Heavers Court

Care UK Community Partnerships Ltd, is registered to provide accommodation, and personal and nursing care to up to 60 people at Heavers Court. The service specialises in supporting older people, some of whom are living with dementia. The provider is only contractually obliged by the commissioning local authority to provide personal and nursing care to people. Another organisation maintains the premises and equipment and provides the cleaning, laundry and catering services. As the registered provider, Care UK Community Partnerships Ltd retains overall responsibility for ensuring all the legal requirements are met in relation to the accommodation and the care and support provided to people. At the time of our inspection there were 52 people using the service.

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

Staff understood how to safeguard people from abuse and reported safeguarding concerns to the relevant people and agencies. Risks to people’s safety and wellbeing were managed well.

There were enough staff to support people and meet their needs. Recruitment checks were undertaken on staff to make sure they were suitable to support people.

Senior staff undertook checks of the premises and equipment to make sure these were safe. They worked well with the organisation responsible for maintaining the premises and equipment, to make sure any issues were dealt with appropriately. Staff followed current infection control and hygiene practice to reduce the risk of infections.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff were supported and valued by managers and encouraged to put people’s needs and wishes at the heart of everything they did. People were satisfied with the care and support they received from staff.

The service worked proactively with healthcare professionals and acted on their recommendations to deliver care and support that met people’s needs. People were supported to take their prescribed medicines.

The service was managed well. The registered manager had the skills and experience to perform their role. They undertook checks to monitor, review and improve the quality and safety of the service. The registered manager was well supported by the provider, who undertook their own checks of the service to make sure required standards were being met.

The provider obtained people’s feedback about how the service could be improved and these were acted on. There were systems in place to ensure accidents and incidents were investigated and the learning from these shared with the staff team, to help the service improve the quality and safety of the support provided.

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 the service was good (published on 20 November 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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 COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

This inspection took place on 17 October 2018. At our last comprehensive inspection of the service in September 2017 we gave the service an overall rating of ‘requires improvement’. This was because the mealtime service was not always tailored to meeting people’s needs. Some aspects of the environment were not tailored to support people living with dementia. At times, there was also not enough for people to do to meet their social and physical needs. We saw the range and quality of activities on offer was variable. Because of the issues we identified, we found the provider and the other organisation did not always work as well as they could to ensure people experienced good quality personalised care that met their needs

At this inspection we found the provider had taken on board our findings from the previous inspection and used this to drive improvement at the service. The provider was now working more proactively with the other organisation to meet the needs of people using the service. Communication between the two organisations about the timings of the meal service was better and meals were served promptly. The registered manager had driven improvements to the presentation and quality of meals so that these were attractive, well balanced and nutritious. Staff supported people to eat and drink enough to meet their needs.

Changes to the environment had been made to make this more suitable for people living with dementia. New flooring was put in to make it easier for people to move freely around. Memory boxes were used to help orientate people to their rooms. New signage was due to go up by the end of the year which would make it easier for people to find their way around the premises.

Activities provision at the service had improved. People had been involved in designing an activities programme that reflected the preferences, choices and needs of people using the service. There was a range of activities and events for people to participate in to meet their social and physical needs. People’s families and friends were encouraged to take part in events and activities at the service to help them feel included in the lives of their loves ones.

Staff continued to be well supported to safeguard people from the risk of abuse and knew when and how to report any safeguarding concerns about people to the appropriate person and agencies. Staff were provided with up to date information about the risks posed to people and knew how these should be managed to keep people safe from injury or harm. The provider used learning from accidents and incidents to take appropriate action when things had gone wrong. At this inspection we saw improvements had been made following an incident involving a person to help reduce the risk of a similar incident reoccurring.

The provider maintained arrangements to monitor the safety of the premises and the equipment. They sought assurances from the other organisation, responsible for the premises and equipment and the cleaning, laundry and catering services, that they had appropriate measures in place to check these aspects of the service did not pose unnecessary risks to people’s safety. The provider’s staff followed good practice to ensure risks to people were minimised from poor hygiene and cleanliness when providing personal care and when preparing and serving food. Medicines were stored safely and securely, and people received them as prescribed.

There were enough staff at the time of this inspection to meet people’s needs and keep them safe. The provider maintained a robust recruitment and selection process and carried out appropriate checks to verify staff's suitability to support people.

People’s needs were assessed to determine the level of support they required. Staff continued to receive relevant training to help them meet people's needs. Staff had work objectives that were focussed on people experiencing good quality care. These were monitored and reviewed by managers through supervision and appraisal. Staff knew people well and understood people’s needs, preferences and choices.

People and their relatives remained involved in planning the support people required. Senior staff reviewed the support provided to people monthly and when changes to people’s needs were identified, records were updated promptly so that staff had the latest information about how to support people appropriately. People were supported to keep healthy and well and helped to access healthcare services when needed. Staff referred any concerns they had about a person’s health or wellbeing promptly to the relevant health professionals.

Staff were caring, patient and considerate. They asked people for their consent before care was provided and prompted people to make choices. Staff ensured people's privacy was maintained when being supported with their care needs. People were encouraged by staff to be as independent as they could be. Staff only took over when people could not manage and complete tasks safely.

Staff were aware of their responsibilities in relation to the Mental Capacity Act 2005 (MCA) and supported people in the least restrictive way possible. The policies and systems in the service supported this practice.

People, relatives and staff were asked for their views about the quality of care and how this could be improved. If people were unhappy and wished to make a complaint, the provider had arrangements in place to deal with their concerns appropriately.

The registered manager was approachable and supportive. The registered manager had good understanding and awareness of their registration responsibilities particularly with regards to submission of statutory notifications about key events that occurred at the service.

The provider continued to maintain arrangements to monitor and assess the safety and quality of the service. When these checks highlighted aspects of the service that fell below required standards the registered manager responded accordingly to make the required improvements. Records relating to people, staff and to the management of the service were accurate, up to date and well maintained. The provider worked in partnership with others to continuously improve the delivery of care at the service.

Further information is in the detailed findings below.

At the last Care Quality Commission (CQC) inspection in December 2014 the service was rated ‘good’ overall. However in the key question ‘Is it well led? we rated the service ‘requires improvement’. This was because the service did not have a registered manager in post and we identified some concerns about the lack of continuity in leadership at the service and the quality of management communication with staff.

At this inspection we rated the service ‘requires improvement’ overall. The service demonstrated they met the regulations and fundamental standards. But under the key question ‘Is it effective?’ we rated the service ‘requires improvement’. This is because we found the current provision of the mealtime service did not enable staff to tailor this aspect of the service to meet people’s individual needs. We also found some aspects of the environment were not tailored to support people living with dementia.

Under the key question ‘Is it responsive?’ we rated the service ‘requires improvement’. This is because we found, at times, there was not enough for people to do to meet their social and physical needs. We saw the range and quality of activities on offer was variable. Senior managers were already aware that improvement was needed to this aspect of the service and were taking steps to address this at the time of our inspection.

We also rated the service ‘requires improvement’ under the key question ‘Is it well led?’ This is because we found the provider and the other organisation did not always work as well as they could to ensure people experienced good quality personalised care that met their needs. Some aspects of the service provided were not being driven by the needs of people using the service.

We did identify that improvements had been made since our last inspection. A registered manager and deputy manager had been appointed at the service. People, relatives and staff were positive about the managers and said they were open, transparent, accessible and supportive. Staff told us communication with managers had improved and staff were now kept up to date.

Although people said the provision of activities at the service needed to improve, they were generally satisfied with other aspects of the service. The provider maintained appropriate arrangements to deal with people’s complaints and concerns if they were dissatisfied with any aspect of the service.

People continued to be safe at Heavers Court. Staff knew how to protect people from the risk of abuse and followed appropriate guidance to minimise identified risks to people's health, safety and welfare. There were enough staff deployed to keep people safe. The provider had arrangements in place to check the suitability and fitness of all staff to support people.

The provider had arrangements in place to monitor the premises and equipment to check these did not pose unnecessary risks to people’s safety. The environment was clean and clear of slip and trip hazards.

People had a current care plan which reflected their choices and preferences for how their care and support needs should be met by staff. These were reviewed regularly by senior staff. Staff received relevant training and were well supported by senior staff to help them to meet people’s needs effectively. Staff knew people well and had a good understanding of their needs, preferences and wishes.

People were supported to eat and drink enough to meet their needs. They also received the support they needed to stay healthy and to access healthcare services when needed. Medicines were managed safely and people received them as prescribed.

Staff were patient, considerate and treated people with dignity and respect. They ensured people’s privacy was maintained particularly when being supported with their personal care needs. People were supported to retain as much independence and control as possible with daily living tasks. People were encouraged to make choices and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

People and staff were encouraged to provide feedback about how the service could be improved. Regular checks and reviews of the service continued to be made by senior staff to ensure people experienced good quality safe care and support at all times.

Further information is in the detailed findings below.

Heavers Court had a warm, friendly atmosphere with a number of relatives and professionals visiting the home. There were also a large number of support staff who in undertaking their work freed up care staff to undertake work directly with people. In addition, the support staff were generally aware of the needs of people who used the service and were therefore able to engage with them in an understanding and meaningful way.

In total we were able to talk to five relatives who were visiting on the day of our inspection and six people who used the service. On the whole we received some very positive comments, these included, 'my mum is very happy here and she never asked to go home', 'this home is fabulous and so are the carers' and 'I am happy here, this is a very nice home'.

Using our SOFI we observed staff interaction and saw that people had high levels of well being. Staff knew people well and could anticipate needs, whilst giving options where they could.

Two inspectors visited Heavers Court because of the size and complexity of the needs of some of the people who use the service. The home is divided into six clusters of 10 people with each cluster having its own lounge and kitchen/dining area. One of the clusters is designated for people with nursing needs. We were able to spend varying amounts of time on five out of the six clusters.