Archived: The Heathers Nursing Home

Updated 20 June 2020

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection team consisted of two inspectors and an inspection manager.

Service and service type

The Heathers Nursing Home is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service did not have a manager registered with the Care Quality Commission. At the time of our inspection visit the manager was in the process of registering with us. A registered manager and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections.

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used all of this information to plan our inspection.

During the inspection

During the inspection we spoke with one person who used the service, two relatives, four care staff, the laundry assistant and the laundry supervisor. We also spoke with the manager, the deputy manager, the regional director, a regional manager and an advanced nurse practitioner.

We reviewed a range of records. This included seven people’s care records and multiple medication records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

Updated 20 June 2020

About the service

The Heathers Nursing Home provides personal and nursing care to 35 people. The service can support up to 53 people.

The Heathers Nursing Home is located in residential area and accessible to all local amenities. The home is situated on two floors which are accessible via a passenger lift or stairs. The ground floor is specific for people receiving nursing care. Whilst the first floor is dedicated to people living with dementia.

All bedrooms are of single occupancy and equipped with essential furnishings. People had access to communal areas. Bathrooms and toilets are located on both floors and near to communal areas. People have access to a garden at the rear of the property.

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

There was a manager in place. However, at the time of the inspection they had not yet registered with CQC. We found the provider’s governance was ineffective to review, assess and monitor the quality of the service provided to people. This placed people at risk of their specific needs not being met.

The management of people’s prescribed medicines were unsafe because written protocols were not always followed. Staff did not always adhere to information within risk assessments and this compromised people’s safety. Staff did not have the skills or understanding about how to support people to manage their behaviours when they became agitated and distressed.

Staff did not always demonstrate a caring approach and people’s right to dignity was not always respected. There were insufficient systems in place to assist people to make decisions which, placed them at risk of not receiving care and support the way they like. People’s interests had been explored but they were not supported to pursue them. There was no evidence people were supported to engage in meaningful activities to ensure they have positive experiences.

Apart from pictorial menus there were no other systems in place to assist people to communicate their needs. There was no evidence to show people’s involvement in decisions about planning or reviewing their care and treatment. We found the culture of the home was not caring where staff showed very little empathy to people living with dementia.

Staff told us there were not always enough staff on duty to have meaningful engagement with people. Detailed oral health care plans were not in place to promote good oral health. Staff were not always provided with essential training to ensure they had the skills to meet people’s needs safely or effectively.

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 procedures at the Heathers Nursing Home did not support good practice.

New staff were provided with an induction into their new role and all staff had access to one to one supervision sessions to support them in their role. The provider worked with other agencies in providing a service to people. The home was purpose built and although some areas were in need of decorating, essential furnishings were provided.

The assessments of people’s needs were carried out before they moved into the home. People were supported by staff to access healthcare services. People were supported by staff to eat and drink sufficient amounts to ensure their health.

People were unable to tell us if they felt safe living in the home. Although staff demonstrated a good understanding about various forms of abuse and how to safeguard people from this. They did not recognise behaviour management and medicines practices were not appropriate and placed people at the risk of abuse. We found the provider’s recruitment process ensured staff were suitable to work in the home. We observed the home was clean and tidy and audits were carried out to ensure hygiene standards were maintained. The manager was aware of their responsibility to take action when things went wrong to avoid it happening again.

Complaints were listened to and acted on. No one at the time of our inspection was receiving end of life care. However, where people had capacity their wishes in relation to their end of life care had been obtained and recorded. The manager was aware of some of the shortfalls identified during the inspection and was receptive to learning and making improvements to ensure people’s specific needs were met.

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

The last rating for this service was requires improvement (published 14 January 2019), and there were multiple breaches of the regulations. At this inspection not enough improvements had been made and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements, to ensure the safe management of medicines. To ensure staff’s practices reduce the identified risks to people. To ensure the care and support provided to people is person-centred and promotes their dignity. To ensure the governance is effective to monitor and improve the quality of the service.

Enforcement

We have identified breaches in relation to the management of medicines, practices that did not reduce the risk of harm to people, the care and support provided to people that was not person-centred or promoted their dignity and the ineffectiveness of the provider's governance at this inspection.

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.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Heathers Nursing Home on our website at www.cqc.org.uk.