Heathfield Care Home

We found the following examples of good practice.

All people and staff participated in regular whole home testing for Covid 19. Personal protective equipment (PPE) was readily available and there was plenty of it around the service. Staff wore and used PPE appropriately. Items coming into the service such as deliveries, post and parcels were subject to an isolation period

The premises were clean and odour free. There was an enhanced cleaning regime in place which included regular sanitisation of high touch areas. There was a clear system in the kitchen that identified crockery and cutlery from people who were in isolation and additional sanitisation processes were in place.

People had been supported to stay in touch with relatives using technology such as video and voice activated devises. People made cards and crafts which were sent to loved ones on special occasions ,and a range of activities were available for people to participate in. These included group activities such as regular gentle exercise. People also made use of the fully accessible garden area.

All visitors and contractors were required to undertake Lateral Flow Device (LFD) tests on arrival. Visiting was in line with government guidance and had been adapted throughout the pandemic to ensure visiting was compliant with government guidelines.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

People’s experience of using this service:

People and their relatives felt the home provided a safe environment. Staff knew how to keep people safe. Risks to people were identified, assessed and managed safely; staff supported people to be as independent as possible. Sufficient staff were on duty to support people to stay safe and meet their needs. Medicines were managed safely. The home was clean and smelled fresh. Learning had taken place when things went wrong. For example, barriers had been installed on the main staircase to prevent people from falling.

People’s needs and choices were met by staff who knew them well. A relative said, “I am totally reliant on staff and can’t thank them enough for what they do”. Staff had the skills, knowledge and experience to deliver effective care and support and had completed a range of training. Staff had regular supervisions and appraisals.

People were happy with the food on offer and told us they particularly liked roast dinners. A relative said, “At Easter and Christmas they do a good spread, which is very nice”. People had access to a range of healthcare professionals and services. The home was comfortable and people could bring in their own furniture and decorate their rooms if they wished. 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.

People were looked after by kind and caring staff. Staff were patient and warm and provided reassurance if people became anxious or distressed. People were encouraged to be involved in all aspects of their care. They were treated with dignity and respect.

Care plans were personalised and reflected people’s preferences. Activities were planned based on people’s interests and hobbies. There were outings into the community and external entertainers visited the home. People’s diverse needs were met. A relative referred to their family member and said, “Staff dance for her and sing for her and it makes her smile”.

People and their relatives were asked for their feedback through questionnaires; all results were positive. Residents’ meetings took place and suggestions were listened to and acted upon. Staff felt supported in their roles and were complimentary about the management of the home. A range of audits were effective in identifying any actions needed to drive improvement.

Rating at last inspection: At the last inspection, this service was rated as Requires Improvement (published in April 2018).

Why we inspected: We were required to inspect this service within 12 months of the last inspection because of the rating of Requires Improvement. The provider sent us an improvement plan after the last inspection which outlined the actions they proposed to take to address the issues of concern. This inspection took place to check on the improvements made and in line with CQC scheduling guidelines for adult social care services.

Follow up: We will review the service in line with our methodology for ‘Good’ services.

People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Heathfield is a care home which offers care and support for up to 23 predominantly older people. At the time of the inspection there were 20 people living at the service. Some of these people were living with dementia. The service occupies a detached house over two floors with a passenger lift and stair lift for people to access the upper floors. There was an on-going safeguarding investigation being carried out at the time of the inspection by the local authority. This incident is subject to a separate process and as a result this inspection did not examine the circumstances of that specific concern.

People's rights were not always protected because staff did not always act in accordance with the Mental Capacity Act 2005. The service did not have a policy in place to guide staff on the Mental Capacity Act 2005. Training had been attended by the registered manager and staff on this subject. However the registered manager and the staff were not entirely clear on this legislation. The information held in some people’s care plans about the Power of Attorney arrangements they had in place, was inaccurate and misleading. There was no evidence of any best interest process having been put in place before restrictions were applied, such as alarm mats and applications made for people to have a Deprivation of Liberty Safeguards authorisation. The service was not acting in accordance with the Mental Capacity Act 2005 Code of Practice.

We observed the lunchtime meal being provided to people. We saw that people were not always asked for their consent before care was provided. Staff placed clothing protectors over people’s heads, then removed them after the meal without first speaking to the person. People were told to go to the lounge after lunch, without a choice being offered. We heard staff telling people to wait when they asked for support from staff. Two staff were seen to go under the dining tables with dustpans and brushes to sweep up food debris from the floor. This was done while some people were still sitting at the dining table. People were seen to lift their feet up while food was swept up underneath them. This did not respect people’s dignity.

There were systems in place for the management and administration of medicines. It was clear that people had received their medicines as prescribed. Regular medicines audits were being carried out on specific areas of medicines administration and these were identifying if any errors occurred such as gaps in medicine administration records (MAR). However, handwritten entries on the MAR, which had not been signed and witnessed had not been identified by the audits.

The premises were well maintained and regularly checked by the provider. There was a programme of redecoration and refurbishment as rooms became vacant. New carpets had been laid in the dining room. There were no incontinence odours throughout the service. There was some pictorial signage at the service to support people who were living with dementia, who may require additional support with recognising their surroundings. Equipment and services used at Heathfield were regularly checked by competent people to ensure hey were safe to use. People’s bedrooms were personalised to reflect their individual tastes.

Risks in relation to people’s daily lives were identified, assessed and planned to minimise the risk of harm whilst helping people to be as independent as possible.

Staff were supported by a system of induction training, supervision and appraisals. Staff felt well supported by the registered manager. There were regular staff meetings held where staff felt they could raise any concerns or issues.

People were supported by staff who had been provided with training on Safeguarding Adults. The service held appropriate safeguarding policies to support staff with current guidance. However, staff did not know how to respond to concerns outside of the service when asked. The registered manager and the provider assured us they would address this at the next staff meeting.

Mandatory training was provided to all staff with regular updates provided. The manager had a record which provided them with an overview of staff training needs.

The service had identified the minimum numbers of staff required to meet people’s needs and these were being met. The service had one staff vacancy at the time of this inspection.

Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Where necessary staff monitored what people ate to help ensure they stayed healthy.

Care plans were well organised and contained information about people care needs, wishes and preferences. Care planning was reviewed regularly and people’s changing needs were recorded. Daily notes were completed by staff.

People had access to a programme of activities within the service. The minibus which had previously been used to take people out into the community was not in use at the time of this inspection. The purpose built bar in the dining room had been removed and was in the process of being changed in to a shop/bar. An activity co-ordinator was in post and provided activities throughout the day. We observed activities being provided mostly on a one to one basis with people all gathered in the lounge. It was not clear how activities were chosen and if they were always relevant and meaningful to people. People’s views on the activities provided were varied.

The registered manager was supported by the provider and a stable staff team. Many aspects of the service provided were regularly audited, such as medicines administration, to help ensure any improvements needed were identified and put in place. However, these audits had failed to identify the issues highlighted in this inspection.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see the action we have told the provider to take at the end of this report.