Archived: Heatherside House Care Centre

Updated 23 June 2021

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. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Inspection team: Two adult social care inspectors and an assistant inspector.

Service and service type: Residential care home

Heatherside House Care Centre 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 had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection: This inspection was unannounced.

What we did: 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 reviewed information we had received about the service since the last inspection. We also sought feedback from the local authority quality team. We used this information to plan our inspection.

During the inspection:

We spoke with six people who used the service and one relative about their experience of the care provided. We spoke with eleven members of staff including the provider, registered manager, senior care workers, care workers, activities co-ordinator and a member of the domestic staff. Some people could not easily communicate their views of the service, so we observed how people interacted with staff and how people spent their time.

We reviewed a range of records. This included nine people’s care records and multiple medication records. We looked at two 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 also reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at the provider’s staffing tool and sought clarity on one person’s care needs. We also contacted four professionals who knew the service well and spoke with six relatives by phone.

Updated 23 June 2021

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. The service was a large, isolated setting without easy access to the local community. People lacked choice and control over their lives through their limited knowledge of opportunity and limited staffing levels in the service. The model of care was institutional and was not person centred.

Staff did not have the right skills or knowledge to provide person centred care that was based on people’s individual wishes for their preferred lifestyle. The lack of skills, knowledge and understanding of people’s needs enabled ongoing acceptance of situations, such as behaviour that challenges, that compromised people’s dignity.

The provider and registered manager did not always lead by example and had allowed a disabling, maternal culture to develop. The provider spoke disrespectfully about a person during the inspection and we made a safeguarding alert about this. Following the inspection, the provider stated they did not recall using the sentence. The safeguarding concern was closed as the safeguarding team was unable to evidence it. In addition, the provider and registered managers failure to follow current infection control guidance exposed people to risk of harm. Good practice regarding infection prevention and control was not being followed, particularly in relation to enhanced procedures required to protect people due to the pandemic.

Sufficient action had not been taken to protect people from the risks of incidents of behaviour that challenges. This impacted on the lives of people who challenged others, and those who witnessed these behaviours regularly.

Information about people’s needs and incidents that occurred was not fully recorded and investigated. This meant the service was unable to learn from incidents that occurred and exposed people to ongoing risk.

Staffing levels were too low to offer genuine choice and opportunity to people. People were allocated minimal staff time each day and this impacted on their ability to access the community and develop their skills and interests.

The provider’s recruitment procedures had not been followed to ensure new staff members were safe to work with vulnerable adults. Staff had been provided with some further training opportunities but could not describe how their practice had changed as a result. Training records showed some staff had not completed training in infection prevention and control, or safeguarding.

Clear information regarding people’s medicines was not available in all cases. There was no evidence people had been consulted in a way they would understand about taking more control of their medicines.

Risks to people had not always been assessed or defined clearly in their records. Some perceived risks were assumptions rather than based on assessment and resulted in further limitations for some individuals.

People had been asked if they were happy with the service and had made some small suggestions; however no consultation about the impact the environment had on people or the possible changes that could improve their experiences had been completed.

The registered manager and staff did not have a clear understanding of the Mental Capacity Act 2005 (MCA). People’s capacity to make specific decisions had not been appropriately assessed. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Information about how some people communicated was limited, which meant their needs were not fully understood. Information provided to people was not always provided in a format that was tailored to their needs.

People’s care plans did not always use respectful language and we found some examples of people’s dignity not being promoted. People did not always receive the right support to increase their independence.

The culture in the service did not value people’s differences or focus on ensuring people had equality of opportunity within the service and the community. Observations during the inspection and records of how people spent their time showed people did not live a similar life to that of any other citizen. People were given basic options and choices but were not routinely offered or encouraged to try new or different things to increase their ability to make informed choices. This meant people chose the same options that had been offered over a long period of time.

People spent most of their days in the service doing repetitive activities, which although meaningful to the person in the context of the limited opportunities available to them; did not assure us each person was living a full and meaningful life. There was no evidence people were given real opportunities to be part of their local community.

The provider and registered manager had not taken the opportunity, since the last inspection, to implement effective change to ensure the service met regulations, reflected best practice and offered improved outcomes to people. They had relied on external bodies for guidance but had not understood the reasons behind the changes they were making. As a result, the culture in the service, staff ability to implement best practice and the opportunities offered to people remained poor.

People did not raise any concerns about the service. They told us they felt safe and enjoyed the things on offer. Relatives and professionals on the whole provided positive feedback about the service, the staff and the registered manager; however, this was not reflected in the findings from our site visit or in the records we reviewed.

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 inadequate (published 11 March 2020). Since this inspection, the registered manager has been sharing fortnightly updates of the actions taken to improve the service.

At a comprehensive inspection in March 2017, we found ongoing breaches of the Health and Social Care Act

2008 (Regulated Activities) Regulations 2014. This included breaches of Regulation 12 (Safe care and

treatment), 17 (Good governance), 18 (Staffing) and 19 (Fit and proper persons employed). We asked the provider to complete an action plan to show what they would do and by when, to make improvements. We

also served a warning notice on the provider and on the registered manager which required improvements

to be made, within six months.

In December 2017, we undertook a focussed inspection to check whether the service had addressed the concerns in the warning notices. At this inspection we only looked at the Well-led domain. We found that the requirements of the warning notice had not been met and there was still a breach of Regulation 17. Following the focussed inspection, we met with the provider to discuss how they were going to meet the requirements of the warning notice and improve the service to ensure that they were good in all domains.

At our inspection in November 2018, we found the quality assurance and governance arrangements for the home were still not sufficient to ensure people received safe, effective care. We found breaches of regulation 11 (Consent), 12 (Safe care and treatment), 17 (Good governance) and 18 (Staffing). Following this inspection, the provider submitted an action plan stating how they would make the required improvements. The service was placed in 'special measures'.

In May 2019 we completed a comprehensive inspection and found the provider had not made enough improvements. We found continued breaches of regulations 11 (Consent), 12 (safe care and treatment), 17 (Good governance) and a breach of regulation 9 (Person Centred Care). Following this inspection, the service stayed in special measures and we took action to remove the location from the provider's registration.

At our last inspection in January 2020 we found the provider had still not made enough improvements. We found continued breaches of regulations 9 (Person Centred Care), 11 (Consent), 12 (safe care and treatment) and 17 (Good governance). We also found breaches of regulations 10 (Dignity and Respect), 13 (Safeguarding service users from abuse and improper treatment) and 18 (Staffing).

At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected:

This was a planned inspection based on the previous rating.

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 coronavirus and other infection outbreaks effectively.

Enforcement

We have identified breaches in relation to person centred care, dignity and respect, the Mental Capacity Act 2005 (MCA), the safe care of people, staffing, safeguarding service users from abuse and improper treatment, the governance of the service and the failure to notify the commission of an injury to a person.

Please see the action we have taken at the end of the report.

Follow up

The overall rating for this service is ‘Inadequate’ and the service therefore remains in ‘special measures’. This means we will keep the service under review and,