Archived: Surrey Heights

We found the following examples of good practice.

Staff had access to the personal protective equipment (PPE) they needed and there were appropriate arrangements for the donning, doffing and disposal of PPE. We observed that staff used PPE safely and effectively during our visit.

The home was clean and hygienic. Additional cleaning schedules had been implemented, including of frequently-touched areas, and an extra cleaner had been deployed each day.

The service had maintained safe staffing levels and people were supported by a consistent staff team. The manager said the permanent staff team had responded positively to the demands placed upon the service by working additional shifts if needed. Any agency staff used were booked on long-term placements.

People had been supported to access healthcare advice and treatment when they needed it. For example, district nurses had visited people to provide wound care. The manager said the home’s GP contacted the service on a daily basis to discuss any residents who were unwell.

All visitors to the home completed COVID-19 screening forms, had their temperature taken and were required to wear appropriate PPE. Family visits had been supported safely. There was a designated visiting area accessible via an external door, which meant visitors did not need to walk through the home. During periods when visiting was not possible due to national or regional restrictions, staff had supported people to keep in touch with their families through platforms such as FaceTime.

Staff attended IPC training as part of their mandatory training and had attended COVID-19 training provided by the local Clinical Commissioning Group (CCG). The manager had engaged well with other agencies, such as Public Health England (PHE) and the CCG, to ensure relevant advice and guidance was implemented.

Staff accessed regular testing for COVID-19. If positive test results were returned, staff did not return to work until they had completed an appropriate period of self-isolation.

People who lived at the home also had access to testing and the provider sought their consent to this. If people returned positive test results, staff supported them to self-isolate in their bedrooms. Zoning had not been possible due to the layout of the home and the recent number of positive test results. However, the provider had minimised the risks of transmission by assigning a dedicated staff team on each floor to care for people who had returned positive test results.

No new admissions had been made during the pandemic. The manager had sought advice from PHE regarding the readmission of people who were discharged from hospital.

The risks involved in staff travel to and from the home had been minimised. Some staff lived on-site. Those who travelled to and from work had been given advice about how to minimise any risks involved in their journeys.

Staff ensured social distancing was maintained where possible. For example, staff taking their breaks did so in separate rooms and handovers took place in the lounge to enable social distancing.

Risk assessments had been carried out to identify and manage risks to staff who may be vulnerable to COVID-19. Some staff had been supported to work from home due to their vulnerability.

The service had been well-supported by the provider. The manager said the provider had supplied additional staffing resources and ensured staff always had access to the PPE they needed.

The provider had put systems in place to support the well-being of staff. These included individual supervisions, team meetings, a WhatsApp group and more frequent handovers. The manager told us the provider’s senior management team was in regular contact with the home and available for advice and support when needed.

Further information is in the detailed findings below.

This inspection took place on 5 July 2018 and was unannounced.

At the last inspection, on 27 April 2017, we found there were six breaches of the regulations. These were in relation to the safe care and treatment of some people, insufficient staffing levels, consent to care, premises and equipment, dignity and respect and good governance. We asked the registered provider to complete an action plan showing what they would do to address all the issues we found and to meet the regulations.

The registered provider acted to improve the living conditions in the premises and upgraded all the beds and bedrooms for people. They temporarily stopped admissions to reassess levels of dependency and the staffing they required to be able to safely meet people’s needs. A staff recruitment programme and new induction was developed. The approach used for mental capacity assessments and consent was reviewed. Significant changes were made to the way the service was managed, governed and audited.

At this inspection we found that the improvements we had been told about had developed and were being sustained. We could see the impact these changes had on the quality of people’s care and on their lives.

There was a registered manager present on the day of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

People were being cared for by sufficient numbers of staff who were working well together to maximise their time and roles. Staff recruitment was safely managed and the registered manager continued to reduce their reliance on agency staffing. There was a commitment by staff to enabling people to be safe and to improve their well-being and happiness.

People were protected from abuse and there were systems and processes in place to deal with safeguarding incidents. Staff were aware of their role and felt confident to speak up about any concerns.

People’s needs and risks were routinely and well assessed and monitored. Changes were made to care plans and staff were aware of the risks and took appropriate actions to keep people safe. The risk of falls was being managed well and staff were involved in identifying patterns and solutions for some individuals.

There had been a big improvement in the cleanliness and condition of the home. A re-decoration and deep cleansing programme had been undertaken and the standards within the premises were being maintained.

Medicines management and administration was safe. The service had a robust audit process and any errors were picked up very quickly. There was an emphasis on staff learning from these and training was put in place where needed.

Staff were vigilant in addressing people’s health and care needs. They had received training in caring for people living with dementia and this was evident in the way they supported people throughout the day. Staff received a good induction when they started. There was a clear staff structure in place and the care staff were supported and formally supervised. People were supported to stay healthy and to receive medical treatment when they needed it.

People had access to food, snacks and choice of drinks during the day. The menus and choice at meals had improved and the food was praised. The way meals were served and the pleasant environment meant people were enjoying their food and their nutritional health benefitted.

The registered manager and staff understood their responsibilities in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Capacity assessments were evident and people’s best interests had been considered when decisions that affected them were made. Applications for DoLS authorisations had been submitted where restrictions were imposed upon people to keep them safe.

People were cared for by kind and attentive staff who clearly had a positive relationship with people. Staff created a calm and relaxed atmosphere in the home and we saw that they spoke with people in a respectful yet warm and friendly manner. People’s independence and dignity was being valued and protected. Relatives were welcomed into the home.

We noted there had been a big improvement in the care plans, that reflected people’s assessed needs, personalities, interests and preferences in appropriate language. There was information accessible to staff to that they could know people and provide a person-centred approach in their care. Work was underway to develop a ‘life story book’ for each person, reflecting who they were, and the important people and events in their lives.

Activities were happening during the day and were varied and appropriate. People made a choice about what to take part in. In the communal areas we saw staff talking with people individually and that people were engaged and content.

The complaints procedure was clearly displayed around the home. There was a clear process for managing complaints and we saw that these were responded to in a clear and timely way, with a record of actions taken.

People’s wishes for end of life were recorded. The service had worked with local doctors to enable people to record their preferred place of care in the event of illness.

The registered manager provided strong leadership to set new standards of care and to look for areas where they can continuously improve. There was a positive culture. Staff were proud to work at the home and contribute their own ideas to how people’s lives can be improved.

There was a monthly clinical governance and quality assurance system in place to ensure that all key areas of the service were monitored. There was recorded evidence that this was effective and management oversight was strong. The legal requirement for statutory notifications to the CQC were understood and met.

People, relatives and professionals gave us very positive feedback about the visible improvements and changes that have been made at the home and in the way the care is provided. The management has been open to new ideas and sought out the resources, best practice and evidence to develop the service. We saw there was an ambition to develop further and ensure that quality care and strong values were embedded into the culture of the service.

Surrey Heights is registered to provide accommodation with nursing care for up to 39 people. At the time of our visit, there were 26 older people living at the home. The majority of the people who lived at the home were living with dementia and a mental health diagnosis. The accommodation is provided over three floors that are accessible by stairs and a lift. The service is a detached house with communal lounges, dining room, kitchen and bathroom facilities.

There was a registered manager in post however they were not present on the day of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. On the day of the inspection we were supported by the deputy manager. Since the inspection changes to the management arrangements have taken place and a new manager is in post who will apply to register with the commission.

At our previous inspection on 18 May 2016 we found a breach in relation to ineffective recruitment systems. We also made two recommendations to the provider in regard to infection control, to improve care plans and improvements around the supervision of staff. The provider sent us an action plan and provided timescales by which time the regulations would be met. They stated that the actions would be completed by 1 September 2016.

During this inspection we found that although some improvements had been made in regard to our recommendations and breach of regulation we found new concerns that put people at risk of harm.

People were at risk because there were inadequate systems and arrangements to protect people from the spread of infection. Appropriate standards of cleanliness were not being maintained. Infection control policies and procedures were in place; however staff had not followed these. We raised concerns about the conditions of mattresses, furniture, commodes, and bedding in the home.

There were insufficient numbers of staff deployed to meet people’s needs. This had an impact on the care and support provided and the cleanliness of the home.

People were not always safe because up to date risk assessments were not in place to identify, assess and manage risk safely and to minimise the risk of harm to people.

Staff did not have a clear understanding of their responsibilities regarding the Mental Capacity Act or Deprivation of Liberty Safeguards. Where people lacked capacity they were not fully protected and best practices were not being followed. MCA assessments were not being completed specific to particular decisions.

There were inconsistencies in how staff used their training and put this into practice which put people at risk. We made a recommendation that the registered provider follow their policy in relation to supervision to ensure staff received appropriate support and supervision for their role.

The home could be improved because it was not easy for people living with dementia or who had impaired sight to find their rooms or their way around the service as all areas looked the same. We made a recommendation that the provider researches and implements relevant guidance on how to make environments used by people who live with dementia more ‘dementia friendly’.

People were not always treated with dignity and respect. There was a strong smell of urine in people’s rooms and in the corridor outside rooms that people had to endure. Staff were not always listening to what people wanted.

Some peoples’ rooms were bare and lacked personalisation. Other rooms did have people’s own furniture and personal items so that they are surrounded by things that were familiar to them.

Pre-assessments of people needs were undertaken before they moved in however; these were not always used effectively in determining whether their needs could be met.

Care plans did not always reflect up to date information regarding people’s care and support needs, therefore they did not provide staff with guidance they needed to deliver responsive care. There was a risk that new staff would not have this knowledge or access to up to date information to enable them to provide appropriate and safe care to people. Staff who had been at the home for some time had got to know people well and they were providing care that meet peoples individual needs and preferences.

Activities took place, however they were not person-centred. During the inspection we observed activities taking place but this did not include the majority of the people and there were only a few one to one activities taking place. We found there was no physical stimulation around the home for people that would provide them with something to do during the day when organised activities were not happening.

The quality assurance systems were ineffective in reviewing the quality of the service provided. Audits did not identify poor practices and therefore action was not taken to improve the care people received.

People told us they were safe at the home. Staff had a good understanding about the signs of abuse and were aware of what to do if they suspected abuse was taking place. The home had a business contingency plan that identified how the home would function in the event of an emergency such as fire, adverse weather conditions, flooding and power cuts.

People were not always offered choices of the meal they wanted. However people had enough to eat and drink throughout the day. Where people needed support with eating; they were supported by a member of staff, apart from in one instance we observed.

People were supported to have access to healthcare services and healthcare professionals were involved in the regular monitoring of their well-being. The provider worked effectively with healthcare professionals and was pro-active in referring people for assessment or treatment.

Staff treated people with compassion and kindness when providing care. People’s relatives and friends were able to visit when they wanted.

People knew how to make a complaint. People told us if they had any issues they would speak to the manager. People told us the staff were friendly, supportive and management were always approachable.

During this inspection we found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also made three recommendations to the provider. You can see what action we told the provider to take at the back of the full version of this report

Surrey Heights is a care home which provides accommodation and personal care for up to 39 people. At the time of our visit there were 24 people living at the home most of who are living with dementia. The accommodation is provided over two floors that were accessible by stairs and a lift.

At the time of our visit there was a registered manager 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.

People were not always protected from being cared for by unsuitable staff because although recruitment processes in place, they were not always followed.

Although quality assurance systems were in place and had improved. We have made a recommendation with the intention that quality assurance systems continue to improve to identify and rectify record keeping and staff practices.

Although the home was clean, people were not always safe because the processes in place to prevent and control infection were not always followed by staff. We have made a recommendation that the provider ensures that staff follow the current guidelines and policies in regard to infection control.

People and relatives told us they were safe at Surrey Heights. Staff had a good understanding about the signs of abuse and were aware of what to do if they suspected abuse was taking place. There were systems and processes in place to protect people from harm.

There were sufficient numbers of staff deployed who had the necessary skills and knowledge to meet people’s needs.

Medicines were managed, stored and disposed of safely. Any changes to people’s medicines were prescribed by the person’s GP and administered appropriately.

Fire safety arrangements and risk assessments for the environment were in place to help keep people safe. The service had a business contingency plan that identified how the home would function in the event of an emergency such as fire, adverse weather conditions, flooding or power cuts.

Staff were up to date with current guidance to support people to make decisions. Staff had a clear understanding of Deprivation of Liberty Safeguards (DoLS) and the Mental Capacity Act (MCA) as well as their responsibilities in respect of this.

The registered manager ensured staff had the skills and experience which were necessary to carry out their role. Staff had received appropriate support that promoted their development. The staff team were knowledgeable about people’s care needs. People told us they felt supported and staff knew what they were doing.

People had enough to eat and drink and there were arrangements in place to identify and support people who were nutritionally at risk. People were supported to have access to healthcare services and were involved in the regular monitoring of their health. The provider worked effectively with healthcare professionals and was pro-active in referring people for assessment or treatment.

Staff treated people with compassion, kindness, dignity and respect. People’s preferences, likes and dislikes had been taken into consideration and support was provided in accordance with people’s wishes. People’s privacy and dignity were respected and promoted when personal care was undertaken.

People’s needs were assessed when they entered the home and on a continuous basis to reflect changes in their needs. Staff understood the importance of promoting independence and choice. People were able to personalise their room with their own furniture and personal items so that they were surrounded by things that were familiar to them. People had the right to refuse treatment or care and this information was recorded in their care plans.

People were encouraged to voice their concerns or complaints about the service and there were different ways for their voice to be heard. Suggestions, concerns and complaints were used as an opportunity to learn and improve the service people received.

People had access to activities that were important and relevant to them. People were protected from social isolation through systems the service had in place. There were a range of activities available within the home and the community.

People’s care and welfare was monitored regularly to ensure their needs were met. The provider had systems in place to regularly assess and monitor the quality of the care provided.

People told us the staff were friendly and management were always approachable. Staff were encouraged to contribute to the improvement of the home. Staff told us they would report any concerns to their manager and felt supported by the management.

We found one breach 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 this report.

We spoke with three people and one person's relative. Many people had a diagnosis of dementia and some were not able to communicate with us in a meaningful way. Therefore we used our Short Observational Framework for Inspection (SOFI) to enable us to observe people's experiences of the care provided. We spoke with two visiting professionals about the service people received.

We found that staff were caring and responsive to people's needs. One person told us that it was 'Very nice' and another person's relative told us 'There are some wonderful staff.' Health professionals told us that they had no concerns and that the service had improved.

We found that adequate information had been provided to people.

Staff had improved the quality of their interactions with people. Action had been taken in relation to people's sensory mats.

The home was clean and infection control guidance had been followed.

There was evidence of the required pre-employment checks for agency staff.

Staff had received regular supervision that had been documented.

The provider had monitored the quality of the service provided.

Records were kept securely.

We found that a number of people had dementia and that insufficient information had been provided for their needs.

People had care plans and risk assessments in place. However people's care had not always been delivered in a way that promoted their welfare and safety.

There were processes in place to safeguard people.

Infection control guidance had not always been followed.

The provider was unable to provide evidence that the required pre-employment checks had been completed in relation to all agency staff.

Staff had not all received regular supervision, in particular agency staff.

There were systems in place to identify and assess risks to people, however, these were not fully effective.

People's personal records had not been stored securely.

In this report the name of a registered manager appears who was not in post and not

managing the regulatory activities at this location at the time of the inspection. Their

name appears because they were still a Registered Manager on our register at the time.