to report faulty or broken equipment or any risks in the environment. Staff were able to report issues to the maintenance team. Staff said they, “Check rooms every day for any concerns” and when they report any issues, “Things get done quickly.”

The service was in a good condition. Dining areas were well presented with tablecloths, drinks and condiments available for people to use. The service had colour coding of doors and handrails which aimed to support people to navigate their way around the home. Flooring in the home was well maintained. We observed some uneven patio slabs in the garden which could present a trip hazard. We informed the registered manager of this during our inspection. We were provided with evidence following the inspection this had been rectified.

Staff completed safety checks. This included checks to the gas, electrical safety and portable appliances. Staff had completed environmental risk assessments and checks of people’s rooms so any safety issue could be identified, and actions taken. The service conducted fire drills. People had personal emergency evacuation plans (PEEPs) which contained clear information on the assistance people needed in the event of an emergency. Water temperatures were checked and recorded regularly. The service had a current legionella certificate. However, infrequently used water outlets, such as in unoccupied bedrooms, were not checked as often as the guidance specified. Regular checks of unused water outlets are important to ensure they do not contain legionella bacteria which can be harmful for people. We did not find anyone had come to harm because of this. The provider implemented a legionella risk assessment during the assessment.

People were well supported. Relatives told us people were well cared for and staff knew people’s individualised needs and preferences. One relative said, “I like the way staff treat the residents with patience.” Another relative said, “They know how to approach and treat the residents. They take time to care.” We heard mixed views on staffing levels in the service. While several relatives told us there were “plenty of staff” some relatives were not assured there were enough staff. One relative said, “I don’t think that they have enough staff, sometimes it is difficult to find someone if necessary.”

Staff had received an induction and completed shadow shifts when they started working at the service. Staff told us they had access to training, supervision and support. Staff had received the training they needed to be able to support people living at the service, this included specific training where required, such as diabetes training. Staff had regular one to one supervision with a manager. Staff worked extra shifts at times to cover people attending appointments and to cover any staffing shortfalls due to sickness. Most staff told us staffing levels were sufficient. Staff said, “There are enough staff” and staffing levels were, “Overall fine, but can be difficult if people’s needs change.”

We observed positive interactions between the registered manager, staff and people throughout our inspection. People were treated with kindness. People were encouraged to take part in a range of activities, their choices and independence were promoted. Drinks and snacks were readily available in the open kitchen area to people and their visitors.

The provider had recruitment processes to ensure staff employed were suitable for the role. This included reference checks, Disclosure and Barring Service (DBS) checks and right to work checks for overseas staff. However, we found shortfalls in employee records we reviewed. The provider had not requested a full employment history for staff, as part of their employment application. Gaps in some people’s employment history had not been explored. This is important so the provider can ensure potential staff are safe to work with vulnerable people. Interview records were limited and did not demonstrate how a person may be suitable for a caring role. The service did not use an overall dependency tool to calculate safe staffing ratios within the service. We were told the provider had purchased a dependency tool which they planned to use. We found some staff whose primary role at the service did not include care duties had provided care to people, during staff shortages. These staff were not appropriately skilled and trained to do so. Training records showed some staff working as carers did not have the mandatory training in place for care staff. This included dementia training. This meant they may not be able to adequately support people who were living with dementia. We did not find evidence anyone had come to harm because of this. The service had systems to support and monitor new staff, this included an induction, ongoing training, competency checks and staff supervisions. Staff who were new to care were supported to complete the Care Certificate. However, records we reviewed showed 1 staff member, who worked as a kitchen assistant some of the time, had not completed their food hygiene training, despite working regular shifts in the kitchen.

People were protected from the risk of infection and supported by staff who wore Personal protective equipment (PPE) as required. Relatives told us the service was clean. One relative said, “The home is clean, there are no smells”.

There was enough personal protective equipment (PPE) available for staff to use. Staff knew what PPE to use and when. Staff told us, “Face masks when we need them, gloves and aprons for personal care, fabric aprons at lunch times.” Staff also said they had a “motto of clean as you go.”

The home was clean and odour free. Clinical bins were used for the disposal of PPE. We observed domestic staff cleaning communal areas and bedrooms. We observed staff wearing PPE as appropriate. Signage was in place to remind visitors not to enter the service if they had any signs or symptoms of infection.

The provider's infection prevention and control policies and procedures reflected current best practice guidelines. Housekeeping staff followed a daily cleaning schedule. Regular infection prevention control audits had been carried out and the service had risk assessments to follow in the event of any outbreaks of infection in the service. Staff had been trained in infection prevention and control.

We saw medicines were given to people in a safe way, with staff taking time with people to make sure their medicines were taken correctly. People received their medicines in the way prescribed for them.

Staff we spoke with told us that they felt well supported with medicines, and they knew how to report any issues. Staff had training and competency checks to make sure they gave medicines safely. Staff were knowledgeable about people and their medicines.

Records showed people received their medicines safely as prescribed. There were arrangements for the storage, administration and disposal of medicines. Medicines (including controlled drugs) were mostly stored safely and there were appropriate arrangements for disposal. However, staff did not monitor the fridge temperatures effectively so the provider could not be assured these medicines had been stored safely. Following our inspection, we were provided with an amended monitoring system that showed checks would be carried out appropriately and evidence that advice had been sought around the medicines currently stored. Records showed people received their medicines as prescribed and at suitable times. When medicines were prescribed to be taken ‘when required’ there were protocols to guide staff however, these lacked some detail. Following our inspection, we were provided with updated plans that described when these might need to be given for each person, and how they were to be supported after administration. When people were prescribed patches to help with pain relief the records did not always show they were applied as per the manufacturer’s directions and there was no monitoring that they remained in place. Following our inspection, we were provided with revised recording tools and evidence that staff were now monitoring that the patch remained in place. Medicines audits were completed by the registered manager and senior carer’s and these helped identify any areas for improvement. Errors or incidents were reported, investigated and any actions put in place to prevent recurrence. Staff training and competency checks were recorded and were up to date.