Archived: Heartlands

Updated 25 August 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on the 10 and 13 July 2018 and was unannounced. On day one of the inspection, the team consisted of two inspectors, a specialist advisor and two experts by experience. The specialist advisor was a nursing practitioner with experience of working within a dementia setting. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of dementia care service. On day two of the inspection, the team consisted of one inspector.

As part of the inspection process we looked at information we already held about the provider. Providers are required to notify the Care Quality Commission about specific events and incidents that occur including serious injuries to people receiving care and any incidences that put people at risk of harm. We refer to these as notifications. We checked if the provider had sent us notifications in order to plan the areas we wanted to focus on during our inspection. We also reviewed the Provider Information Return (PIR) the provider had submitted to us. A PIR is a form that asks the provider to give key information about the home, what the service does well and improvements they plan to make. We reviewed regular quality reports sent to us by the local authority to see what information they held about the service. These are reports that tell us if the local authority commissioners have concerns about the service they purchase on behalf of people. We also contacted the Clinical Commissioning Group for information they held about the service and reviewed the Healthwatch website, which provides information on health and social care providers. This helped us to plan the inspection.

We used a number of different methods to help us understand the experiences of people who lived at the home. We spoke with 11 people, ten relatives, eight staff members that included nursing, care and domestic staff. We also spoke with the registered manager and deputy manager and spent time observing the daily life in the home including the care and support being delivered to people. As there were a number of people living at the home who could not tell us about their experience, we undertook a Short Observational Framework for Inspection (SOFI) observation. SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We sampled six people’s care records to see how their care and treatment was planned and delivered and five medication records to see how their medicine was managed. Other records looked at included three staff files to check suitable staff members were recruited. The provider’s training records were looked at to check staff were appropriately trained and supported to deliver care that met people’s individual needs. We also looked at records relating to the management of the service along with a selection of the provider’s policies and procedures, to ensure people received a good quality service.

Updated 25 August 2018

This unannounced, comprehensive inspection took place on the 10 and 13 July 2018. At the last inspection on the 10 and 11 November 2016, the provider had not met some of the legal requirements and the service required improvement in the key questions: is the service effective and well-led? The remaining key questions is the service safe, caring and responsive were rated as ‘good’.

Heartlands 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.

At the time of our November 2016 inspection, Heartlands was undergoing a major modernisation project. At this inspection the work had been completed and the service was registered to accommodate 62 people in one adapted, three story building comprising of three separate units. The ground and first floor units provided support to people requiring residential and dementia care. The second floor unit provided support to people that required nursing care and lived with more complex needs. At the time of our inspection 34 people lived at the home. The home provides care and support to people from a range of ages, gender, ethnicity and physical abilities.

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 and associated Regulations about how the service is run.

At the last inspection in November 2016, the provider had not met all the legal requirements because mental capacity assessments were not specific decision based, consent was sought solely from family members who were not authorised to do so and best interests meetings were not consistently recording the decisions required to be made. This meant the principles of the Mental Capacity Act 2005 had not been followed. At this inspection, we found there had been an improvement because the provider had taken appropriate action when they had identified people who did not have capacity to consent to their care or treatment. Best interests processes had been followed, mental capacity assessments were time relative and decision based and applications had been made to authorise restrictions on people's liberty in their best interests.

Although the service employed sufficient numbers of staff, improvement was required to ensure staff levels were assessed, where appropriate to ensure people’s needs were consistently met. There was also some improvement required to ensure there was a consistent approach from staff to support people that presented with behaviours that challenge. Improvement was also required to ensure medicines were stored at a constant, safe room temperature. The provider had governance systems in place to monitor the quality of the service being delivered to people. However, improvement was required to ensure audits identified areas for improvement for example, medicine wastage and expired DoLS applications to make sure people were not being unlawfully restricted.

People felt safe living at Heartlands. The provider had processes in place to protect people from risk of abuse and staff knew what action to take to report any suspicion of abuse. Risks to people were appropriately assessed and staff knew how to keep people safe from the risk of avoidable harm. People were supported to take their medicines safely. The home environment was clean and people were protected from risk of infection. The provider had processes in place to share information with staff when things had gone wrong so learning could take place to reduce risk of reoccurrence.

People were supported by staff that received training. People’s needs were assessed and staff knew people well. The provider ensured people’s nutritional needs were met with good quality food, regular drinks and snacks and where appropriate referrals were made to healthcare professionals for people at risk of losing weight. Staff followed advice given by healthcare professionals to support people’s wellbeing. The provider had designed the home environment to consider people living with dementia with large spacious areas, dementia friendly signage and colour schemes.

People were supported by staff that were kind and caring and they treated people with respect. People and their relatives were involved in the planning and review of their care and support. Staff encouraged people to, where possible, maintain their independence.

When people’s needs changed, they were referred quickly and appropriately to healthcare professionals. There were a range of individual and group activities available for people to enjoy although some felt there could be more done with individual based interests to maintain people’s hobbies. People and their relatives had no complaints but knew how and who to complain to if they needed to. The provider had appropriate processes in place to ensure people at the end of their life were treated with respect and had their final wishes followed.

People and relatives told us they thought the service was well managed and staff felt supported by the management team.