Heathwood Care Home

We found the following examples of good practice.

We were shown around the communal parts of the home but did not enter people’s bedrooms apart from two bedrooms that were currently unused. The home was exceptionally clean throughout. The provider had increased the number of housekeeping and laundry hours each day to ensure the home was maintained hygienically clean. The registered manager, deputy manager or a senior member of staff completed frequent walk-arounds to ensure the home was cleaned to a high standard and tidy, and to ensure all staff were following good practice. This included checking that the staff were wearing the appropriate personal protective equipment (PPE).

There is only one entrance to the home for both staff and visitors. Staff were only permitted to enter the home one-by-one, their temperature was checked and they had to change into clean clothes and put on their PPE. Each staff member had their own face-shield, and these were sanitised at the end of each shift. The staff used a ‘fogging machine’ when they were ready to enter the main part of the home and before the next staff member could enter the room. Fogging uses an antiviral disinfectant solution which cleans and sanitises large areas of a building quickly and effectively.

There were strict procedures in place for any visitors to the home. Visitors could include people’ family and friends, health and social care professionals and any contractors. Visitors can only enter the home by appointment, have to sign in and have their temperature checked. As from Monday 25 January 2021 lateral flow tests will be carried out on all visitors to the home. Visitors were provided with PPE – a single- use body suit to go over outdoor clothes, gloves, a facemask and a face shield. They were then escorted to the area of the home they were visiting. Where possible and practical, people were seen in this entrance room so visitors in to the main part of the home were kept to a minimum. The room was also sanitised after every use.

Information was clearly displayed regarding the visiting arrangments and the procedures that had to be adhered to. Information was also displayed regarding the correct order that staff had to put on and take off their PPE. Staff we spoke with fully understood their responsibility as regards PPE.

In preparation for any new admission to the home or a person returning from hospital, the home had cordoned off an area of the home (referred to as the Red Zone). At the time of this inspection, the area was empty. Only dedicated staff would be allocated to work in this area and there were additional IPC measures in place. If people developed end of life care needs they would be moved to this area so that family could visit and enter the home via patio doors direct in to the person’s bedroom.

People were supported to maintain contact with their family and friends. This was achieved in a variety of means; pre booked window visits, virtual visits using technology and actual pre booked visits to the home. Staff were also supporting people to write letters to their friends and family and a post box had been sited in the courtyard. The provider had supplied additional technology to accommodate the increase in use of computer equipment. The provider produced a monthly newsletter and sent this to family to keep them up to date on information and inform them of any changes in policy.

Staff had all completed online infection prevention and control training and this included the correct procedures for using PPE. The home has taken part in regular testing for COVID-19. The staff team have routinely been tested each week with the people who live at Heathwood being tested each month. If either presented with COVID-19 symptoms they would be re-tested and isolated until test results known.

The staff team and each person had already received their first COVID-19 vaccination with the second dose planned to be administered before the end of February 2021.

The service had a robust plan to be followed to prevent any spread of infection should this situation change. The registered manager and provider had regular contact with the local authority COVID team and kept abreast of any changes in policy.

Heathwood is a residential home providing personal care to 27 people living with dementia.

There were 25 people living there at the time of our inspection.

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

People received good care and support. The registered manager made use of tools developed by university research in to dementia, to empower people and listen to their views. Everyone’s views and opinions were important, even if the person was unable to express themselves verbally. Strong relationships were built between staff and people using the service. There was a positive, joyful atmosphere in the home throughout our inspection. Our observations, showed staff were attentive to people’s needs and moods.

People were able to live active, fulfilling lives. There was a range of activities and excursions planned in accordance with people’s preferences and wishes. People were all valued as individuals and staff knew them very well.

The home was well led. There was a strong commitment to continued improvement and learning. The registered manager had been very successful in creating links with the community and it was clear that this brought a lot of joy to the people living in the home. There was high staff morale within the team and so people benefitted from being supported by an enthusiastic and motivated staff team.

People were safe. Staff were trained in and understood how to safeguard people from abuse. Risks were managed and measures were in place to guide staff. People received safe support with their medicines.

Staff told us they felt well trained and supported in their roles. There were positive working relationships with healthcare professionals involved in the home.

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.

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 Outstanding when our last report was published in December 2016.

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.

Heathwood Care Home provides accommodation and personal care to up to 29 older people. The home specialises in the care of people who have a dementia. There were 24 people resident at the time of the inspection.

Heathwood Care Home has a registered manager. 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.

People benefitted from a service run in accordance with current, research based, best practice in dementia care. It informed staff practice in how to support people in a way which valued each person’s individuality. The registered manager said, “We make sure the (condition of) dementia comes second to how people want to live their lives.” Through this approach people were able engage with every day community events, such as shopping and visiting a rugby club. Difficulties were overcome so that people’s strengths and desires were promoted.

Dementia care good practice influenced the home environment, which was designed to help people maintain their independence, safety and help them feel at home. It also fed into the home’s quality monitoring arrangements, with the use of tools designed specifically to understand the experience of people unable to talk about their feelings. Staff took time and knew how to engage with people so as to find what really mattered to them. They promoted their feelings of value and well-being by listening to their views and supporting them to achieve. For example, people wanted a record player, so they held an event to get the funds and then bought the item they wanted themselves.

There was a very wide choice of activities for people to engage in. These included arts and crafts, gardening, quizzes, sport, entertainment and current affairs. People’s behaviour differences were understood and supported, in a risk managed way. Staff negotiated with people so they could do as they wished as safely as possible.

People, their family members, staff and health care professionals spoke highly of the home. One health care professional said of the registered manager, “I found the manager caring, on the ball and it is a really well run home.” The registered person and the registered manager worked closely together to provide a very caring and effective service which put the person at the heart of decision making.

The service ethos was to provide a home from home for people. People’s family members told us, “It makes people feel it is their home” and “He’s happy here. He thinks this is his home.” To this end staff shared their time with people, wearing the same clothing (including nightware), eating together and sharing experiences, such as sports both within the home and outside at sports venues.

Staff respected people's privacy and dignity at all times and interacted with people in a caring, respectful and professional manner. Staff had made close relationships with people.

People were protected through safe recruitment practice and a high ratio of staff to people using the service. There were enough staff to support people in activities within the home, in the community and for their general safety and well-being. One staff member was seen helping people wind wool for their knitting. Multiple activity groups were held with enough staff to support each group.

The Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions, and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. The service was upholding people’s legal rights.

People were protected from abuse because there was a lot of information available to inform staff how to respond if they had any concerns and the registered manager met her responsibilities.

Medicines were managed in a safe way for people, in consultation with people’s GP.

Staff received training, supervision and support to enable them to provide a high standard of care. Staff practice was closely monitored. This included unannounced night time visits by the registered manager.

People’s needs were under regular review, taking into account their wishes. People’s health care was promoted through appropriate contacts with health care professionals and identifying, and reducing risk where possible. One said, “They just know their residents so well.”

Staff were very attentive to people's appetites and ensured that people were provided with a meal of their choice. Risks to people's nutrition were minimised and dietary needs were closely monitored. People said they liked the food. We found that some people had difficulty managing the food presented to them. We have recommended that the use of equipment, which might support people’s independence when eating, is reviewed.

The home had a complaints policy and a niggles book was also available for people’s use, at their request. People's relatives said they would have no concerns about taking any complaint to the registered manager, who we saw them engaging with throughout the inspection. People were confident that any concerns or complaint would be followed up. The one complaint had been followed up with a good result for the person using the service.

There were very effective quality monitoring arrangements in place, which included a tool to observe the experience of people with dementia, audits, spot checks on staff practice and listening to people’s and staff’s views. Staff fully understood their roles and responsibilities, worked as a team and said how much they enjoyed their work at Heathwood. One said, “The (registered manager) is one thousand per cent here, on call 24/7. She listens and she never lets us down.”

The service was meeting all is regulatory obligations.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe. We found that staff knew how to report any concerns they had regarding people's safety and that the provider responded appropriately to any concerns in order to protect people.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve. The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This means that people would be safeguarded as required.

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk.

People told us there were enough staff to meet their needs. One staff member told us "there are enough staff and people help out whenever needed". The registered manager set the staff rotas and we saw that a consistent level of staffing was provided. This helps to ensure that people's needs are always met.

Is the service effective?

People's needs were assessed and plans drawn up to meet their individual needs. We found that people were supported in line with these plans. One staff member we spoke with told us "all the staff treat people well, as individuals and people".

People's health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. Where people's needs meant they were unable to be involved in this, care was taken to involve others such as other professionals and family representatives to ensure people's best interests were taken into account.

People's needs were considered with signage and the layout of the service enabling people to move around freely and safely. The premises had been sensitively adapted to meet the needs of people with physical impairments.

Visitors confirmed that they were able to see people in private and that visiting times were flexible.

Is the service caring?

People were supported by kind and attentive staff. We spoke with people using the service who told "the staff are nice" and "the staff care". We spoke with family representatives of two people who told us they were happy with the care, treatment and support of their relative. We observed people being cared for and supported throughout the day. We saw that care workers showed patience and gave encouragement when supporting people.

People using the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People completed a range of activities in and outside the service regularly. We looked at the activities planner for the week. This was clearly displayed in the lounge area. We saw that the activities on offer were those planned for the day. People told us they enjoyed the activities offered. One person said "I like the gardening group". Family representatives we spoke with told us they felt there were enough activities for their relatives.

The provider had in place systems to assess and monitor the quality of service provided. We were told of changes that had been put in place as a result of comments and complaints and learning from accidents and incidents. People can therefore be assured that complaints are investigated and action is taken as necessary.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system, records showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuously improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes. We were told by staff that "we get lots of support". We saw that staff received training. We were told by family representatives that "we are listened to and kept informed". This helped to ensure that people received a good quality service at all times

Throughout the day we observed staff were respectful and kind in their manner towards people. The people we talked with were positive about the staff and the way they were supported by them. One person told us, 'I like it here." The manager told us," we offer several activities each morning and afternoon so people have real choices about how they want to spend their time."

We reviewed three people's care plans so we could find out how people were supported with their care needs. We saw people had individual care plans which described their preferences and routines. We saw the plans were well maintained by the staff team. We asked people about the care and support that they received. One person told us, "the staff are nice."

We saw the premises were well maintained. The toilets were clean and hygienic and all communal areas were tidy and organised.

People and their relatives told us they knew how to make a complaint and were confident the manager would resolve any complaint they had. A staff member told us,' if someone makes a complaint to me or I can see something is upsetting one of the residents then I tell the manager. Some people here can't tell us if they are unhappy about something so we need to keep a careful eye on them."