Heathlands Care Centre

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

Changes had been made to improve the quality and safety of care delivered. However, insufficient time had passed to demonstrate sustained improvements.

Staff were not always provided with clear guidance about how to manage risks for people. Care plans contained inaccurate and contradictory information.

People were not always protected from the risk of abuse. We observed a staff member forcefully put a spoon in someone's mouth whilst supporting them to eat.

People were not always given person-centred care. The provider had not ensured people’s care plans contained sufficiently detailed or accurate information to support staff to meet people’s needs and preferences.

Improvements to people’s dining experience had been made by staff. People were supported to maintain a healthy diet. The food was varied and appealing and alternatives were offered at mealtimes. Snacks and drinks were available at all times.

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 consent to receiving care and support was sought by staff.

Staff reported safeguarding concerns to the relevant authorities. Enough staff were deployed to support people. Medicines were managed safely. People were protected from the risk of acquiring an infection. Staff reflected on incidents and accidents to prevent recurrences.

People's needs, choices and preferences were assessed using evidence based methods. Staff training in relevant and specific areas was up to date. Staff worked with external professionals to meet people's needs and help them access healthcare services. Improvements to the environment had been made to ensure it met the needs of people living with dementia.

Some improvements to systems and processes were in place to ensure the delivery of safe, compassionate, well-led care. The provider was no longer in breach of some regulations, but some breaches have continued at this inspection. The registered manager used the action plan to track progress. There was a programme of audits, completed at different intervals, however more time is required to embed the new system of audits and checks. There is evidence of meetings with, relatives and staff, however there was a lack of evidence to demonstrate people’s views were recorded and acted upon. The registered manager and clinical lead work collaboratively to implement and review service improvements. Staff reported an improved workplace culture.

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

This service has been in Special Measures since 23 February 2023. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

The last rating for this service was inadequate (report published 23 February 2023) and there were 9 breaches of regulations.

We served a warning notice against the provider and issued 8 requirement notices. For the requirements notices, 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 the provider had complied with some regulations but remained in breach of other regulations.

At our last inspection we recommended that staff receive training in legionella management. At this inspection we found the service made progress towards this recommendation.

Why we inspected

This inspection was prompted due to the previous rating and to follow up on a warning notice.

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.

You can see what action we have asked the provider to take at the end of this full report by selecting the 'all reports' link for Heathlands Care Centre on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to person centred care, safe care and treatment and good governance. We have made a recommendation to the provider regarding investigating and responding to concerns raised. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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 overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Heathlands Care Centre is a residential care home providing personal and nursing care to up to 46 people. The service provides support to older people including with dementia and other mental health needs. The service is provided over two floors. At the time of our inspection there were 16 people using the service.

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

The provider did not operate effective quality assurance systems to oversee the service. These systems did not identify shortfalls in the quality and safety of the service or ensure that expected standards were met. People's, relatives' and staff’s feedback were not continuously used for making improvements to the service. We are mindful that relatives’ and professionals’ feedback was positive compared to our inspection findings and observations. To be fair and proportionate, we have included some of their feedback in the report.

The provider did not ensure consistent actions were taken to reduce risks to people and plans were not in place to minimise those risks. The provider did not ensure their safeguarding systems were operated effectively to investigate and follow the provider's procedure after becoming aware of an allegation of abuse. Effective recruitment processes were not in place to ensure, as far as possible, that people were protected from staff being employed who were not suitable. The management of medicines was not safe. Staff did not always follow correct infection prevention and control processes. Not all staff were up to date with, or had received, their competency checks and mandatory training. When incidents or accidents happened, they were not fully investigated, and there was little evidence of any lessons learned, or themes and trends reviewed. The provider did not ensure that clear and consistent records were kept for people who use the service and the service management. The provider did not inform us about notifiable incidents in a timely manner.

Staff deployment was not always managed effectively as we observed people did not always receive timely support. The provider did not ensure people’s hydration and food intake was consistently monitored and managed. People were at risk of social isolation because the provider did not ensure activities were more personalised and people had opportunities for social engagement according to their interests. The provider did not ensure the premises were suitable for people living with dementia or comply with the Accessible Information Standard. The care plans did not consistently contain information specific to people’s needs and how to manage any conditions they had. Staff did not have detailed guidance for them to follow when supporting people with complex needs.

We have made a recommendation about provider seeking training for Legionella awareness and how to manage the fire safety of the building.

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; the policies and systems in the service did not support this practice.

We observed that the interactions between people and staff were better but we also observed some practices still had to be improved. Staff upheld people's privacy and responded in a way that maintained people's dignity. People’s families and other people that mattered felt they were involved in the planning of their care. Most relatives said they were kept informed about their relative’s health and welfare. Relatives were positive about staff being kind, caring and respectful. Relatives felt they could approach the management or staff with any concerns and felt they had better communication and relationships with the service. The home manager appreciated staff’s work, contributions and efforts to ensure people received the care and support. Staff felt they could approach the management team for support and advice. Relatives felt people were safe living at the service and relatives felt their family members were kept safe. Staff described their responsibilities to raise concerns and report incidents or allegations of abuse. They felt confident issues would be addressed appropriately.

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 inadequate (published 19 August 2022). 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 the provider remained in breach of regulations. At our last inspection we recommended the provider sought advice and guidance on how to make the environment more dementia friendly and ensure they met the principles of Accessible Information Standard. At this inspection we found the provider had failed to act on both recommendations therefore had not made further improvements.

Why we inspected

This inspection was prompted due to the previous rating and to follow up on a warning notice.

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.

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We have found evidence that the provider needs to make further improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.

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

Enforcement and Recommendations

We have identified breaches in relation to quality assurance; risk management; safeguarding alerts management; notification of incidents; record keeping; effective and person-centred care planning; assessing and reviewing capacity and seeking consent; management of medicines, infection control; suitability of the environment for dementia; staff deployment, training, competence, and recruitment at this inspection. We have made a recommendation about further training regarding legionella safety management for the maintenance staff.

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.

Please see all the actions we have told the provider to take at the end of this report.

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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. 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.

Special Measures

The overall rating for this service remains ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Heathlands Care Centre is a residential care home providing personal and nursing care to up to 46 people. The service provides support to older people including with dementia and other mental health needs. The service is provided over two floors. At the time of our inspection there were 16 people using the service.

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

The provider and the registered manager did not operate effective quality assurance systems to oversee the service. These systems did not identify shortfalls in the quality and safety of the service or ensure that expected standards were met. People's, relatives' and staff’s feedback were not continuously sought to use for making improvements to the service. We are mindful that relatives’ and people’s feedback was positive compared to our inspection’s findings and observations. To be fair and proportionate, we have include their feedback throughout the report.

The provider and the registered manager did not ensure consistent actions were taken to reduce risks to people and plans were not in place to minimise those risks. Effective recruitment processes were not in place to ensure, as far as possible, that people were protected from staff being employed who were not suitable. The management of medicines was not always safe. Not all staff were up to date with, or had received, their competency checks and mandatory training. We did not have evidence the management team kept their knowledge and competencies checked and up to date. Staff did not have regular supervision and appraisals, and team meetings.

When incidents or accidents happened, it was not always clear that it was fully investigated, and if any lessons were learnt or themes and trends reviewed. The registered manager did not ensure that clear and consistent records were kept for people who use the service and the service management. The registered manager did not inform us about notifiable incidents in a timely manner. Staffing levels did not always support people to stay safe and well. Staff deployment was not always managed effectively as we observed people did not always receive timely support. People were at risk of social isolation because the provider did not ensure activities were more personalised and people had opportunities for social engagement according to their interests.

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; the policies and systems in the service did not support this practice.

People’s families and other people that mattered felt they were involved in the planning of their care. However, the care plans did not contain information specific to people’s needs and how to manage any conditions they had. Staff did not have detailed guidance for them to follow when supporting people with complex needs. Staff were not always following the care plan to provide the right support to people. Staff did not understand they used restrictive practice with people and did not have any guidance how to support people when they were anxious or distressed. People had meals to meet their nutrition needs. Hot and cold drinks and snacks were available between meals. However, we were not assured people’s hydration needs were monitored and met in a consistent way. Relatives said they were kept informed about their relative’s health and welfare. Care plans and related documents had some information about people, but it did not always contain information specific to people's needs and how to manage any conditions they had.

We have made a recommendation about the premises being suitable for people living with dementia. We have made a recommendation about compliance with the Accessible Information Standard.

People and relatives were positive about staff being kind, caring and respectful. However, our observation did not confirm this during the inspection. Staff also did not always uphold people's privacy or respond in a way that maintained people's dignity. People and relatives felt they could approach the management or staff with any concerns and felt they had good communication and relationships with the service.

Most of the staff members felt staffing levels were sufficient to do their job safely and effectively. However, some made comments that more staff were needed to complete their tasks as part of the job. The registered manager appreciated staff’s work, contributions and efforts to ensure people received the care and support. Staff felt they could approach the management team for support and advice.

People said they were safe living at the service and relatives felt their family members were kept safe. Staff told us they understood their responsibilities to raise concerns and report incidents or allegations of abuse. They felt confident issues would be addressed appropriately. The management team was working with the local authority to investigate safeguarding cases and make other improvements.

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

Rating at last inspection

This service was registered with us on 19 April 2022 and this is the first inspection.

Why we inspected

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.

The inspection was prompted in part due to concerns received about people’s safety and wellbeing, care and risk management, and staff skills in supporting people such as moving and handling techniques. A decision was made for us to inspect and examine those risks. We have found evidence that the provider needs to make improvements. Please see all the key question sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

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 quality assurance; risk management; notification of incidents; record keeping; effective and person-centred care planning; seeking consent, respecting people’s decisions and using restrictive practices; privacy and respect, management of medicine; staff training, competence, and recruitment at this inspection. We have made a recommendation about the premises being suitable for people living with dementia. We have made a recommendation about meeting the Accessible Information Standard.

We took civil enforcement to ensure people's safety and ensure improvement occurred at the service. We served a warning notice to the provider following the inspection for the breach of regulation 17 (Good governance). A warning notice gives a date the service must be compliant by and we inspect again to check that compliance against the content is achieved within the timescale.

Please see all the actions we have told the provider to take at the end of this report.

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.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefor in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.