Archived: Heron House Care Home

On 23 April 2014 we carried out an unannounced inspection and found that people living at Heron House Care Home needed to have a better quality of life. We also found that the management of the service was not as good as it should have been.

Since our last inspection, we had received a number of concerns from the public, including relatives of people living at the care home, and from the local authority in relation to the standard and quality of people's care. The concerns also included those in relation to the management of the service. The purpose of the inspection of 23 September 2014 was, therefore, to assess how people were being looked after and if improvements had been made following our last inspection of 23 April 2014.

An adult social care inspector, a pharmacist inspector and an inspection manager carried out this unannounced inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

We spoke with a number of people who used the service, but most of these were unable to tell us what it was like living at the care home, because of their complex communication needs. We also spoke with representatives of the owner of the care home, Four Seasons Homes No 4 Limited, and spoke with seventeen members of staff, which included nursing and care staff, housekeeping, maintenance and catering staff. In addition we spoke with three visiting relatives.

We looked at records in relation to the management of the service and eight out of eighty-two people's care records and twenty people's medications. We observed activities taking place throughout the care home; this also included observations of the lunch time activities on Wendreda and Eastwood units. We reviewed the information that we have received about the care home since our last inspection.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

If you wish to see the evidence supporting our summary, please read the full report.

Is the service safe?

People told us they felt safe because the staff had treated them well.

Health and safety risk assessments had been carried out. However, some people remained at risk of harm to their health in relation to choking developing pressure ulcers and not having direct access to their call bells. We have asked the provider to take action in relation to care and welfare.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care services. An application had been submitted and work was in progress to submit other applications to the relevant authorities. Policies and procedures were in place in relation to this matter.

The management of medicines failed to protect people from harm. We have asked the provider to take action in relation to the management of medicines.

There was a sufficient number of trained staff employed to provide people with safe support and care. Arrangements had been made to recruit more permanent nursing and care staff.

Records were now being kept safe and secure and records were maintained for fire safety and temperatures of hot water. Not all care records were kept up-to-date. This meant that people were at risk of unsafe support and care, especially with the high number of agency staff working at the home. We have asked the provider to take action in relation to quality assurance.

Is the service effective?

We found that effective measures had been taken to promote the healing of people's pressure ulcers.

At our last inspection we found that there was a lack of meaningful activities provided and this situation remained the same. We saw people had minimal stimulation to keep them from falling asleep or 'looking into space'. Where people were provided with stimulation, this was not always in line with the principles of good dementia care.

Quality improvements were needed so that people could make choices from the menu options and at the time of when their meal was being served. A range of food options was available to meet people's individual dietary likes and dislikes. People were given enough to eat and drink to keep them healthy.

Members of staff had not received one-to-one supervision sessions to monitor their work performance or assess their individual training needs. However, work was in progress to provide members of staff with supervised support. Staff members told us that they felt an increased level of support since the changes had been made with the current leadership of the home.

is the service caring?

People who we spoke with said that they had no concerns about how they were being looked after. We observed that they were looked after by caring and respectful members of staff. However, the culture of care was task driven when staff missed opportunities to engage with people when helping them with their eating, drinking and moving and handling needs. We have asked the provider to take action in relation to how people are looked after to maintain and promote their health and wellbeing.

Is the service responsive?

People's needs, choices and personal preferences had not been assessed or recorded. Therefore, we found it was difficult to know if these had been acted on. However, people who were able to tell us said they were satisfied with how their needs were responded to.

Is the service well-led?

Following our last inspection of 23 April 2014, we had received an action plan which told us that remedial action would be taken to become complaint with the regulations. The action plan was ineffective and failings in safe and quality care remained. There were inadequate monitoring and reviewing systems in place in relation to the management of staff, records and audits.

A registered manager was in post. In their current absence, there had been temporary arrangements made to manage the service. Since these management changes had been put in place, people's relatives and staff said that they felt listened to and supported.

Members of staff told us that they had training to do their job. However, they said that they had not had the support or leadership to enable them to enjoy their work or to work as a joined up team. Some staff members indicated that they had become demoralised. However, since the temporary management changes, they said that they felt more supported and encouraged to do their job.

We found that there had been a lack of timely action to replace emergency lights in Heron Court unit. We noted that these had been found to not be working when they had been tested during July 2014. This lack of action meant that people may not be fully protected during fire safety evacuation procedures.

We have asked the provider to take action in relation to the quality and safety of people's support and care.

Is the service caring?

People told us that they received respectful support from care and nursing staff. Staff told us that they were well supported so that they could provide safe care and support to people but that more support was needed at key times during the day to ensure people received appropriate care and support. We saw that care and support was not always consistently provided especially at mealtimes.

Is the service responsive?

We saw that people's personal care and social support needs were not always being met. People's individual choices and preferences as to how they liked to be supported were recorded. People we spoke with told us that staff were kind and helpful. Observations we made during the inspection confirmed this to be the case but that support was task orientated and there was little time for social interaction

Is the service safe?

Risk assessments regarding people's individual care and support needs were in place to minimise any potential harm to people using the service. Safeguarding procedures were in place to ensure incidents were appropriately reported. Carers understood their roles and responsibilities in making sure people were protected from harm. We saw that Mental Capacity Assessments were in place and best interest meetings involving the person's family where needed to ensure people's needs were being safely met. The provider needs to ensure that there are appropriate levels of staff to meet people's needs at all times as there were a lack of activities and time for staff to socialise with people living in the home. Improvements were needed regarding quality assurance arrangements and to preserve confidentiality of some records held in the home and monitoring of medication stocks.

Is the service effective?

We found that nurses and care staff were knowledgeable about people's individual care and support needs. People that we spoke with and from our observations confirmed that staff provided respectful and kind support. Care planning documentation was detailed and reviewed to ensure that care and support needs were being met. However, some records were not always up to date. The manager stated that support documentation would be audited to ensure they met people's assessed needs.

Is the service well led?

Some staff that we spoke with told us that they did not always feel supported by the management team. Staff regularly received training to safely provide care and support. People that we spoke with and observations made showed that people were listened to and support was provided in a kind and safe manner. Surveys were carried out to gather opinions from people using the service and their relatives. Quality assurance systems were in place to audit the care and services provided however, some quality assurance procedures need improvement to ensure that people received safe care and have their records stored to protect confidentiality.

Relatives who we spoke with made positive comments about the care that was being provided. One relative said, "They have always kept me informed about my mother's needs". Another relative said they would like to be informed more frequently about their relative health and wanted to know when things were alright as well as when there had been adverse changes in their family member's wellbeing.

Care and support had been regularly reviewed to ensure that people's needs were being met. There was evidence of people's involvement in the planning of their care and support.

There were safeguarding policies and processes in place. It was noted that improvements had been made to ensure that the Local Authority's safeguarding policies and contact information were available to all staff.

There were appropriate arrangements in place for the safe management of medication.

There were suitably trained and adequate numbers of staff working to ensure that people's needs were being met.

The service had appropriately reported all safeguarding concerns to the Local Authority and had regularly notified CQC when these events had occurred.