We carried out a review of the data available to us about Heathfield (Horsham) Limited on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Heathfield (Horsham) Limited, you can give feedback on this service.
Heathfield (Horsham) Limited is a residential care home providing personal care and accommodation for up to 36 older people. At the time of the inspection 35 people were living at the service. Heathfield (Horsham) Limited accommodates people in 1 adapted building.
People had a range of care and support needs including diabetes, epilepsy and some people were living with dementia and the frailties of old age. Any nursing needs were provided by community nursing services.
People’s experience of using this service and what we found
Risks to people's safety had been assessed, and actions taken to mitigate them. People’s care plans detailed health needs and reflected the personalised care which was being delivered. One person told us, "They are keen for me to call staff if I need to go downstairs, so they can help because I can fall.”
People and their relatives were happy with the care they received and felt safe with the staff that were supporting them. Staff knew how to identify potential harm and report concerns. People received their medicines safely from staff trained to administer them. Checks were carried out prior to staff starting work to ensure their suitability to work with people who used the service.
The culture of the service was positive, and people, relatives and staff were complimentary of the management and provider. Comments included, “Staff are caring and know what they are talking about.” And, “Managers are approachable and there is good supervision and training. Big changes much better now.” Improvements had been made to systems and processes that monitored the quality of the service being delivered and accuracy of records. Staff knew people well and provided support in line with people's preferences. People's diverse needs were catered for and they were treated with dignity and respect. People and relatives described the staff as caring and thoughtful and said they were treated with care and kindness. Feedback about the service from people and those close to them was positive.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 9 June 2021) and there were breaches of regulation. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
We carried out an unannounced focused inspection of this service on 13 May 2021. Breaches of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating.
The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Heathfield (Horsham) on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Heathfield (Horsham) Limited is a residential care home providing personal care and accommodation for up to 36 older people. At the time of the inspection 26 people were living at the service. Heathfield (Horsham) Limited accommodates people in one adapted building.
People’s experience of using this service and what we found
There was not an adequate process for assessing and monitoring the quality of the services provided and that records were accurate and complete. People's care plans and risk assessments lacked important detail to guide staff on how to keep people safe. People did not always receive timely support with pain relief, guidance for staff about what to do when people refused prescribed medicine was not available in people’s care or medicine records.
Aspects of leadership and governance of the service were not effective in identifying some service shortfalls, such as failing to assess, monitor and mitigate risks relating to the health and safety and welfare of people and medicine administration.
People were relaxed, comfortable and happy in the company of staff and told us they felt safe. People's independence was considered important by staff and their privacy and dignity was promoted. Staff had a caring approach to their work, which was observed at inspection.
People and their relatives had the opportunity to share their views about the service and felt they were listened too.
People and relatives spoke confidently about the registered manager and were positive in their feedback. One person said, “She is marvellous.” A relative told us the registered manager was, “Very approachable, fair, deals with things.”
Systems were in place to protect people from the risk of abuse and improper treatment and staff knew how to identify potential harm and report concerns.
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 Good (published 28 June 2019). We also carried out an infection prevention and control inspection (published 10 August 2020) This inspection was not rated.
Why we inspected
The inspection was prompted in part due to concerns received about falls, pain relief and management of the service. A decision was made for us to inspect and examine those risks. This report only covers our findings in relation to Key Questions, Safe and Well-led. The ratings from the previous comprehensive inspection for the key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Heathfield (Horsham) limited on our website at www.cqc.org.uk.
We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this report.
You can see what action we have asked the provider to take at the end of this full report.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.
We have identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulation 17- Good Governance. There was a failure to ensure adequate systems to assess, monitor and improve the quality and safety of services provided. Accurate, complete and contemporaneous records were not always maintained regarding people's care and Regulation 12- Safe Care and Treatment. The provider had failed to ensure that staff had sufficient guidance to administer medicines. There was a failure to assess and manage risks relating to people's health and welfare.
Please see the action we have told the provider to take at the end of this report.
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.
We found the following examples of good practice.
There was clear communication to visitors who were visiting the service. Visiting was by appointment and there were two different arrangements in place, one was through an open window visit and the other was inside with a screen in a separated area. Visitors used face masks for both arrangements. People told us they understood why precautions were in place and were pleased that the arrangements were flexible.
The layout of the service had allowed for isolation when needed and staff were working on separate floors. The service was very clean. Additional housekeeping staff had been employed and a robust cleaning schedule was maintained. The layout of the service had been adjusted to give space between people when using communal areas. People chose to eat in their rooms which meant that social distancing could be maintained at mealtimes.
Further information is in the detailed findings below
Heathfield (Horsham) Limited is a residential care home providing personal care to 33 people aged 65 and over at the time of the inspection. The service can support up to 36 people. Heathfield (Horsham) Limited accommodates people in one adapted building.
People’s experience of using this service and what we found:
People received safe, personalised and responsive care. However care records did not always reflect the personalised care being delivered. Improvements were required to ensure the information contained within people’s care records was personalised, consistent and accurately reflected peoples current care and support needs. Staff were knowledgeable about people's needs and people’s safety had not been impacted. We have made a recommendation for the provider to seek advice and guidance from a reputable source, about how to record / assess people’s needs and choices; in line with standards, guidance and the law.
People received care and support that was safe. One person said, "I feel very safe here. The staff support me safely when helping me move around." People were supported by staff who received training and were able to identify and respond appropriately to abuse. There were sufficient staff to support people with their daily living and activities. A member of staff said, "The (staffing) levels are very good and keep people safe."
Training and observation of staff practice as well as supervision ensured staff were competent in their roles. People enjoyed a healthy balanced and nutritious diet based on their preferences and health needs. People were supported to have 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.
People received care from staff who were kind and caring. People told us staff always respected their privacy and dignity. One person said, "I may be getting on, I didn't think I would end up in a home, its made that little bit easier because of the type of staff here. They have become my family. Very kind they are." Staff supported people to be fully involved in their care planning and reviews.
Records showed the service responded to concerns and complaints and learnt from the issues raised. No formal complaints had been made since the previous inspection.
People told us the home was well-organised and commented on the pleasant working atmosphere amongst staff. The board of trustees and the registered manager provided a visible presence at the home. People were encouraged in their involvement and development of the home.
Staff felt well supported in their roles. Staff meetings provided opportunities to reflect on people’s care and anything that might be done differently. A system of audits monitored and measured all aspects of the home and were used to drive improvement. The home worked proactively with the NHS and Social Services to proactively meet peoples care needs.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update:
The last rating for this service was requires improvement (published 12 June 2018).
Why we inspected
This was a planned inspection based on the previous rating.
The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Heathfield (Horsham) Limited on our website at www.cqc.org.uk.
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.
We inspected Heathfield (Horsham) Limited on 6 April 2018. This was an unannounced inspection. We carried out our last comprehensive inspection on 13 May 2015. At this time we rated the service as Good overall, but asked the provider to improve the provision of meaningful activities. At this inspection they had met this requirement. They had employed an activities lead and had arranged visits to local places, including taking people out for a pub lunch and afternoon tea in the local park. They had also made an activities corner, where people could find jigsaws and colouring. The activity lead was in the process of reviewing the activity programme and had sent a survey to people to ask what activities they liked best.
At the time of the inspection a registered manager was not in post. The previous registered manager had not been in post since August 2017. 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. There was a care manager who, at the time of the inspection, had been in post for three weeks. They were planning to register with the CQC to become the new registered manager; however, at the time of our inspection, no application to register had been received.
There were regular Trustee reviews which involved talking to staff and people within the home. The Trustees did act upon concerns raised, but had not addressed the full impact caused by the changes in management. There was also no system of gaining regular feedback from the people, their relatives or the staff through regular meetings with the different groups. The home had audits and quality assurance systems, however, these had failed to consistently drive change or sustain improvements. Risks assessments relating to the individual did not always have sufficient details and this had not been identified by the management team. There were no personal emergency evacuation plans (PEEPs), which could affect people’s safety in the event of an emergency. We have made a recommendation in relation to this.
Staff had not received regular supervision or appraisals. However, they continued to receive regular training and were aware of safeguarding principles and the Mental Capacity Act (MCA). The staff were able to talk through how they would overcome barriers to communication, although there was no formal Accessible Information Standard (AIS) in place.
People felt safe within the home. There were personal and environmental risk assessments in place, medicines were administered appropriately and the environment was clean and tidy. The home had a good recruitment process and there was enough staff on duty. Staff reported they felt able to complete their work and knew the people they were looking after. There was a discrimination policy in place and staff told us they treated everyone with the same level of respect. We observed friendly and caring interactions between the people and the staff. There was a formal complaints procedure in place and the people felt able to voice their concerns.
People’s care needs were recorded clearly in care plans. These included details of the person, their family history and likes and dislikes. People reported they were happy at the home. The home worked closely with other health care professionals to ensure everyone’s medical and nursing needs were supported. Attention was given to treating the person as an individual and choices were offered and consent gained. People enjoyed the food. The home had aids and supports to help people remain independent. People liked the garden, which had railings to make it easy for people to walk around.
We inspected Heathfield (Horsham) Limited on 13 May 2015. This was an unannounced inspection. The service was registered to provide accommodation and personal care for up to 36 older people, with a range of age related conditions, including arthritis, mobility issues and dementia. On the day of our inspection there were 33 people living in the home, who required varying levels of support.
People received care from staff who were appropriately trained and confident to meet their individual needs and they were supported to access health, social and medical care, as required. However, there was a lack of stimulation and meaningful, person-centred activities, which put people at risk of social isolation.
This represented 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 this report.
A registered manager was in post and present on the day of the inspection. 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’s needs were assessed and their care plans provided staff with clear guidance about how they
wanted their individual needs met. Care plans we looked at were person centred and contained appropriate risk assessments. They were regularly reviewed and amended as necessary to ensure they reflected people’s changing support needs.
There were procedures in place to keep people safe and there were sufficient staff on duty to meet people’s needs. Staff told us they had completed training in safe working practices. We saw people were supported with patience, consideration and kindness and their privacy and dignity was respected.
Safe recruitment procedures were followed and appropriate pre-employment checks had been made
including written references, Disclosure and Barring Service (DBS) checks, and evidence of identity had also been obtained.
Medicines were stored and administered safely and handled by staff who had received appropriate training.
People’s nutritional needs were assessed and records were accurately maintained to ensure people were protected from risks associated with eating and drinking. Where risks to people had been identified, these had been appropriately monitored and referrals made to relevant professionals.
Staff received Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) training to make sure they knew how to protect people’s rights. The manager told us that to ensure the service acted in people’s best interests, they maintained regular contact with social workers, health professionals, relatives and advocates. Following individual assessments, the manager had recently made DoLS applications to the Local Authority, for 10 people and was awaiting decisions.
There was a formal complaints process. The provider recognised that, due to their dementia not all people could raise concerns or complaints and their feedback was sought through regular involvement with their keyworker.
People were encouraged and supported to express their views about their care and staff were responsive to their comments.
The organisation’s values were embedded within the service and staff practice. The manager told us they monitored awareness and understanding of the culture of the service by observation, discussion and working alongside staff. Staff said they were encouraged to question practice and changes had taken place as a result.
The manager assessed and monitored the quality of service through regular audits, including
health and safety and medication. Satisfaction questionnaires were used to obtain the views of people who lived in the home, their relatives and other stakeholders.
'I don't think there could be a better place.'
'It's great. Staff are friendly and helpful.'
We also gathered evidence of people's experiences of the service by indirectly observing the care they received from staff. We observed staff addressing people by their preferred names. Personal care was carried out in private and staff were discreet when asking about care needs.
We also spoke with the administrator, manager and three care staff.
We were concerned that people were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines. For example, we found recording errors which meant it could not be confirmed that medicines had been administered correctly.
One person said, 'I would not want to live anywhere else'.
Another person said, 'I am very happy here, I like the staff and I am able to choose what I want to do'
People we spoke with told us they were involved in making decisions about the way they lived their lives and the care they received. They felt the staff always respected their privacy and dignity and that the staff helped them to remain as independent as possible. Staff knew the people living at the home well and had a good understanding of their care needs.
Feedback on surveys given out by the home and completed by the people who live there were positive.