The Heathers is a ‘care home’. 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. The home can accommodate up to 24 people in one adapted building. At the time of the inspection they were full. The home had six short stay beds. These beds were used by people who were transferred from the local hospitals for rehabilitation, prior to their returning home. The expectation was that the short stay people would stay at the home for six weeks but some of them stayed longer. At the time of the inspection one of these people had been resident at the home since January 2018.We inspected The Heathers on 27 and 28 June 2018. The first day was unannounced. It was a comprehensive inspection. The last inspection had been on 15 February 2015. At that time we rated the service as Good.
People were happy at the home and felt that they received good care. There was a system of policies and audits in place. However, on review of the documentation we found some risk assessments had not been updated, to reflect changes in people’s care needs and some of the people did not have essential risk assessments in place. Similarly, some of the care plans did not reflect the care people were receiving and some people did not have relevant care plans. The impact of this was minimised, as the staff knew the people under their care and the care each person required. However, this lack of up to date risk assessments and care plans, could potentially put people at risk, of receiving inadequate or inappropriate care. The management team were implementing changes, to improve the standard of the documentation. However, at the time of the inspection these changes had not insured that all people had contemporary and complete records. You can see what action we told the provider to take at the back of the full version of the report.
At the time of our inspection a registered manager was in post. 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. The registered manager was based at the sister home and was not available on the day of the inspection. The day to day management of the home was the responsibility of the care manager. The home had a system of audits and quality assurance in place. However, these had not improved the quality of the documentation in regards to personal risk assessments or care plans.
There was a system in place for determining the level of dependency of the different people and thereby calculating the number of staff required. However, there was little flexibility within the staff numbers. On occasions when people’s dependencies changed staff were very busy and it impacted on the ability of the care manager to complete the more administrative parts of their role, for example reviewing and updating the care plans.
There were environmental risk assessments in place and the home had been adapted to suit the needs of the people living there, with a lift between the different floors. The home was clean and tidy and was odour free and people enjoyed an enclosed garden. There was an infection control policy in place and we saw evidence of the use of personal protective equipment, including gloves and aprons.
There was a comprehensive training schedule for all staff. This included training on safe-guarding and the Mental Capacity Act (MCA). All staff received supervision and appraisals at regular intervals. There was a system in place for orientating and supporting any new member of staff. New staff had the appropriate checks, prior to starting work, to ensure they were appropriate for the job and could work within the care industry.
The staff were committed to keeping people safe and could tell us the principles of safe guarding. Similarly, 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 given choice within their daily lives, including how they wanted to spend their time and how they wanted to dress or decorate their rooms. People told us they felt happy in the home and were able to talk to the care manager about any concerns. They also told us they had good relationships with the staff and we observed people being treated with dignity and respect.
Staff were trained in the safe administration of medication. We witnessed people receiving their medicines in a safe and dignified manner. The medicines were kept appropriately and there was a system in place for the ordering and disposal of medications.
Any accidents and incidents within the home were reviewed to see if there were any lessons to be learnt. This was discussed at the regular staff meetings. There was also a complaints procedure in place, which was clearly displayed on the walls. People also received a written copy of this policy when they first arrived and they could request an audio version if they preferred. This was one example of how the staff aimed to make information more accessible to people, in compliance to the Accessible Information Standard (AIS).
There was an activity program in place and this had recently been increased, following people’s feedback. Within the activity program each person received one to one time with the activity lead. This also enabled people to feedback about what they liked about the home and the activities and facilities on offer. People were able spend the day how they wanted. Visitors could visit within reasonable hours and were made to feel welcome.
The home had a chef during the working week but there was a meal delivery service at weekends. People told us they liked the food prepared by the chef but were less keen on the weekend food. This system was under review, following people’s feedback. We observed a weekday lunch. We saw people receiving nutritious and tasty looking food and enjoying the meal time. There was ready access to fluids throughout the day and people, who were identified as being at risk of dehydration or malnutrition, were monitored, to enable changes to be identified and addressed.
Staff had a good working relationship with other health care professions. People were helped to access health services as required. If appropriate, the staff referred people to a local scheme, which provided specialist support and advice for people as they approached the end of their lives.
The staff were proud of the homely atmosphere within the home and people told us that they felt well cared for.
At this inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities 2014). You can see what action we told the provider to take at the back of the full version of this report.