Archived: Heathgrove Lodge Care Home

Heathgrove Lodge Care Home is a residential care home providing personal and nursing care to 29 older people at the time of the inspection.

The care home accommodates 29 people in one adapted building

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

Due to inconsistencies in records, we could not be assured two staff members were involved in the repositioning of people where needed and people received care and support that was safe.

The décor and layout of the building was not adapted to meet people’s needs. Aspects of the home were not dementia friendly, easily accessible to people with mobility needs and did not encourage and promote independence and social interaction. People were dependent on staff to take them to other parts of the home when needed.

Medicines were not managed safely, discrepancies were found with medicines stock counts.

People were encouraged to eat healthy food for their wellbeing. However, some fluid intake records had not been completed to ensure people were sufficiently hydrated.

There were systems in place to assess and monitor the quality of the service provided. However, these were not effective to sustain improvement.

The majority of people spoke positively about the service. They said they felt safe and their needs were being met. Care and support was personalised to individual needs. Staff followed appropriate infection control practices. Assessments were carried out to ensure, people’s needs could be met. Where risks were identified, there was guidance in place for staff to ensure that people were safe.

The provider had systems in place to record and respond to accidents and incidents in a timely manner. Any lessons learnt were used as opportunities to improve the quality of service.

Staff had the knowledge and experience to support people's needs and were supported through induction, training and supervision to ensure they performed their roles effectively.

People were supported to maintain good health and had access to healthcare services.

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's privacy, dignity and independence was promoted. People told us staff were kind and caring.

There were procedures in place to respond to complaints. The provider had investigated and responded promptly to any concerns received.

The provider worked with healthcare services and professionals to plan and deliver an effective service.

Rating at last inspection and update

The last rating for this service was requires improvement (published 6 July 2018) and there was one breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, enough improvement had not been sustained and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on previous rating.

Enforcement

We have identified breaches in relation to safe care and treatment, premises, person centred care and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner

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

The service had a registered manager, which 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.

The service is registered to provide accommodation and personal care for up to 36 people, although the registered manager told us the maximum practical occupancy is 33. There were 27 people using the service at the start of this inspection. The service specialises in dementia care and is operated by a national care provider.

This was an unannounced comprehensive inspection, to make sure the service was providing care that is safe, caring, effective, responsive to people's needs, and well-led.

At our last inspection of this service, in April 2017, we found three breaches of legal requirements. These were in respect of receiving and acting on complaints, fit and proper persons employed, and duty of candour. The service was rated 'Requires Improvement.' The provider completed an action plan to show what they would do and by when to improve the rating of key questions of 'Is it Safe?', ‘Is it Responsive?’ and 'Is it Well-Led?' to at least ‘Good.’

At this inspection, we found the necessary improvements had been made to addresses the previous regulatory breaches. However, we also found there were not enough call-bell pagers available for all staff to be aware of anyone’s call-bell being activated, and so we found call-bells were not always promptly attended to. We found that up-to-date information in people’s care plans was not always easily accessible in support of ensuring staff provided people with an individualised service. The service was also not making sure any conditions on Deprivation of Liberty Safeguard (DoLS) authorisations were being met.

There were many auditing processes at the service that fed into an overall improvement plan that was kept under review. However, these processes had not identified and addressed the care delivery concerns we identified, which demonstrated weaknesses in the provider’s governance framework.

Some people praised the service and told us they would recommend it, and no-one said they would not. Most relatives and representatives agreed.

Community professionals praised the service for working well with them in support of meeting people’s needs. People were supported to have access to healthcare services and receive ongoing healthcare input, for example, in relation to skin care or nutritional concerns. People were safely supported to eat and drink enough and maintain a balanced diet.

There were a number of systems in place to monitor and improve on the way staff interacted with people. This helped ensure people were treated respectfully.

The service assessed people’s needs so that care and support was delivered in line with standards to achieve effective outcomes. There was good oversight of people’s significant and developing needs.

The service assessed and managed risks to people, to balance their safety with their freedom. This included for individual needs and in terms of health and safety across the premises. Improvements were being made to help ensure the adaptation, design and decoration of premises supported people's individual needs to be met, as the design of the building was not ideal.

People's medicines were managed and administered safely, so that people received their medicines as prescribed.

The service provided people with daily communal activities that attempted to reflect their interests.

The service’s systems, processes and practices helped to safeguard people from abuse. This included through stronger staff recruitment systems, to ensure only suitable staff started working at the service.

Minimum staffing levels were identified and maintained based on people’s needs. There was ongoing recruitment of staff to address vacancies that were causing a degree of agency staff use. The service made sure employed staff had the skills, knowledge and experience to deliver effective care and support.

People and their representatives were supported to express their views and be actively involved in making decisions about their care and support. The service listened and responded to people’s concerns and complaints, and used this to improve the quality of care.

The service worked in partnership with other agencies to develop care provision. There was active engagement with the local authority in particular, in support of improving care and treatment outcomes for people.

The service was aiming to promote a positive and inclusive culture that achieved good outcomes for people. There was ongoing work to continue to improve the calibre of the staff team and the working culture at the service.

The service’s rating from this current inspection remains ‘Requires Improvement’, the third consecutive time it has received that rating based on a comprehensive inspection. We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 at this inspection. You can see what action we told the provider to take at the back of the full version of the report.

The service had a registered manager, which 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 the last inspection in February 2016, we found the service to be compliant with relevant regulations. Our findings at this inspection have, however, identified breaches of regulations.

There was insufficient evidence at this inspection to demonstrate that complaints were consistently handled and monitored effectively. Complaint response letters were not always written. Those that were sent did not fully inform the complainant of what they could do if dissatisfied with the response. Actions agreed in response to one complaint had not occurred. Two verbal complaints had not been recorded on the provider’s complaints monitoring system, and a third had not been recorded accurately, meaning that the provider may not have been able to effectively monitor complaints at the service. This reflected mixed views we received about complaints systems at the service.

The provider’s Duty of Candour policy had not been followed in respect of two incidents, which did not reflect a culture of learning from incidents so as to minimise the risk of reoccurrence.

Staff recruitment processes were not robust enough to ensure that only suitable staff provided care and treatment to people. This was due to failures to explore employment gaps and acquire appropriate written references.

There were a number of systems used to scrutinise the service in good detail and implement improvements. However, they had not picked up on the above matters. We were not assured the management changes at the service provided the consistent leadership and direction required of a well-led service.

Whilst most people spoke of staff being responsive and helpful, we found that two people did not have access to their calls bells when we checked on them. There had also been no recent meeting for people using the service and their relatives for them to share views.

Most people and their relatives praised the service highly, describing it as “excellent” for example. However, some felt they would not recommend the service.

People were treated well at the service on a day-to-day basis. There were good visiting and contact arrangements for people’s friends and relatives. Activities provision had been expanded to seven days a week, and there was ongoing work to improve on people’s levels of engagement. There were enough staff supplied to meet people’s needs.

Good attention was paid to people’s individual healthcare care needs, and liaising with community healthcare professionals in support of that. The service supported people to take medicines as prescribed.

People spoke positively of the food provided at the service, and we saw that people’s nutritional needs and preferences were kept under review and addressed.

People’s care plans were up-to-date and reflected their individual needs and preferences, including for people newly using the service. Risk assessments were regularly reviewed.

Appropriate attention was paid to ensuring the safety of equipment and the premises. There was a good standard of cleanliness and sufficient attention to the prevention and control of infection.

The provider was ensuring that an empowering and positive leadership culture was being set up at the service, and that staff were engaging better in their roles. Staff were provided with training and support for their role, although some weaknesses in these areas had also been identified and were being addressed.

There were overall many areas of positive care at this service, but there were also three 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 undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report mainly covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Heathgrove Lodge Nursing Home on our website at www.cqc.org.uk .

Heathgrove Lodge Nursing Home is a nursing home for up to 36 people. There were 31 people using the service when we inspected, and we were informed that their maximum practical occupancy is 33. The service’s stated specialisms included dementia care. The accommodation is purpose-built with passenger lift access to all floors.

There was a registered manager in place at the service at the time of our 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.

We found that the provider had followed their plan to address our previous concerns, and so they were now meeting legal requirements in support of ensuring appropriate care and treatment of people using the service.

Care plans were now promptly set up for new people using the service, to help ensure their safe care and treatment.

Where anyone had wound care needs, action was taken to monitor and address the needs effectively.

Records of care and treatment delivery such as repositioning charts for people at risk of pressure ulcers were now kept up-to-date and were used effectively.

The service provided good support of people’s health and nutritional needs, and worked in partnership with community healthcare professionals.

There was good overall feedback, from people using the service and their representatives, about the services provided.

Where people or their representatives were unhappy with any aspect of the service, or raised a complaint, timely action was taken to try to improve matters. Further staff training had been completed in support of this.

The provider had effective systems in place to monitor service quality and identify care and treatment risks.

People overall received personalised care and treatment that was responsive to their needs and preferences.

At this inspection we found that improvements had been made. Systems had been set up to ensure and monitor that call-bells were answered in a timely manner. For example, there were enough call-bell receivers for all staff working, and records showed that most activations of the call-bell were now responded to in less than five minutes.

We spoke with five people using the service during the inspection. They confirmed that call-bells were responded to quickly. One person said, 'they respond quickly and with genuine concern.' Despite this, there were some concerns expressed about staff being too busy. However, it was evident that staffing levels were kept under review, and extra staff had been provided during the day recently. This helped to ensure that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

Most people fedback positively about the overall services provided. Comments included, 'they've very good, it's lovely here' and 'I don't want for anything.'

Seven of the eleven people we spoke with gave us feedback that care and treatment was not always provided in a timely manner. Comments included, 'they don't have enough helpers. If you ring the bell, its ages before they come and they're always too busy to talk" and "they could do with more staff. You can press this button and wait 10-15 minutes.'

We checked records of response times to people's call-bells, which confirmed that they were not always responded to in a timely manner. This failed to ensure that each person was properly protected against the risks or receiving care or treatment that was inappropriate or unsafe.

There had been recent refurbishment of the environment and d'cor, for which there was positive feedback. We found that people were protected against the risks of unsafe or unsuitable premises and equipment.

We also found that there were appropriate arrangements in place to manage medicines, and to identify the possibility of abuse and prevent abuse from happening.

People we spoke with were happy with the recent refurbishment of the home. One person told us that great care had been taken to ensure people were not upset by the process, and that 'the whole place looks a lot nicer.'

Most people said that they received the care and support they needed. 'The staff are all lovely,' one person told us. We saw that care was delivered at a relaxed pace that met people's needs. Staff knew how to communicate with people, and interacted warmly with them.

There were systems in place aimed at ensuring people experienced care and treatment that met their needs. However, we found that some pressure-relieving equipment was not being used and maintained correctly. This may have failed to protect people against inappropriate or unsafe care and treatment.