We inspected SeeAbility - Heather House Nursing Home on 15 and 17 July 2015. This was an unannounced inspection.
SeeAbility - Heather House Nursing Home consists of two purpose built ground floor units and is set in a wooded site on the outskirts of Tadley. Facilities include a sensory suite, indoor hydropool, Jacuzzi baths and other specialist activity rooms. The home also provides a guest suite for visiting families to promote family relationships and maintain family links.
SeeAbility - Heather House Nursing Home is a residential nursing home providing specialist care for up to 16 young adults with degenerative conditions. These include Juvenile Batten disease (JBD). They also support individuals who have complex physical and learning disabilities. At the time of the inspection there were 14 people living in the home with varying degrees of visual impairment, moderate to severe learning disabilities and healthcare needs. Some people had very limited verbal communication skills and they required staff support with all aspects of their personal care, nutrition, mobility and to go into the community.
Ten of the 14 people in the home were living with JBD. The provider’s webpage notes ‘Batten disease describes a group of rare inherited neurodegenerative disorders that occur in children and adults. Juvenile Batten disease usually begins at early school age. It often begins with vision problems. Later short-term memory loss, epilepsy, motor problems and declining school progress becomes apparent. Life expectancy is limited to between late teens and mid thirties’.
The registered manager was a trustee of the Batten Disease Family Association. They worked with scientists and healthcare professionals to share expertise in Batten Disease as any advancements have potential benefit for people living at Heather House. Staff had improved their understanding and treatment of epilepsy of people with JBD at the home following this joint working.
The home had a registered manager. 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 home is run.
Staff knew people well and supported them appropriately to stay safe and well. However, people’s records did not always include all the information staff required to know how to manage risks to people’s health and how decisions relating to people’s care had been made. The provider was employing new staff and had increased the use of agency staff. An accurate, up to date record of people’s care and risks was required to ensure staff, who did not know people well, would know how to support them appropriately without being overly reliant on the support of experienced staff.
Quarterly quality monitoring visits were undertaken by senior management. However, the quality assurance systems implemented by the registered manager between the quarterly provider visits were not sufficiently robust for such a complex, high risk service. Regular health and safety checks were carried out to ensure the physical environment in the home was safe for people to live in.
There was a nurturing atmosphere within the home and staff put people at the heart of the home. People and their relatives were encouraged to be involved in the planning of care. Staff were motivated and flexible to ensure people’s plans were realised, and that they had meaningful and enjoyable lives.
Staff had a positive approach to keeping people safe. Staff showed commitment to managing people’s changing risks. Staff were familiar with the health risks people living with JBD faced and nurses knew how to respond if people experienced health emergencies. People had varying levels of independence in meeting their own nutrition and hydration needs. Several people required the use of a Percutaneous Endoscopic Gastrostomy (PEG) to receive nutrition. When a person was having ongoing and serious trouble swallowing and couldn’t get enough food or liquids by mouth, a feeding tube was put directly into the stomach through the abdominal skin. This procedure is called a percutaneous endoscopic gastrostomy (PEG). Staff were skilled in managing people’s PEG nutrition appropriately in line with professional guidance and checked that people’s PEGs were used safely.
All of the staff received training that provided them with the knowledge and skills to meet people’s needs in an effective and individualised manner.
Relatives we spoke with told us people received excellent health care at SeeAbility - Heather House Nursing Home. People living with JBD had ongoing complex health needs and they received timely support from appropriate health professionals. This included support from the provider’s physiotherapy team and speech and language therapist; and established access to a range of community healthcare resources including; dietician; occupational therapist and wheelchair services. A local GP visited the home weekly to monitor people’s health needs. People’s health was reviewed as needed and staff implemented professional’s guidelines appropriately. Systems were in place to ensure people received their medicines as prescribed.
The registered manager and staff’s response to people’s complex health needs, was outstanding. Staff found creative ways to maintain people’s skills and independence. Staff proactively supported people living with JBD to retain their muscle, communication and social function. The home had a purpose built activity centre where people were supported to engage in a variety of leisure and therapeutic activities. Staff told us that people’s loved ones were an integral part of care for people and care and support was extended to them as well. Accommodation was available to people’s relatives at the home and creative ways were used to support people to stay in touch with their loved ones.
Staff sought people’s consent before they provided care and support. However, some people were unable to make certain decisions about their care. In these circumstances the legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were followed. Where people had restrictions placed upon them to keep them safe, the staff ensured people’s rights to receive care that met their needs and preferences were protected. Where people were legally restricted to promote their safety, the staff continued to ensure people’s care preferences were respected and met in the least restrictive way.
People and their relatives were involved in the assessment and review of their care. Staff supported and encouraged people to access the community and participate in activities that were important to them.
Feedback was sought from relatives and people and used to improve the care. People knew how to make a complaint and these were managed in accordance with the provider’s complaints policy.
The culture of the home was nurturing and supportive. People were treated with kindness, compassion and respect, and staff promoted people’s independence and right to privacy. The staff were highly committed and provided people with positive care experiences. They ensured people’s care preferences were met and gave people opportunities to try new experiences.
We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.