Archived: Heritage Healthcare-Middlesbrough

Updated 29 April 2017

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.

One adult social care inspector carried out an announced inspection on 8 November 2016 and one adult social care inspector and one pharmacist inspector carried out inspection on 22 November 2016. This meant the registered provider and staff knew we would be attending on both days of our inspection because we needed to be sure that someone would be in the office.

Before the inspection we reviewed all of the information we held about the service, such as notifications we had received from the service and also information received from the local authority who commissioned the service. Notifications are changes, events or incidents that the provider is legally obliged to send us within the required timescale. We also spoke with the responsible commissioning officer from the local authority commissioning team about the service. Prior to inspection, the registered provider had made us aware of some concerns relating to the quality of the service, which had been identified following a whistleblowing.

The registered provided completed a provider information return (PIR) when we asked them to. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

During this inspection, we spoke with 12 people who used the service and 19 relatives over the telephone. We also visited four people in their own home. We spoke with the registered provider, manager, deputy manager, care coordinator and six care staff.

We reviewed six care records and ten medicine administration records. We looked at the supervision, appraisal and training summary records for 61 staff; three staff induction records and three supervision and appraisal records. We also looked at five staff recruitment records and records relating to the day to day running of the service at the registered providers office.

Updated 29 April 2017

This inspection took place on 8 and 22 November 2016. Both days of inspection were announced which meant the registered provider and staff knew that we would be attending. This meant we could be sure someone would be in when we visited the service.

This service was registered on 8 November 2013 and we carried out a previous inspection on 7 May 2014. We found the service was meeting all of the requirements of the Health and Social Care Act 2008 and associated regulations.

Heritage healthcare Middlesbrough provided personal care to 131 people living in their own homes in Stockton-On-Tees. This included people living with a dementia and people with physical and mental health difficulties. At the time of inspection 61 staff provided personal care to people.

Prior to inspection, the registered provider made us aware that the registered manager had left the service in 6 October 2016. 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. At the time of inspection, a registered manager from another service within the registered provider’s portfolio had taken over the running of this service.

The manager who took over from the registered manager had made us aware of concerns surrounding the service. We found that the concerns they raised around staff practices were valid.

Staff training in safeguarding was up to date, however staff were not always clear about what aspects of care could constitute a safeguarding concern. We found staff did not always raise safeguarding concerns or when they had raised concerns with the previous registered manager, they told us safeguarding alerts had not always been made to the local authority safeguarding team. There were gaps in safeguarding records.

Staff understood the whistleblowing procedure, but told us they did not feel confident raising concerns with the registered manager in post prior to our inspection. When a staff member did raise concerns with the registered provider, immediate action was taken to address these concerns.

Risk assessments were in place but didn’t always reflect people’s actual risks. There were gaps in the information in these risk assessments and they had not always been regularly reviewed.

Missed calls had not always been recorded. Missed calls meant people could be left at risk of harm as no one would know if they had become unwell or had an accident . Records did not show what action had been taken to reduce missed calls and the impact of harm to people.

We heard mixed reviews about staffing levels. Staff told us there were missed calls because of staff shortages and they felt pressured to take on extra calls.

Medicines were not managed safely. People did not always receive their medicines as prescribed. Risk assessments for medicines were not always in place and there were gaps in all medicines records looked at.

Most staff had completed mandatory training; however we identified that staff lacked knowledge in areas such as the Mental Capacity Act and deprivation of liberties safeguards.

All staff were enrolled onto the care certificate. The registered provider told us that observations of staff had been carried out to determine their competency in each of the key areas, however records were not in place to confirm this during inspection.

There was conflicting information in the care records about people’s ability to give consent. Staff lacked understanding about the Mental Capacity Act and best interest’s decision making.

Staff had not received regular supervision and appraisals. This meant staff had not been supported to carry out their roles

Staff did not know which people had a valid ‘Do not attempt cardio-pulmonary resuscitation’ (DNAR) certificate in place. There were gaps in the care records for this.

We spoke to people, their relatives and staff about the care provided. We heard mixed reviews about the quality of care.

People told us they were involved in their care when they started using the service. However, some people’s records showed that care and support was delivered to them without any care plans in place. This meant staff did not know people’s needs, wishes and preferences. Regular reviews of people’s care had not been carried out.

We found that people’s privacy and dignity was not always respected or maintained. People told us care was not always carried out in the way they expected and they were not always spoken to in a caring and respectful manner.

Care plans for end of life care had not always been put in place. We identified this was because of a lack of communication at the service. Not all staff were aware when people were on the end of life pathway and the care and support people needed.

Care plans were not person-centred and did not reflect people’s needs, wishes and preferences. This meant staff did not have the information they needed to provide the care which people wanted and monitoring and reviewing of specific conditions such as epilepsy had not taken place. We also found that recently updated care plans still contained gaps in information.

Care plan reviews did not regularly take place with people. Where actions were identified, they had not been addressed. When people made verbal requests, such as changes to the care they needed or the time they needed it we identified these requests were not met.

People and relatives told us they had made complaints. We found that complaints had not been recorded; some had been recorded as incidents. There were no records in place to show what action was taken to address complaints when they were made.

Audits had not been regularly carried out at the service. Audits by the registered provider had been carried out and actions identified, however they did not highlight the level of concerns which we had during inspection. Action plans had not been addressed and had been signed off as completed when they were still outstanding.

The registered provider had failed to notify the Commission when required to do so when people using the service died in their own home. Where safeguarding alerts had been made to the local authority, the Commission had not been notified. We are dealing with these matters outside of the inspection process.

Staff told us that they had noticed some positive changes at the service since the new manager came into post.

Staff worked with health professionals to support people with their nutrition, hydration and pressure area care.

Staff supported people to seek medical advice when they became unwell

We found eight breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and two breaches of the Care Quality Commission (Registration) Regulations 2009 during inspection on 8 and 21 November 2016. These breaches related to person centred care, dignity, consent, safe care and treatment, safeguarding, complaints, good governance, staffing and failure to notify the Commission about the death or a service user and safeguarding alerts. You can see what action we told the provider to take at the back of the full version of this report.