Archived: Heathcote House

The service provides extra care housing for people living in each of the 24 flats within the same secure building. At the time of our inspection 25 people were resident. Staff are onsite 24 hours a day and people who use the service are able to summon help outside of their normal contracted care visits by using a call bell system. Although aspects of the service operate in a very similar way to a registered care home, the Care Quality Commission only regulate the provision of personal care in services such as this.

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.

Staff had received training in safeguarding people from abuse. Staff understood their responsibilities in this area and safeguarding concerns had been appropriately referred to the local authority for investigation and CQC notified.

Risks people faced were assessed and there was sufficient guidance for staff to follow to reduce the likelihood of people coming to harm. People were supported to remain as independent as possible through risk assessment.

Safe staffing levels had been assessed but the service sometimes operated with fewer than the assessed safe levels of staff. Staffing had been recognised as a concern and action had been taken to try to ensure consistent staffing as much as possible.

Medicines were not consistently well managed. The provider’s audit system had identified a significant number of medication errors and had taken action to address them. However this had not been effective in significantly reducing them and this was now a priority for the manager. Records related to medicines were clear but could have benefitted from a little more information to guide staff. We have made a recommendation with regard to how the service manages medicines.

Training and support was provided for staff to help them carry out their roles and increase their knowledge. There was an induction process in place and staff received regular appraisal

People gave their consent before care and treatment was provided. Staff had received training in the Mental Capacity Act (MCA) 2005 and demonstrated a good understanding of it. The MCA ensures that, where people lack capacity to make decisions for themselves, decisions are made in their best interests according to a structured process.

People were supported with their eating and drinking and staff helped to ensure that people had access to the food and drink they might need after staff had left for their next call. Staff also supported people well with their day to day health needs and worked in partnership with other healthcare professionals.

Staff were caring and people were treated respectfully and their dignity was maintained. Relationships between the staff and those they were caring for and supporting were very good. Agency staff were used as consistently as possible to try to minimise concerns people had regarding staff not being familiar with their needs. The communal areas of the service provided opportunities for social interaction which was noted as having a positive effect on people’s quality of life.

People were involved in planning and reviewing their own care and were encouraged to provide feedback about the service. There was a commitment to preserving people’s own skills and maintaining their independence.

A formal complaints procedure was in place but none had been received. Informal complaints were dealt with appropriately.

Staff understood their roles and were supported by the management team. There was an open culture which staff and people using the service valued.

Comprehensive quality assurance systems were in place to monitor the quality and safety of the service.

As part of our inspection on 11 April 2014 we followed up on the non-compliance found at the last inspection. We found that improvements had been made to address our concerns.

During this inspection we spoke with six people who used the service. We also spoke with eight members of staff including the registered manager and a visiting health professional. We looked at five people's care records. Other records seen included: staff rota, staff training plan, staff supervision documentation, health and safety checks, maintenance records, provider's safeguarding vulnerable adults from abuse policy and procedures, complaints log, staff and tenant's meeting minutes and tenant's satisfaction questionnaires completed by people who used the service.

We considered the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask; Is the service safe, Is the service effective, Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

When we arrived at the service a member of staff asked to see our identification and asked us to sign in the visitor's book. This meant that appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access the extra sheltered housing scheme.

People told us they felt safe, protected and their needs were met. One person said, 'They (staff) are sweet and kind. They know how I like things done, are very gentle with me.'

We saw that staff were provided with training in safeguarding vulnerable adults from abuse. Safeguarding procedures were robust and displayed in the service. Staff we spoke with understood how to safeguard people they supported.

We saw that improvements to staffing levels had been made since our last inspection. The registered manager told us that they had recruited five new staff and increased the staffing levels during the day to meet people's needs. Records seen confirmed this and showed there was enough staff on duty to meet the needs of people living at the service.

Records seen confirmed health and safety was regularly checked in the service and equipment was maintained and serviced frequently.

Is the service effective?

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The records were regularly reviewed and updated which meant that staff were provided with up to date information about how people's needs were to be met. People who used the service received regular support and access from a variety of health and social care services and professionals as their conditions and circumstances required.

The service conducted regular staff supervision and training was delivered as required. This meant that staff had the support and skills to deliver care effectively.

Is the service caring?

Staff interacted with people who used the service in a caring, respectful and professional manner. People told us they were happy with the care they received and their needs were met. One person told us, 'The staff here are hard workers, kind, reliable and trustworthy.' Another person said, 'They (staff) are ever so good to me and treat me with respect. They fuss about and make sure the door is shut and curtains closed and talk to me whilst helping me. Sometimes we have a chat and a good laugh if they are not too rushed.'

Staff had a good understanding of the people's care and support needs and knew them well.

Is the service responsive?

People's choices were taken in to account and listened to.

People's care records showed that where concerns about their wellbeing had been identified the staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance from health care professionals, including a doctor, district nurses, mental health teams and chiropodists.

Is the service well-led?

The provider had systems and procedures in place to monitor and assess the quality of the service provided. Records including people's care records and staff records were accurate and up to date.

The provider had systems in place to gather the views of people who used the service. Records including tenants meeting minutes and the annual satisfaction survey completed by people who used the service showed issues raised were acted on.

We looked at four people's care records which provided information for staff on how to meet people's individual health and care needs. The records showed that people's needs were assessed and care and treatment was planned in line with their individual care plan. We saw evidence in the care records that people received safe and coordinated care, treatment and support where more than one provider was involved.

During our inspection we saw that staff interacted with people in a caring, respectful and professional manner.

We found that staffing levels were insufficient to meet people's care needs. One person told us, 'It was ok when I first came here; you never waited long when you pressed your call bell. They (staff) came very quickly, but now there is not enough staff. The girls (staff) are run ragged. You ring and they (staff) often can't come for over 20 minutes. That's a long time to wait to go to the bathroom. I have no complaints with the care when they get here. They are well trained. But it is the waiting; it is not fair on us or them.'

The service did not have robust systems in place to assess and monitor the quality of the care provided.

The registered manager identified in this report is no longer the registered manager of the service. We were advised that the provider had submitted an application to remove them from our records.