Archived: Heathlands

This inspection was carried out on 1 August 2017 and was unannounced.

There was a registered manager in place, who had taken up their post since our last inspection. 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.

At our last inspection on 7 April 2016 we identified three breaches of the Health and Social Care Act 2008 Regulations. People were not always supported to eat safely. Staff did not follow the guidance put in place by a speech and language therapist regarding one person’s meals. People's changing needs were not always responded to in a timely manner. One person's behaviour had changed significantly but guidance for staff on how to support the person had not been reviewed or updated. There was insufficient managerial oversight of the home and records were not well organised.

Following our last inspection, the provider sent us an action plan setting out how they intended to make improvements and meet the regulations.

At this inspection we found the provider had taken action to address these concerns and to meet the relevant regulations.

People were supported to eat safely. People who had needs related to eating and drinking had been reviewed by a speech and language therapist since our last inspection. Staff were knowledgeable about the revised guidelines put in place by the speech and language therapist and followed these when supporting the person during our inspection. People were supported to eat food they enjoyed and were encouraged to maintain a healthy diet.

There were guidelines in place for staff about how to provide the care and support people needed. Where necessary, referrals had been made to health and social care professionals to ensure that appropriate guidance was provided to staff.

The management oversight of the home had improved. Relatives and advocates told us the registered manager provided good leadership for the home and staff told us the registered manager had improved the support they received. The registered manager also managed another of the provider’s registered care homes but demonstrated that this did not diminish their ability to manage Heathlands effectively. Records were well organised, up to date and stored confidentially where necessary.

People were safe because staff understood any risks involved in their care and took action to minimise these risks. There were sufficient staff on each shift to keep people safe and meet their needs. Staff understood their roles in keeping people safe and protecting them from abuse. The provider carried out appropriate pre-employment checks before staff started work.

Medicines were managed safely. Accidents and incidents were recorded and reviewed to ensure any measures that could prevent a recurrence had been implemented. Staff maintained a safe environment, including appropriate standards of fire safety. The provider had developed plans to ensure people would continue to receive care in the event of an emergency.

People’s care was provided by staff who knew their needs well and provided support in a consistent way. Staff had access to the induction, training and support they needed to do their jobs.

People’s care was provided in line with the Mental Capacity Act 2005. Staff supported people to make decisions and respected their choices. Where people did not have the capacity to make decisions, relevant people had been involved in making the decision in the person’s best interests. Applications for DoLS authorisations had been submitted where restrictions were imposed upon people to keep them safe

People’s healthcare needs were monitored and they were supported to obtain treatment if they needed it. People who had ongoing healthcare conditions were supported to see healthcare professionals regularly.

People were supported by caring staff. Staff treated people with respect and maintained their privacy and dignity. People were encouraged to be independent and were supported by staff to learn and develop new skills.

Staff understood people’s individual communication needs and supported people to give their views about their care. People had access to activities they enjoyed and had opportunities to enjoy an active social life.

People’s needs had been assessed before they moved into the home to ensure staff could provide the care they needed. Where needs were identified during the assessment, a care plan had been developed to address them.

The provider had an appropriate complaints procedure, which explained how complaints would be managed and listed agencies people could contact if they were not satisfied with the provider’s response. There had been no complaints since our last inspection.

The service was well led, with an open and inclusive culture. Staff shared important information about people’s needs effectively. Team meetings were used to ensure staff were providing consistent care that reflected best practice. There was evidence of learning from events, including incidents and accidents.

The provider’s quality monitoring checks ensured people received safe and effective care. Staff made regular in-house checks and the provider’s area manager carried out a monthly audit. An action plan was developed to address any areas identified for improvement and incorporated into the home’s continuous improvement plan.

This inspection took place on 7 April 2016 and was unannounced. The inspection was carried out by two inspectors.

There was a registered manager in post who assisted us with our inspection on the day. 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.

People received support with their healthcare needs although systems to manage and record appointments were not consistent which had led to delays in people receiving the healthcare they required. Professional advice was not always followed. For example, staff were unaware of and had not followed guidelines for one person who had been assessed by professionals as requiring a pureed diet to reduce the risk of choking.

People’s needs were not always responded to in a responsive manner. Behaviour support plans were not appropriate which led to inconsistencies in the support provided.

There was a lack of managerial oversight of the service. The registered manager was responsible for the running of two services which limited the time they were able to dedicate to the management of the service. Quality assurance systems were in place but had not identified and addressed concerns within the service. Records were not stored in an organised manner which meant that information was difficult to access.

A range of activities were available to people. However, these were not always planned or provided in a consistent manner so people were unable to predict and anticipate their routines or follow their chosen activities regularly.

Risks to people’s safety and well-being were assessed and control measures implemented to keep people safe. Medicines were managed safely and staff understood the process involved in supporting people with their medicines. Maintenance of the premises and equipment were monitored and health and safety checks of the environment were completed.

People were supported by sufficient numbers of staff who had received training in their role and recruitment checks were completed to ensure they were suitable to work at the service. Staff were aware of their responsibilities in relation to safeguarding people from abuse.

Care plans were person centred and recorded people’s needs and preferences and people were actively encouraged to participate in the running of their home. Staff knew people well and supported people with courtesy and kindness.

People’s legal rights were respected as the principles of the Mental Capacity Act 2005 were followed. People’s capacity was assessed and where restrictions were in place applications to deprive people of their liberties had been submitted to the local authority. There was a complaints policy in place which was displayed and available in an easy read format.

Regular staff and resident meetings took place and staff told us they felt supported by the organisation.

During this inspection we identified five breaches 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.

We saw staff treated people with respect and were caring. People who lived at the home were relaxed and happy. The relatives we spoke with told us that they thought the staff were caring and that their family member liked living there. One relative told us 'I can't fault it.'

We found that the service supported people with their nutritional needs. The people in the service chose what they wanted to eat and drink. We saw some people accessed the kitchen when they wanted and that saw that they enjoyed the meal that was served.

The service handled medicines in a safe, secure and appropriate way. The staff we spoke with told us that they would always explain to people what they were giving them before any medicine was administered.

The home had systems in place that monitored the quality of the service and to identify when things needed to be improved. We saw that this included auditing the health and safety of the home.

We saw evidence of the processes used for decision-making and involving the people who used the service, their families and other professional staff, for example, care managers and health professionals. This included day to day choices and also more important decisions concerning health interventions of choices about where to live.

We saw comprehensive support plans, assessments and guidelines and evidence that the people who use the service were fully engaged with planning their support. Staff were very familiar with these and there was evidence that they were followed at all times.

There were sufficient numbers of staff with appropriate skills and experience to meet the needs of people using the service. Staff had been trained in relation to a number of areas including safeguarding vulnerable people.

There were systems in place for managing emergencies, safeguarding, whistleblowing and complaints.

Having assessed the evidence we considered the service demonstrated how it met the safety and care needs of the people living in the home.