Heaton House 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 identified a breach of legal regulations. Medicines were still not being managed safely. Records relating to the receipt, storage and administration of medicines required improving. We also identified concerns with medicines stock control, staff competency checks and governance processes. During and following the assessment site visits, the provider responded to feedback and began to make the required improvements to the safety of medicines management. Risks relating to people and the environment were not always assessed timely or considered all contingencies. Records indicated staff training completion had improved; however, we were not assured this data was wholly accurate, due to the number of sessions staff were reported to have completed on specific days. People told us they felt safe living at the home and would raise any concerns with staff or management. Enough staff were deployed during the day to keep people safe and meet needs. However, some people raised concerns about staffing levels at night. Required safety checks had been completed with certification in place to confirm the premises and equipment were safe to use.

This service scored 47 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us they felt safe living at the home. Relatives supported this view. Comments included, “Oh yes, I feel safe. You are well looked after…and the staff are nice,” and, “I do feel [relative] is safe here.”

Staff confirmed they had received training in safeguarding and knew how to report concerns, telling us they would speak to a senior carer or manager and document what they had witnessed. The deputy manager told us either they or the registered manager, once one was in post, would report safeguarding concerns to the local authority and take ownership for updating and tracking any actions.

The provider used a log to document safeguarding concerns, and other issues which impacted on people’s safety. Providers have a statutory responsibility to notify CQC about certain events, including allegations of abuse and events which stop the service running safely. From reviewing the log, we identified at least four incidents, relating to potential abuse and/or the safe running of the home, which had not been reported to CQC. The log indicated 2 of these incidents had been reported. However, we found no record of this on our systems, nor was evidence of submission provided during the assessment. A new accident and incident file had been introduced in July 2024. This was used to log and store accident and incident forms. Each accident or incident was reviewed by management with actions generated to help in preventing a reoccurrence. However, documentation did not include any written updates on whether actions had been completed and if they had been successful. We noted the number of recorded incidents had noticeably reduced. In June 2024, records indicated 7 incidents or accidents had occurred within the home. Since the new process and file had been introduced, only 2 had been documented over a 3 month period. It was not clear whether this was due to improvements in practice or due to recording issues, as data for the last 12 months was not available for review, to check for patterns and trends.

People and relatives were happy with how risks and incidents had been managed, this included falls and accidents. One relative stated, “When [relative] first came to the home, they were falling quite a bit. They have made improvements and haven’t fallen seriously in about 18 months.” A person told us, “I have had a couple of falls, where I just lost the power in my legs. Staff came quickly and I was taken to hospital for checks, but I hadn’t injured myself.”

The provider used an electronic care planning system. Care records included a number of generic and individual assessments, which explained risks to people and how these would be managed. Information to compile these assessments had been taken from information received upon admission or from getting to know people over time. People and relatives we spoke with could not recall being directly involved in the care planning or risk assessment process.

During the assessment we spoke with a visiting medical professional. They told us staff listened to them and acted on what they were told. They said staff asked the right questions and as a professional, they had no concerns about how the home was managing people’s skin integrity.

At the last assessment, contingency plans did not include a place of safety, in case the home was temporarily uninhabitable, for example, due to a power failure. Two places of safety had now been identified, a restaurant and another care home. However, transportation had not been considered. We asked the provider how people would get to either location, and was told they would walk. One was located 0.3 miles away with a walking time of 8 minutes, the other was 0.8 miles away, with a walking time of 17 minutes. It had not been explored whether people living at the home could safely walk this far, nor how the time of day and/or weather may also be a factor. Personal emergency evacuation plans (PEEP’s) were in place for each person, which explained what support they would need to evacuate in an emergency. PEEP’s referenced people’s mobility needs and use of equipment, such as a Zimmer frame or wheelchair. However, we noted for people living on the first floor, as the lift could not be used in an emergency, there was nothing documented to confirm they had been assessed and were able to safely use the stairs. As well as PEEP’s being within people’s electronic care records, copies were also stored in a dedicated PEEP’s file. This file also contained general evacuation guidance for staff. We noted there were two sets of guidance, which gave conflicting information. One stated staff should check for the source of a fire, report this information to the senior who would ring 999; the other advised staff to trigger the relevant call point and await instructions from the fire marshal or delegated person.

The provider explained actions they had taken to address shortfalls to the environment and completion of safety checks. They told us new documentation had been implemented and contractors employed to fit new fire doors throughout the home. This work was ongoing at the time of our assessment. People and relatives told us they had noted some improvements being made to the environment, with some decorating having taken place. However, they felt further work was needed. One relative stated, “It is a bit tired looking in parts but there is work being done to bring it up”. Another said, “The home and garden area needs some work. However, there is a lot of redecoration and repairs going on at the minute.”

Due to the ongoing works, we asked for a copy of the building work risk assessment. Although works had commenced in July 2024, the risk assessment was dated 25 September 2024. This meant work had been ongoing for nearly 2 months without a risk assessment in place. One of the control measures listed on the risk assessment, was for physical barriers and warning signs to be erected between work and residents. During our site visits, we saw no evidence of barriers being used, and the use of signage was limited. We also noted the contractors were using the emergency fire escape exits on both the upper and lower floors to enter and exit the building. Both we and care home staff observed these doors being left open on numerous occasions. This posed a risk for people, who may purposefully or accidentally exit the building through the open door, and could trip or fall on the external metal staircase. This risk had not been considered on the risk assessment. We asked the provider how there were assessing and responding to risks, including those relating to premises and equipment. We were told they used a risk register, which was sent to us following our assessment visits. We noted the issues contained within the risk register were predominantly things we had identified and reported during the assessment, such as the lift door not closing properly and potential issues with accessibility to the home.

Safety checks had been completed with certification in place, to confirm utilities and equipment were safe to use. Work had been carried out to ensure hot and cold water temperatures were within required temperature ranges. A new fire alarm system had been fitted, as the previous one was not fit for purpose. Regular fire safety checks were being completed. We found some improvements were needed with recording actions and outcomes, following the completion of safety checks. Documentation used did not explain what had been done to rectify shortfalls, and we did not see this information recorded anywhere else.

Overall, people and relatives said enough staff were deployed to meet their needs during the day. However, some concerns were reported with staffing levels at night. Comments included, “I would say so, it seems well staffed when I visit,” and, “During the day they are brilliant, but they need more [staff] at night,” and, “I think they need more staff on at night. With 2 staff putting people to bed, if there is an emergency, there is no-one to help you, get you to bed or go to the toilet.” Similarly, we received mixed feedback about whether staff appeared well trained and competent. One relative stated, “The staff are very caring. There has been a big turnaround of staff which has led to a better standard of care and more well trained staff.” Whilst a person told us, “I think they are in some ways and not in others. I feel some staff don’t understand my needs.” Whilst another person commented, “Yes and no. Sometimes when you ask staff something, they will have to go and ask someone else. It may be they are still learning the job.”

Staff raised no concerns about staffing levels, or the training and support provided to them. We asked the provider how they determined how many staff were needed to meet people's needs. The deputy manager reported, “As we are still under the occupancy level that we were previously we have not changed the staffing levels. If we were to increase in occupancy a dependency tool would be used to assess each resident’s needs, and we would adjust staffing levels accordingly. We are looking at a dependency tool for when our occupancy increases.” We asked the provider to explain the induction process for new staff. The deputy manager told us, “Staff are enrolled onto online training from day 1. Staff have 12 weeks to complete their care certificate. There is a list of mandatory courses which have to be completed while going through their induction. Staff then have shadowing shifts for around 2-3 weeks before they are added in to the numbers.”

As reported by the deputy manager, the provider did not use a system for determining how many staff were needed day and night. This wasn’t currently an issue for during the day, but meant they could not evidence staffing levels at night had been assessed and were based around people’s needs. The provider used a spreadsheet for documenting staff training completion. We reviewed this and overall found completion rates across the home were good. However, we did note a number of staff were listed as completing an unrealistic number of courses on particular days, which called into question to validity of the data. For example, 1 staff member was listed as having completed 41 courses in a single day, another 36 in a single day and 60 over a 3 day period. The deputy manager provided us with a list of mandatory training courses, which staff had to complete as part of their induction. The list contained 57 courses. It was not clear which of these had to be completed before staff were added to the rota, and which could be done over the 12 week induction period. For new staff or staff returning to care after a period of absence, this would be important to ensure they had the necessary skills and knowledge to complete the role safely and effectively. Documentation viewed on assessment indicated staff would receive 6 supervision sessions per year. Based on the supervision matrix provided, we were unable to evidence this target had been achieved. We identified improvements with safe staff recruitment processes. Disclosure and Baring Service checks had been completed, with documentation on file and accurate. Professional references had also been sought for new staff. We did identify some issues with contradictory information on application forms, gaps in work history, or frequent job changes not being explored and documented during interview.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

Some people went without their medicine, including painkillers, as there was no supply available. This meant they might have experienced avoidable symptoms of their medical condition, including pain. We found peoples medicine administration records (MAR) did not always list all of their medicines, including medicines administered by other health care professionals. There was a risk their medicines might not be reconciled correctly if they were to attend hospital, which placed them at risk of harm. Additional information and special instructions, for example take with or after food, was not included on the MAR, therefore there was a risk the medicines might not be administered in line with manufacturers information. The quantities of medicines received was not recorded, therefore the service could not reconcile the remaining quantities and be assured all medicines had been given as prescribed. The provider had completed audits, however they had not identified the issues found during this inspection. Therefore, the audits were not effective in driving forward improvement. Staff completed medicines training, however, we found staff were administering medicines, despite not being competent to do so. This placed people at risk of harm.

Several people were prescribed ‘when required’ medicines or medicines with an option to give 1 or 2 tablets; person centred information to support staff to safely administer these medicines was not always available. This meant there was a risk people might not have received their medicines, or the correct dose of medicine, when it was needed. Staff wrote a new MAR for one person and changed the name of one medicine to another medicine by mistake. The staff involved and subsequent staff had not noted the error; it was only identified by the inspector during the assessment process. The MAR showed no doses had been given to the person, therefore they were not harmed. The medicine fridge was not being safely monitored as the minimum and maximum temperatures were outside of the recommended temperature range and there was no evidence any action had been taken to ensure the medicines were still safe to be used. We found medicines were not always safely stored in adherence to regulations and the provider’s medicine policies.