Archived: Heartlands

Updated 13 January 2016

We carried out this focused inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This unannounced inspection took place on 25 and 26 November 2015. This was in response to a series of concerns that had been raised by other agencies with the Care Quality Commission. We wanted to check that improvements and action had been taken in line with the provider’s action plan in response to issues raised from a previous inspection on 26 and 27 February 2015. This related to two of the five questions we ask about the service. Is the service safe? Is the service effective?

The inspection was conducted by two inspectors, a pharmacy inspector, bank inspector, an expert by experience and a specialist advisor. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of dementia care service. The specialist advisor had an in-depth knowledge in nursing care. Two trainee inspectors were also present as part of their post induction training programme.

We looked at the information we held about the service. This included notifications received from the provider about deaths, accidents/incidents and safeguarding alerts which they are required to send us by law. We looked at information received from other local agencies and used this information as part of our inspection process.

During our inspection we visited all four units and spoke with 13 people who lived at the home, five relatives, eight nursing and care staff, the acting manager and the independent consultant. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We reviewed the care plans of seven people, 16 people’s medicine administration records to see how their care was planned and looked at. We also looked at records which supported the provider to monitor staffing levels and staff training to see if they were effective and up to date.

Updated 13 January 2016

This inspection took place on the 25 and 26 November 2015 and was unannounced.

We last inspected Heartlands on the 26 and 27 February 2015 where we found the provider had breached the Health and Social Care Act 2008 in two regulations. The provider sent us an action plan detailing the improvements they would make.

This was a planned comprehensive inspection that would have inspected the service under the five domains of Safe, Effective, Caring, Responsive and Well led. When we arrived, we were told by a representative of the organisation that the provider was in the process of selling Heartlands, which was subject to contract, with a possible date for the contracts be exchanged. As there would have been a change in the legal status of ownership of Heartlands, we changed our inspection to a focused inspection, looking at whether the service was Safe and Effective. Therefore, this report only covers the findings under Safe and Effective and in relation to the breaches; with regard to care and treatment being provided in a safe way and with the people’s consent. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Heartlands on our website at www.cqc.org.uk.

Heartlands is registered to provide accommodation and nursing care to up to 76 people. The home is purpose built and divided into four separate units across two floors. Broadstone and Yardley on the ground floor and Dovecote and Osbourne on the first floor. The home has a second floor that is not in use. Three of the four units provide nursing care to people with a form of advanced dementia and / or other health conditions. The fourth unit provides personal care, without nursing, to people suffering from mild to moderate dementia. On the day of our visits we were told there were 64 people living at the home.

The registered manager had recently resigned. 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. There was an acting manager, who at the time of this inspection, had been in the post for eight days. The acting manager has submitted their application to the Care Quality Commission to become the new registered manager. The acting manager was also being supported by an independent consultant.

There had been some improvements made to the safe way treatment and care was being provided to people. However, we observed that further improvements were needed in all four units to ensure people’s needs were well met.

There had been some improvement in the medicine management practices at the home; however there was still room for improvement.

Staff understood their responsibility to take action to protect people from the risk of abuse and harm because the provider had systems in place to minimise the risk of abuse. However, we saw that staff did not always follow the assessments to minimise the risks associated with people‘s care and this put people at further risk of injury. You can see what action we told the provider to take at the back of the full version of the report.

Referrals for people requiring support from other health care professionals; were not always made in a timely way to ensure risks to people were minimised.

The provider had not always recognised when the care being offered had put restrictions on people’s ability to choose and move around freely. Restricting people’s freedom to move around without the necessary authorisation meant that the provider was not meeting the requirements of the Mental Capacity Act and Deprivation of Liberty Safeguards. Therefore people’s human rights were not always protected. You can see what action we told the provider to take at the back of the full version of the report.

Staff knew about people’s needs but this was not consistent across the four units. Staff had received training but this had been ineffective to enable them to deliver care safely and effectively.

People were not always supported in a timely manner. Staff deployment was not sufficiently effective to ensure that people were adequately supervised, so that their care needs were met in the way people preferred.

People who needed support to eat and drink to prevent the risk of poor nutrition and dehydration had not always received this support effectively. People felt staff that supported them were caring and kind and they felt safe with staff.