Heaton House Care Home

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

During our assessment of this key question, we found concerns around person-centred care. The provider had not done everything reasonably practicable to ensure people received person centered care, which was appropriate, met their needs and reflected their personal preferences. This has resulted in a breach of regulation relating to person-centred care. You can find more details of our concerns in the evidence category findings below. There was no programme of weekly activities in place, which provided options to people so they could choose what to engage in. The processes in place did not promote equality or ensure people were not discriminated against. The provider was not meeting the requirements of the Accessible Information Standard (AIS). The AIS tells organisations what they have to do to help ensure people with a disability or sensory loss, and in some circumstances, their carers, get information in a way they can understand it. Meetings with people and relatives did not happen frequently. Care plans did not always accurate information which reflected people's immediate circumstances.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We found our previous recommendation about activities had not been implemented. A senior fitness session was held every Thursday, facilitated by an external provider, however, aside from this, any activities were facilitated by care staff and provided inconsistently or sporadically. The deputy manager confirmed there was no schedule of activities in place, but they planned to speak with people to see what sort of activities they would like to do; they said, ‘There is no overall activity schedule, we just advertise what we're doing on the day. Every Thursday we do senior fitness which they [people] enjoy; need to find out what things they would like to do." Records of people's engagement in an activities were only documented in people’s care notes, with no other monitoring or oversight completed. Care plans contained some inconsistent, inaccurate, or contradictory information about people’s needs, as well as a lack of detail for staff to follow. Care plans were not easy to read or navigate, due to the amount of extraneous information, usually relating to mental capacity and decision making which each contained. Most people we spoke with told us they had not been asked for their views and opinions about the care they received and there had not been any resident and relatives meetings held.

Care plans viewed contained contradictory information. For example, one person was described as having natural teeth in good condition, before later being described as having a partial set of dentures. Their care plan stated they required full support with oral care, but then also stated they only needed prompts to keep teeth clean. They were reported to have good physical ability and able to walk short distances, however, the same care plan then stated they were immobile and cared for in bed. Another person’s care plan stated they had a pressure cushion and overlay for their mattress which inflated, and for staff to ensure settings were correct for this person; we asked what these settings should be and was informed by the deputy manager, this person had a normal mattress and no overlay and did not used a pressure cushion. One care plan also referred to the use of bed rails and these being fitted as the least restrictive option; this was incorrect, as the person had was a grab rail fitted to help them pull themselves up when lying down. People were mostly complimentary about staff, one person told us, "I have a call bell in my room and if I ring it you have to wait a little while, but it is never too long. If we need someone in the lounge there is a call bell in there." Another person said, "The carers are very kind on the whole."

We did not look at Care provision, Integration and continuity during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We found the provider had not done everything reasonably practicable to ensure people received person centred care, which was appropriate, met their needs and reflected personal preferences. There was an Accessible Information Standard policy document in place. However, we found no examples of information being available in an accessible way, and none were provided to us. We asked the deputy manager if they could provide any examples of how they were meeting the accessible information standard; they told us they were looking at making an audio version of the service user guide for a person with visual impairments, but this was not completed yet. Key information for people such as the complaints process, safeguarding process, evacuation information and service user guide were all in a standard font, which may be difficult for some people to read and understand. We saw no evidence people had been asked whether information was provided in a way they could understand.

We found no evidence to show people were involved in making decisions about their care or their views sought. Care plan reviews did not indicate people or their relatives had been involved. People told us they were not asked about their opinions of the care provided and they had not been invited to any resident and relatives meetings. Five out of 6 people also told us they had never seen their care plan. One person told us, "No meetings, we just sit and talk amongst ourselves." The complaints file we reviewed, held only a single entry which dated back to September 2022. During our assessment of this key question, people and relatives told us they had reported some issues or concerns to staff and management, however, there was no record of these, and as a result, no record of actions taken to drive improvements. A person told us, "My family would complain for me; they made a complaint about the mix up with my medication after being in hospital." Other people told us they would 'just tell the staff,' if they had a complaint. There was no evidence to identify if people had been involved in discussing the decoration of the environment, what activities there should be and what they would like on the menu.

People and their relatives views and opinions were not being sought regularly or consistently. Only one meeting had been held with people and their relatives since June 2023; this had occurred in February 2024. The deputy manager told us, "These are the only minutes available. I have now put a schedule in place for this for the year." We also noted from reviewing the meeting minutes, some of the information provided was not accurate, or actions which the provider said would take, had not ben actioned by the time of our assessment. For example, the provider had reassured a relative, staff recruitment processes were robust, which was not what we found. The provider stated they would speak to a dietician or GP about a person's weight loss, hoewver, we saw no evidence this had happened. The provider was unable to demonstrate any other ways in which people’s views had been sought or how they were involved in making decisions about their care. No surveys or questionnaires had been circulated to gather people’s views about the home or their care. Feedback from the provider and staff did not demonstrate they were able to provide the standard of care described in the quality statement. The complaints process was not being implemented effectively.

We did not look at Equity in access during this assessment. The score for this quality statement is based on the previous rating for Responsive.

The provider and staff did not provide regular opportunities for people to feel empowered to give their views and understand their rights, including their rights to equality and their human rights. People’s views and opinions were not sought regularly, in order to identify issues, concerns or inequalities in care delivery. We found no examples people’s care being changed in response to information or feedback received from people.

The processes in place did not promote equality or ensure people were not discriminated against. There was no equality and diversity policy and procedure in place for people living at the home. The policy provided to us, specifically related to how staff members employment rights would be met. We asked the deputy manager if they had any other equality and diversity policies, however, they were unable to provide one. The provider did not proactively seek out ways to address barriers to improve people’s experience, act on information about people's experiences and outcomes and allocate resources and opportunities to achieve equity.

We reviewed one person's care plan, whom staff had told us was in receipt of palliative care. However, it was not clear this person was at the end of life or in receipt of palliative care; the last wishes and end of life care plan did not indicate this. The care plan stated, 'statement of intent in place', however, there were no further details about this, nor was the actual document included in the person's care file or provided to us. There was no end of life guidance within their care plan, to explain how care should be provided to meet the person's needs. A statement of preferred priorities for care' had not been recorded.

The provider was unable to demonstrate how they had acted upon and implemented our previous recommendations made in June 2023; these included in part, making timely referrals to professionals, documenting professional involvement, and the provision of end of life training for staff. We identified continued issues in all of these areas during this on-site assessment visit, which demonstrates a failure to act on past risks or known risks. The provider could not demonstrate how people's decisions and what matters to them were delivered through personalised care plans which were shared with others who may need to be informed.

The provider's processes to ensure people were supported to plan and make informed decisions about their end of their life care were not robust. Although only 1 person was identified to us as requiring palliative care, the last wishes and end of life sections of the other care plans we viewed were lacking in detail. Where people had a DNACPR in place, this was referenced within care plans, however, the documents had not been uploaded and attached to the care plans as these were kept in separate files. There was no specific documentation in place to record the provision of end of life care or to evidence any other professionals, such as district nurses had been, or were involved in care provision for one person. Processes in place did not ensure people were supported to make informed choices about their care and plan their future care while they had the capacity to do so. The provider was not following best practice guidance regarding end of life care.