The inspection visit took place on the 25 October 2016 and was unannounced which meant the staff and provider did not know we were visiting.Heartly Green is situated in Irlam and provides an intermediate care unit on the first floor which is registered to Salford Royal hospital and a 30 bedded residential unit on the ground floor of the home. The registered provider supply care staff for both units but the first floor intermediate care unit is managed and nurses and therapists are provided by the NHS.
The service was registered by the Care Quality Commission to the new provider in February 2015 and it has not been inspected since that time.
There was a registered manager in post who joined the inspection visit on the day for feedback as they were on annual leave. 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. The inspection was facilitated by the experienced deputy manager who had worked at the service for 11 years.
There were policies and procedures in place in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). The registered manager had the appropriate knowledge to know when an application should be made and how to submit one. The registered manager also ensured that capacity assessments were completed and ‘best interest’ decisions were made in line with the MCA code of practice. This meant people were safeguarded.
We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.
All people told us they felt safe at the service. Staff were aware of procedures to follow if they observed any concerns. The staff team were supportive of the registered manager and each other and feedback from visiting professionals on the day were very positive about the service at Heartly Green.
Appropriate systems were in place for the management of medicines so that people received their medicines safely. Medicines were stored in a safe manner. We witnessed staff administering medication in a safe and correct way. Staff ensured people were given time to take their medicines at their own pace.
There was a regular programme of staff supervision in place and records of these were detailed and showed the service worked with staff to identify their personal and professional development. The food had recently been changed to offer a ready prepared meals called “Apetito” which had been implemented in August 2016. Feedback about this change was mixed but we saw the kitchen staff immediately responded and acted on any complaints or issues. We spoke with kitchen staff who had a good awareness of people’s dietary needs and staff also knew people’s food preferences well.
The service told us it was changing its care plan approach to become more person centred and based on the views of the person. We saw people’s new care plans were personalised and had been well assessed. Staff told us they referred to care plans regularly and they showed regular review that involved, when they were able, the person. We saw people being given choices and encouraged to take part in all aspects of day to day life at the service.
We observed that all staff and the deputy manager were very caring in their interactions with people at the service. People clearly felt very comfortable with all staff members and there was a lovely warm and caring atmosphere in the service and people were very relaxed. We saw people being treated with dignity and respect and relatives and people told us that staff were kind and professional.
The service did obtain feedback from people using the service and relatives through meetings but we fed back that it was not recorded what actions the service had taken in response to feedback and the management team said they would address this in future.. The service had an accessible complaints procedure and people told us they knew how to raise a complaint if they needed to. We saw that complaints were responded to and lessons learnt from them. This showed the service listened to the views of people.
Any accidents and incidents were monitored by the management team to ensure any trends were identified. This system helped to ensure that any patterns of accidents and incidents could be identified and action taken to reduce any identified risks.
The service had a comprehensive range of audits in place to check the quality and safety of the service and equipment at Heartly Green and actions plans and lessons learnt were part of their on-going quality review of the service.