The Heathers

The Heather's is a specialist residential service providing accommodation and personal care to a maximum of 34 people, inclusive of respite service. The service provides support to people with alcohol and/or substance misuse. The Heather's is an adapted building which includes double bedrooms for people and ensuite facilities. At the time of our inspection there were 27 people using the service.

People’s experience of using this service and what we found

The home was clean, and the risk of infection was reduced by effective infection prevention and control measures being followed. The provider had refurbished some areas of the home and had plans for further development. People were supported by sufficient staff who received training to support them in their role. People's risks were assessed, and care plans put in place to support people in the way they wanted. We identified some inconsistencies in care plans, but the provider took immediate action to address this.

People experienced safe care from staff who understood how to protect them from abuse and avoidable harm. Risks to people's safety were mitigated and people received their medicine as prescribed. Where incidents or accidents occurred, these were investigated and analysed to reduce the risk of re occurrence.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People’s hydration and nutritional needs were met, and people told us they enjoyed the food provided at The Heathers.

The culture we observed within the service was open and friendly. Senior team members were visible throughout the service. Staff said they were well supported by the registered manager and senior team. Regular audits and checks were carried out by the team leaders and the registered manager. These were used to review the quality and safety of the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 25 October 2022), and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced focused inspection of this service on 12 and 21 September 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, medicine management, consent, premises and equipment and good governance.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe, effective, and well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Heathers on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Heathers is a specialist residential service providing personal care to a maximum of 34 people, inclusive of respite service. The service provides support to people with alcohol and/or substance misuse. At the time of our inspection there were 33 people using the service. The Heathers is an adapted building which includes double bedrooms for people and ensuite facilities.

People’s experience of using this service and what we found

We have made a recommendation about the safe storage of some medicines. Medicines were not managed safely. People were not always safe. People were at risk of harm as the provider had not identified, assessed or mitigated risks. This included risks related to people’s health and care needs as well as environmental risks. People told us “I don’t feel safe here, my belongings are stolen, and I get threatened by others but nothing is done about it”. Near misses were not always recorded. The environment was tired, not homely and not well maintained. The quality of basic essentials such as bedding and soft furnishings were poor. There was a lack of care and attention visible throughout the whole home. For example, dining chairs in the conservatory area were heavily stained with food debris.

Recruitment processes were in place to check staff were safe and suitable to work in the service before they were employed. Staffing levels were sufficient through the week days but staff told us they reduced on a weekend making it difficult to complete all tasks.

People’s care records were not all person centred and some did not fully reflect their needs. Preadmissions to the service were not completed safely with assessments and documentation for care plans not completed efficiently. There was little to occupy and interest people. People did not receive sufficient professional support to manage their drug or alcohol dependence and had no plans in place to reduce this reliance, so they were able to live independently.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests. There were no mental capacity assessments or best interest decisions for people who were in receipt of restrictive practices.

There was a lack of effective leadership and an ineffective governance structure which meant the service was not appropriately monitored at manager or provider level.

People’s nutritional needs were met, and people were happy with the choice of food. Staff training was up to date and most staff were receiving supervisions. Infection control measures were followed, staff were observed to be wearing masks correctly on both inspection dates.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 9 March 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service. As a result, we undertook a focused inspection to review the key questions safe, effective and well led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence the provider needs to make improvements. Please see the safe, effective and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Heathers on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, medicines management, premises and equipment, consent to care and good governance at this inspection.

We have made a recommendation about the safe storage of some medicines.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Heathers is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and we looked at both during this inspection. The Heathers provides care and support to people who had past or present alcohol dependency problems. The home is an adapted property. At the time of our inspection there were 33 people using the service.

The last full inspection of the service was in July 2016. At that time we found the provider was in breach of two regulations, there were related to staffing and good governance. The provider sent us an action plan to show what they would do to make the required improvements. During this inspection, we found the provider had made the required improvements. We also carried out a shorter focussed inspection in June 2017. During that inspection, we looked at how the service supported people to manage their money and checked to see if the service was meeting the requirements of the Mental Capacity Act. We did not have any concerns during that inspection.

The service had a registered manager. 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.

We found the service was safe. Staff knew how to recognise and report any concerns about people’s safety and wellbeing. Staff knew about people’s individual needs and risks to people’s safety and welfare were identified and managed.

There were enough staff deployed, the provider had increased the number of staff on duty following the last inspection. Recruitment procedures were robust and were followed. This helped to protect people from the risk of being supported by staff unsuitable to work in a care setting. Staff received the training they needed to carry out their roles safely and effectively. Staff told us they felt well supported.

People’s medicines were managed safely.

The home was clean and safe. The provider was in the process of making improvements to the environment to make sure it met the needs of people who used the service.

People’s nutritional needs were identified and met. People were satisfied with the food and told us they were always offered choices.

Staff understood the Mental Capacity Act and Deprivation of Liberty Safeguards and how this affected their roles. This helped to make sure people’s rights were protected and promoted.

People’s needs were assessed before they moved into the home. This helped to ensure their needs could be met. People had person centred care plans, which detailed their individual needs and preferences. People made decisions about their care and treatment.

The service worked openly and cooperatively with other agencies to make sure people received the support they needed to maintain and improve their health.

The registered manager and staff team were kind and compassion. They treated people with respect and dignity.

Since the last inspection, we found improvements had been made to the range of activities offered to people in the home and in the community.

People knew how to raise concerns. All concerns were recorded and we saw the management acted to try to resolve any issues or concerns raised.

We found the culture in the home was positive and inclusive. The management team and staff had a person centred approach and were committed to continuously improving the experiences of people who used the service.

People who lived at the home, relatives and other stakeholders spoke positively about the service and the standards of care and support provided.

The provider had improved the systems in place to audit and check the quality of the service and we found they were being operated effectively.

The provider used people’s views and feedback to make changes and improvements to the service.

The Heathers is privately owned by Yorkshire Regency Health Care Limited. The home provides care and support for up to 34 people who have past or present alcohol dependency problems. The home is a detached adapted property located close to Bradford City centre and within walking distances of Lister Park, local shops and other amenities. It is on a main bus route and there is a car park to the front of the property.

At the time of the focused inspection on 14 June 2017 there were 32 people using the service.

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 told us they felt safe living at The Heathers and we found staff understood how to keep people safe from harm. Good systems were in place to make sure people were protected from any financial abuse.

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 support this practice. The legal requirements relating to Deprivation of Liberty Safeguards (DoLS) were being met.

The Heathers Residential Care Home provides care and support to people who have past or present alcohol dependency problems. The home is a detached adapted property located close to Bradford City centre and within walking distances of Lister Park, local shops and other amenities.

The home had a registered manager in post at the time of the inspection. 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 home had a safeguarding policy in place which made staff aware of their roles and responsibilities. We found staff knew and understood how to protect people from abuse and harm and what might constitute abuse.

We found the service was meeting the requirements of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS).This legislation is used to protect people who might not be able to make informed decisions on their own. We asked the staff about the MCA and DoLS and found they had a good working knowledge of the legislation and how it affected their roles.

We saw staff were patient and caring toward the people they supported and received appropriate levels of training and supervision to carry out their roles effectively. People who used the service told us they were happy living at the home and were complimentary about the registered manager and staff team. However, we had concerns there were at times insufficient staff on duty to meet people’s needs particularly on night duty.

We saw arrangements were in place that made sure people's health needs were met. For example, people had access to the full range of NHS services. This included GPs, hospital consultants, community health nurses, opticians, chiropodists and dentists. We found staff responsible for administering medication received appropriate training and people received their medicines safely. However, the providers medication policy was out of date and based on regulations which were no longer in use.

We saw some areas of the home required refurbishment to ensure they provided people with a safe and comfortable environment.

We saw there was a complaints procedure available which enabled people to raise any concerns or complaints about the care, support or treatment they received. However, the policy referred to regulation which were no longer relevant.

We also saw the statement of purpose, which contains detailed information about the service, required updating as it referred to a policy which had not yet been developed and facilities which were no longer available.

We found the quality assurance monitoring systems in place were not robust as not all shortfalls in the service highlighted in the body of this report had not been identified through the internal audits system.

We identified two breaches 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 the report.

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, their relatives, staff supporting them and from looking at records.

Is the service caring?

We spoke with staff that told us they treated people with respect and dignity and could give us examples of how they do so. We observed staff supporting people according to their care plans. The people who used the service told us staff were positive and they felt they could talk to all staff.

Is the service responsive?

We saw signatures of people who used the service on reviewed documentation. Questionnaires were sent out to people who used the service, staff and external professionals. We saw concerns were looked into and adjustments were made. There was a complaints system in place. One complaint had been acknowledged, investigated and responded too.

Is the service safe?

Care plans identified risk and had supporting risk assessments to keep people safe. We saw sufficient levels of trained staff to support the people using the service. There was a safeguarding policy in place with adult protection literature in the entrance to the building.

Is the service effective?

Care plans showed people's needs had been assessed and care plans were person centred with information about preferences, likes and dislikes taken into account. Daily notes showed external professional were involved at peoples request or if staff believed it would benefit someone's health. We saw end of life plans had been signed by people that used the service.

Is the service well-led?

The service worked well with other agencies to make sure people received care in a joined up way. Records seen by us showed that identified shortfalls were addressed and concerns and complaints were investigated. Staff told us they were clear about their roles and responsibilities. This helped to ensure that people received a good quality service at all times.

A relative told us they were involved in discussions and decisions about their relatives care needs and were kept informed about any changes. They said "my relative loves it here, he gets choices of food and drink. My relative had seen their care plan and signed it and staff respected their dignity and privacy and can go out when they want." Another person who used the service told us "I live here like a king, I have my own room it's my home. I live like I want to live."

People who lived in the home and a relative said the food was good and the home was nice and comfortable.

We also spoke with three visiting health professionals. One told us "the care is always very good, the staff do a good job with clients who can be very challenging to care for, I have seen them calmly deal with conflict between the residents which has diffused the situation and prevented possible harm " Another told us "this is my third visit here and I have found no issues with the care provided."