Heartlands

Updated 19 September 2019

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection team consisted of one inspector, one assistant inspector, one specialist advisor (who was a qualified nurse) and one Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Heartlands is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service did not have a manager registered with the Care Quality Commission as they had recently left. The deputy had become the manager and was in the process of applying.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the clinical commissioning group who work with this service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used this information to plan our inspection.

During the inspection

We spoke with eleven people who used the service and eleven relatives about their experience of the care provided. We spoke with eleven members of staff including the area manager, deputy manager, nurse, senior carer, carers, chef, activity coordinator and domestic staff.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We reviewed a range of records. This included ten people’s care records and multiple medication records. We looked at four staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at safety checks and policies and procedures.

Updated 19 September 2019

About the service

Heartlands is a care home providing personal and nursing care to people aged 65 and over, some of whom are living with dementia. At the time of the inspection 64 people lived at the service. The accommodation is organised into three floors, each with its own communal areas.

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

People and relatives’ views were mixed about staffing levels. Most relatives we spoke to on the nursing unit felt they should be more staff, whereas this was not raised as an issue on the residential units. Our observations were staff were available to meet peoples’ needs and they did not have to wait to receive their care.

Records to assess and monitor risks were not always updated in a timely way or fully completed, however staff knew people well. People told us they felt safe and received their medicines safely. Safeguarding systems and practices protected people from abuse. Accidents and incidents were recorded and followed through with the appropriate action to minimise the risk or re-occurrence.

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. Most people told us the food was good and they had a choice of meals, although some people were not clear they could have culturally appropriate food. Records needed to be clearer to ensure people were receiving the correct support to maintain healthy weights. Staff had received the appropriate training and had the skills to support people effectively.

The home was spacious, well-decorated and clean. There were some excellent facilities within the home such as a cinema room, shop, pub and craft room. The environment was accessible for people living with dementia.

People were treated with respect and dignity and staff were patient and kind with people. Relatives were made to feel welcome in the home and people were involved in decisions about their care.

There were several different activities on offer seven days a week including regular trips into the community. End of life care wishes were discussed with people and their relatives. People’s communication needs were assessed and staff supported people to communicate in an accessible way. People and relatives felt confident to raise a complaint but not all relatives were happy with the outcome of their complaints.

There had been a recent change in management and the deputy manager had moved into the manager post. Most people and relatives told us the home was well organised although some concerns were raised about the nursing unit. The systems in place to monitor the quality and safety of the service were in place but not consistent.

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 requires improvement (published 25 August 2018). Since this rating was awarded the provider has altered its legal entity. The service remains rated requires improvement.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to regulation 17, good governance at this inspection.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.