Archived: Heath Lodge Care Home

Heath Lodge accommodates up to 23 older people in one adapted building. The building was originally an ordinary home which has been extended and adapted to become a care home. At the time of our inspection 19 people were living at Heath Lodge. Many of the people living at Heath Lodge were living with dementia.

People’s experience of using this service

People were supported to have choice in their day to day lives and staff supported them in the least restrictive way possible and in their best interests. However, the provider had not always followed best practice guidance in terms of seeking consent. The systems around ensuring deprivation of liberty safeguards were followed were not always robust.

People and relatives told us they were involved in their assessments and in reviews of their care needs. Records showed care plans were reviewed and updated regularly. Further work is needed to ensure records are clear about what people’s current needs and preferences are.

Feedback from people, relatives and professionals was collected regularly. Most people had a positive experience, however, relatives and professionals had noted the décor required updating. There was a plan in place to redecorate the home.

There were quality assurance and audit systems in place. These had not identified the issues with consent or the content of the care files. The registered manager was very responsive to our feedback and has a plan in place to improve the quality of record keeping within the service.

People and relatives told us they had a positive experience of care and support at Heath Lodge. They told us there was a family atmosphere and they were supported by kind, compassionate staff who knew them and their needs well. We saw staff interacted with people positively and engaged them in activities that were suitable for their needs.

People were kept safe by staff who knew how to support them safely. The registered manager had a plan in place to update risk assessment to ensure they reflect the knowledge of staff. Staff knew how to identify and respond to allegations of abuse.

There were enough staff working to ensure people’s needs were met. People and relatives commented that the staff team was stable, and this helped ensure people’s needs were met. Staff were recruited in a way that ensured they were suitable to work in a care setting.

People’s healthcare needs were met, and they were supported to follow the advice of healthcare professionals.

People told us they liked the food and we saw people were supported to eat in a kind way by staff who respected their choices and promoted their independence in eating.

Relatives confirmed they were able to visit when they wished, which supported people to maintain their relationships and links with their community.

People and relatives knew how to make complaints. Complaints had been investigated and responded to appropriately.

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 July 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to consent and good governance at this inspection.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Heath Lodge is registered to provide accommodation with nursing care for up to 24 people. At the time of our visit, there were 21 older people living at the home. The majority of the people who lived at the home were living with dementia, some have complex needs. The home also provides end of life care. The accommodation is provided over two floors that are accessible by stairs and a stair lift. The service is a detached house with communal lounges, dining room, kitchen and bathroom facilities.

The service had a registered manager in place. 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 our previous inspection on 12 April 2016 we found a breach of one of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to take action in relation to the systems in place to assess and monitor the quality of the service provided. The provider sent us an action plan and provided timescales by which time the regulations would be met. They stated that the actions would be completed by 30 August 2016. We also made three recommendations to the provider in regard to infection control, risk management and deployment of staff.

During this inspection we found that improvements had been made and breaches of the regulation were now met.

There had been some improvements to the environment with new carpets and flooring fitted and further improvements were planned. The were arrangements for managing good hygiene and infection control in place. This reduced the risk of cross infections and maintained a clean environment.

Risks to people's safety had been assessed and staff knew what actions to take to minimise these risks.

People received their medicines as prescribed and on time and the storage of topical creams had improved.

Recruitment systems had improved and new staff would all have the necessary checks in place prior to them starting work, which minimises the risk of unsuitable staff being employed.

There were enough staff effectively deployed to meet people’s needs which meant people were assisted with their care in a reasonable time.

People made positive comments about their care, how good the staff were and how much they liked living in the home.

Staff had clear understanding of their responsibilities regarding the Mental Capacity Act or Deprivation of Liberty Safeguards. Where people lacked capacity they were assessed and best interest meetings had taken place when specific decisions needed to be made.

Staff were trained and supervised. A new supervision system was in place to ensure all staff received regular support and supervision, which included clinical supervision for the nurses.

Care plans had improved and although there were further on-going improvements to make the staff could see from these plans what care they needed to give to each person. Staff understood peoples needs and they could describe how people preferred to be helped with their personal and healthcare needs.

People told us that the activities that were provided could be improved. Although activities took place we have recommended that more emphasis is placed in personalising activity and occupation, especially for people living with dementia.

There were quality assurance systems in place, to review and monitor the quality of the service provided. Audits had been carried out and this had led to an action plan to continue to improve the service.

People had enough to eat and drink throughout the day and they were offered choices.Where people needed support with eating; they were supported by a member of staff.

People were supported to have access to healthcare services and healthcare professionals were involved in the regular monitoring of their well-being. The provider worked effectively with healthcare professionals and was pro-active in referring people for assessment or treatment.

Staff treated people with compassion, kindness, dignity and respect when providing care. Staff told us they always made sure they respected people's privacy and dignity before personal care tasks were performed. People were able to personalise their room with their own furniture and personal items so that they were surrounded by things that were familiar to them. People’s relatives and friends were able to visit.

People knew how to make a complaint. People told us if they had any issues they would speak to the manager. People told us the staff were friendly, supportive and management were always approachable.

During this inspection we have made one recommendation.

Heath Lodge Care Home is a care home which provides accommodation and personal care for up to 26 people. At the time of our visit there were 18 people living at the home all of whom were living with dementia. The home is a large detached house with accommodation arranged over two floors. There was no lift and access to the first floor was via a stair lift.

At the time of our visit 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.

Quality assurance systems were not robust or effective enough to identify all the shortfalls in the service. These included poor infection control practices, lack of some risk assessments and not all records being up to date and accurate.

Although risk assessments were in place, there were some inconsistencies in the recording of information which could put people at risk of harm. Arrangements in place to identify and support people who were at risk of diabetes or smoking were not up to date or monitored. We found that staff were knowledgeable about people’s needs and risks and what action to take to protect them from these risks. However new staff would not have this knowledge or access to up to date information to provide appropriate and safe care to people. We made a recommendation that the provider reviews risk management and assessments in line with people’s current needs.

There were sufficient staff to provide people’s care needs but the deployment of staff had an impact on the personalised support provided. Although staff were provided in the numbers that had been assessed as needed by the registered manager, staff were very busy, responding and providing care tasks such as personal care to people. We made a recommendation that the provider reassess the way staff are deployed to ensure that people have all of their needs, not just the need for personal care, met.

Although the home was clean, people were not always safe because the processes in place to prevent and control infection were not always followed by staff. We made a recommendation that the provider ensures that staff follow the current guidelines and policies in regard to infection control

People were at risk as information for people with special dietary requirements were not always up to date. Although people had enough to eat and drink throughout the day and night they were not involved and consulted in the development of the menus. We made a recommendation that the provider ensures that specialist healthcare professionals are involved with people who have special dietary requirements.

Staff had an understanding of Deprivation of Liberty Safeguards (DoLS), the Mental Capacity Act (MCA) and their responsibilities in respect of this. Mental capacity assessments were fully completed and DoLS applications had been submitted in accordance with current legislation.

People were cared for by caring staff. People’s privacy was respected and promoted. We saw examples of caring practice from staff. People’s preferences, likes and dislikes had always been taken into consideration and support was provided in accordance with people’s wishes.

People were supported to have access to healthcare services and were involved in the regular monitoring of their health. The home worked effectively with healthcare professionals and was proactive in referring people for treatment.

People told us they felt safe at the home. One person told us, “I feel safe here and the girls look after me and I do not have to worry about anything.” Staff had a good understanding about the signs of abuse and were aware of what to do if they suspected abuse was taking place.

Fire safety arrangements and risk assessments for the environment were in place to keep people safe. There was a business contingency plan in place to minimise the risk to the home in the event of an emergency such as fire, adverse weather conditions, power cuts or flooding. Staff knew what to do in the event of an emergency.

Recruitment practices were safe and relevant checks had been completed before staff commenced work. Staff worked within good practice guidelines to ensure people’s care, treatment and support promoted a good quality of life.

People received their medicines when they needed them and the administration and storage of medicines was managed safely.

People told us if they had any issues they would speak to the staff or the registered manager. People were encouraged to voice their concerns, complaints or ideas about the home and there were different ways for their voice to be heard. Although it wasn’t always clear from records what action had been taken as a result of these consultations.

People had access to activities that were important and relevant to them. People were protected from social isolation with the activities, interests and hobbies they were involved with. Staff supported people with their interests and religious beliefs in their local community. People’s relatives and friends were able to visit. People did say they would appreciate more interaction with staff at times other than when their personal care was being provided or when organised activities took place.

The environment was monitored and checked regularly to make sure it was safe for people, relatives and staff.

People told us the staff were friendly and management was always visible and approachable. Staff were encouraged to contribute to the improvement of the home. Staff told us they would report any concerns to their manager. Staff told us they had good management and leadership from the registered manager.

We found a breach 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 this report.

The people we spoke with were happy living in the home. One said 'I am happy here' and another told us 'there is nothing I'd change.'

All of the relatives and healthcare professionals we spoke with spoke highly of the home and felt that the people who used the service were well cared for. They told us that their relatives were given choices and encouraged to be independent.

We saw that the home had appropriate processes in place that ensured that the premises were suitable and safe for the people who lived there.

We looked at six staff files and found that the service had good recruitment processes in place that ensured that they employed suitable staff.

The service had systems in place that monitored the quality of the care the service gave. They also identified when things needed to be changed.