10 July 2018
During a routine inspection
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.