Heron Court Care Home

About the service

Heron Court Care Home is a residential and nursing care home providing care to up to 38 people. The service provides support in one adapted building to older people that may have dementia, physical disabilities and sensory impairment. At the time of our inspection there were 34 people using the service.

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

People and their relatives told us staff were friendly and caring towards them. Staff knew how to keep people safe, as they had received training on how to protect people from abuse and knew the procedure to follow to report concerns.

Systems and processes were in place to maintain people’s safety and the support they required was assessed and monitored on an ongoing basis. People were supported by trained staff to take their medicines and when needed access external health care professionals to support their well-being.

People received support from staff that had undergone recruitment checks to ensure their suitability.

People were protected from catching infections, as staff worked within the provider's policy and procedure for infection prevention and control and followed current government guidance related to COVID-19.

People were supported to provide feedback on the quality of the care they received. The provider monitored the service on an ongoing basis to drive improvement.

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 information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 1 May 2020) and there were no breaches of regulation. At this inspection we found improvements had been made.

Why we inspected

We carried out this inspection to follow up on action we told the provider to take at the last inspection.

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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The care home accommodates up to 72 people across four separate wings, each of which has separate adapted facilities. Each wing specialises in providing care to people living with different stages of dementia.

We found the following examples of good practice.

The provider ensured there were measures in place to reduce the risk of visitors catching and spreading infections. Lateral flow tests (LFT) were encouraged and provided to all type of visitors. The provider supplied all visitors with personal protective equipment (PPE), including masks and gloves.

People and staff were supported to use the home environment safely. The furniture was rearranged in the lounges to encourage social distancing.

The staff were and visitors were asked to change the PPE before entering the home and walking into a separate wing of the home. There were ample supplies of PPE available and hand sanitizing stations were available around the building.

The premises were clean and hygienic. Cleaning schedules were in place and there was a sufficient number of domestic staff to sustain frequent cleaning. The registered manager had an oversight of the cleanliness by completing frequent spot checks of the premises and infection prevention control (IPC) audits. Actions identified in the audits were completed in a timely manner.

Normanton Village View is a residential care home providing personal and nursing care to 42 people aged 65 and over at the time of the inspection.

The care home accommodates up to 72 people across four separate wings, each of which has separate adapted facilities. Each wing specialises in providing care to people living with different stages of dementia. At the time of the inspection only three wings were in general use. The fourth wing was being used by one person who preferred to sleep there because it was quiet.

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

Staffing levels were not always sufficient as the service relied on the use of agency staff to cover carer and nursing shifts. The high use of agency staff meant we could not be assured that people were being cared for by staff with the correct skills and experience or training required for the role.

There were gaps identified in staff training, however these were mostly due to recent changes in the way the training was delivered, and the service had measures in place to ensure all staff training was updated. However, staff knowledge of mental capacity assessment was limited, and all staff were undergoing training. Mental capacity assessments in place lacked information around how decisions were made.

There was no registered manager at the service, however three members of the management team all had applications in progress. However, there had been a lack of management oversight to ensure that the service had the correct number of suitably trained and experienced staff.

The local authority had identified a number of issues at Normanton Village View. The service had been open and honest about this and was working closely with the local authority to put improvements in place around reporting of safeguarding and pressure area care.

People’s wishes at the end of their life were not fully explored and people’s interests and hobbies were not fully supported.

People were protected from the risk of abuse by staff who had up to date training. People’s risks were assessed, and measures were in place to reduce risk. Medicines were administered and managed safely. The service design was suitable for the needs of people, and people were protected against the risk of infection.

Staff were recruited safely, and the service had recently recruited staff to bring staffing numbers up and ensure staff had the experience suitable to meet people’s needs. People’s healthcare needs were assessed and supported. Complaints were dealt with effectively.

Staff were kind and caring towards people. People were treated with dignity and their privacy was respected. People’s independence was supported.

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 26 February 2019)

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels, pressure area care, and reporting of safeguarding incidents and accidents. A decision was made for us to inspect and examine those risks.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Normanton Village View 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.

Normanton Village View 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 accommodates up to 72 people across four separate units, each of which have separate adapted facilities. The service specialises in providing care to people living with dementia with varying dependency needs. At the time of our inspection there were 43 people using the service, and three of the four units were in use.

There were two registered managers in post who shared responsibility for the service. 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.

Records and observations of care provided did not support there were always enough staff deployed in the service to provide people's care in a timely manner. Following our inspection, the registered manager told us they were developing a staff dependency tool to enable them to ensure sufficient staff were always deployed across the service to meet people's needs.

Staff had a good understanding of their role in keeping people safe and protecting people from the risk of abuse. Risk assessments were in place and regularly reviewed to manage potential risks within people's lives, whilst also supporting their independence. Accidents and incidents were analysed to ensure lessons were learnt to reduce the risk of future harm for people.

Staff recruitment procedures ensured that appropriate pre-employment checks were carried out so only suitable staff worked at the service.

Medicines were managed and administered safely and as prescribed. Staff followed safe infection control procedures to protect people from the risk of acquiring health related infections.

Staff induction training and on-going development training was provided to ensure they had the skills, knowledge and support they needed to perform their roles. Specialist training was provided to make sure that people's needs were met. Staff were well supported by line managers and had regular one-to-one supervisions.

People's needs were assessed to ensure care provided met with their needs and they were supported to maintain their health and well-being. People who were at risk of poor nutrition, were supported to ensure they had sufficient amounts to eat and drink. People and relatives were positive about the quality of the meals provided.

People's consent was gained before any care was provided. People were supported to have maximum control and choices of their lives and staff supported them in the least restrictive way possible.

Staff treated people with kindness, dignity and respect and spent time getting to know them and their specific needs and wishes. Care plans reflected people's likes and dislikes and staff were knowledgeable about people's preferences.

People and relatives were involved in care planning and were able to contribute to the way in which they were supported. This supported personalised. Care plans were regularly reviewed and updated to ensure the care provided met people's needs.

People were supported to engage in meaningful, stimulating activities and could choose how they spent their time.

A process was in place which ensured people could raise any complaints or concerns. Concerns were acted upon promptly and lessons were learned through positive communication.

Significant improvements were made for the management and oversight of the service and to the provider's arrangements to check the quality and safety of people's care. People, relatives and external authorities had increased confidence in the management of the service.

Following the last inspection in September 2017, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe, Effective, Caring, Responsive and Well-led to at least good.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this time frame. At this inspection the service demonstrated to us that some improvements had been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Normanton Village View Nursing home is a 'care home' with nursing and is registered to provide accommodation to people who require personal or nursing care for up to 72 people. 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 is provided across two floors which are split into four separate units. At the time of our inspection there were 38 people living in the service, many of whom were living with dementia.

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.

Risks to people had been assessed and staff demonstrated they understood how to support people safely. However, we found inconsistencies in people's care records. Some records lacked clarity in providing guidance for staff on the measures they needed to take to keep people safe. People's care records did not always reflect people received care to meet their assessed needs and keep them safe. Records lacked the detail and guidance staff needed to intervene when people became distressed or anxious in order to keep them safe.

People did not always receive medicines administered covertly (disguised in food and drink) as prescribed. Other aspects of medicines were, in the main, managed safely.

The provider had made improvements to systems and processes to monitor the quality of the care provided. However, these systems were not always effective in bringing about improvements that were embedded into staff working practices to ensure people received consistently good care.

People did not always receive the support they needed to eat their meals. Further improvements were needed to ensure people experienced a positive dining experience.

Staff did not always demonstrate the awareness they needed to ensure people's right to be treated in a dignified manner was protected.

Staff had completed training to enable them to recognise the signs and symptoms of abuse and felt confident in how to report concerns.

People were protected from the risk of unsuitable staff because the provider followed safe recruitment procedures. There were enough staff available to meet people's needs as assessed in their care plans.

Systems were in place to support staff to follow safe infection control procedures and staff were observed adhering to these in practice.

There were arrangements in place for staff to make sure that action was taken and lessons learned when accidents or incidents occurred, to improve safety across the service.

Staff completed an induction process when they first stated working in the service. They received on-going development training and supervision for their role. The registered manager reviewed and evaluated training to ensure it was effective.

People were supported to access a range of health professionals to maintain their health and well-being. The service worked collaboratively with other agencies to ensure people had the care and treatment they needed in line with best practice guidance.

The provider was in the process of upgrading the décor of the premises. This included appropriate directional signage to enable people to move around the premises safely and independently.

People's needs were assessed before they began to use the service. People were supported to make decisions and choices about their care. Staff understood the principles of the Mental Capacity Act 2005 and sought consent before providing care and respected people's right to decline care and support.

Staff had developed caring relationships with staff and people and relatives were positive about the staff who provided care and support. Staff understood the importance of maintaining people's independence where possible.

Staff supported people to express their views and be involved in decisions about their care as far as possible. This included consulting relatives and providing access to independent advocates if necessary.

People and their relatives were involved in planning their care and were able to make changes to how their care was provided. The registered manager was in the process of reviewing and updating all care records to ensure they reflected people's current needs.

People had access to a varied activities programme, either individually or as small groups. People maintained contact with those important to them and were therefore not isolated from those people closest to them.

People's concerns and complaints were listened to and responded to. The registered manager had an open approach to listening and responding to people's concerns and taking action to bring about improvements.

People, those important to them and staff were able to share their views about the service and the quality of care they received. These were used to critically review the service and drive improvements to develop the service.

People, relatives and staff spoke positively about the registered manager. The registered manager was promoting a positive culture in the service that was focussed upon achieving good outcomes for people. They had identified where improvements were required and had taken steps to make changes and develop the service.

You can see what action we told the provider to take at the back of the full report.

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident.

However, the information shared with Care Quality Commission (CQC) about the incident indicated potential concerns about the management of risk of choking. This inspection examined those risks.

The provider is registered to provide accommodation for up to 72 older people living with or without dementia; the home covered two floors and was split into four separate units, two on each floor. There were 55 people using the service at the time of our inspection.

At our last inspection on 7 June 2016, we asked the provider to take action to make improvements in the area of consent. We received an action plan setting out when the provider would be compliant with the regulation. At this inspection we found more work was required in this area and the regulation was not complied with.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

A registered manager was registered with the CQC; however, they had recently stopped working at the service. A representative of the provider was present both days of the inspection and told us they would be applying to register as manager for the service. A registered manager is a person who has registered with the CQC 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.

Risks were not always managed so people were protected from avoidable harm. Staff did not always follow safe medicines management and infection control practices.

Sufficient staff were not always on duty to meet people’s needs. Staff understood their duty to protect people from the risk of abuse but did not always know how to report any concerns to external organisations.

Staff were recruited through safe recruitment practices.

Staff felt supported but did not always receive appropriate induction, training and supervision. People’s rights were not fully protected under the Mental Capacity Act 2005.

People told us they received sufficient to eat and drink but the mealtime experience required improvement. Adaptations could be made to the design of the home to better support people living with dementia.

External professionals were involved in people’s care as appropriate.

Staff did not always respect people’s privacy and dignity. Some staff were kind, however most staff were task orientated. People and their relatives were not involved in decisions about their care. Advocacy information was not available to people.

People received care that promoted their independence. People could receive visitors without unnecessary restriction.

People did not always receive personalised care that was responsive to their needs. Activities needed improvement. Care records did not contain sufficient information to support staff to meet people’s individual needs.

A complaints process was in place and staff knew how to respond to complaints. Complaints were responded to appropriately.

Systems were in place to monitor and improve the quality of the service provided, however, they were not fully effective. As a result the provider and registered manager were not fully meeting their regulatory requirements.

People and their relatives had some opportunities to be involved in the development of the service but could be involved further and their feedback was not always acted upon by staff.

Staff told us they would be confident raising concerns with the management team and appropriate action would be taken.

We found six breaches 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.

Normanton Village View provides nursing and residential care for up to 80 people. At the time of our inspection there were 45 people using the service and one person in hospital.

The service had a registered manager in place at the time of our 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 and their relatives had been involved in planning the care and support they received from the service. Their needs had been identified, assessed and reviewed on a regular basis.

People received care in a dignified manner that protected their privacy. People were protected from the risk of abuse as staff understood what constituted potential abuse or poor care and knew how to report concerns.

The CQC is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. Mental Capacity Assessments were carried out where key decisions were required and the principles of the MCA had been adhered to. Applications had been made to the supervisory body for consideration under DoLS; however the provider was no able to consistently demonstrate that people were supported to make decisions about their care in accordance with MCA.

People received care and support from staff that had appropriate training and who received regular reviews from the registered manager about their performance.

People were encouraged to undertake activities that interested them and to make choices everyday choices about how they spent their time and what they wanted to eat and drink.

Staff had been employed following recruitment checks. We saw that staff had a police check to ensure they were safe to work with people. However we found in some recruitment records that gaps in employment and references were not verified.

The registered manager and registered provider continuously assessed and monitored the quality of the service and actions plans were in place where areas of improvement had been identified. However these audits did not identify the issues we found during the inspection visit.

Feedback was obtained from people who used the service and their relatives. Records showed that systems for recording and managing complaints, safeguarding concerns and incidents and accidents were managed well. However we found that people’s resuscitation records were not correctly completed and people’s care plans did not always contain the sufficient and up to date information.

You can see what action we told the provider to take and the end of this report.

We also spoke with the registered manager, senior manager, deputy manager, care staff including domestic and nursing staff. We looked at some of the records held in the service, including the care files for six people who used the service.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask. This is a summary of what we found.

Is the service safe?

We found there were insufficient numbers of experienced and skilled staff available at all times, to meet people's assessed needs, and safeguard people's health and welfare needs.

The cleanliness of the service, including the cleaning of equipment required improvements to ensure people, visitors and staff were fully protected from the risks of cross contamination.

The service adhered to the Deprivation of Liberty Safeguards. This meant people's human rights were protected.

Is the service effective?

Whilst the provider assessed people's needs, people's plans of care lacked personalised information.

Some people had behavioural needs associated with their dementia. We were concerned that staff did not have the required support, information and guidance from appropriate healthcare professionals.

Is the service responsive?

People received opportunities to participate in activities such as arts and craft. However, these were not always planned for appropriately, and activities were not based on people's known interests and hobbies.

The provider had a complaints procedure available for people and their relatives. We saw what action the provider had taken in response to complaints and concerns raised.

We saw information was available on independent advocacy services.

Is the service caring?

We found staff spoke to people politely and on the whole used people's preferred names. However, our observations of staff engagement with people, showed the quality of care and interaction was poor. People did not always receive care and support that was dignified and respectful.

Is the service well-led?

The registered manager had recently returned from a period of absence. People who used the service, relatives and staff told us they found the registered manager to be supportive and approachable and that their leadership was good.

The provider had asked people who used the service, and relatives through a satisfaction survey for their views about the service provided.

We saw accidents and incident were recorded and analysed to look for lessons learnt to reduce further incident. Checks were in place that monitored the safety of the service.

Visitors told us, 'I have no worries about the care here; the staff are very good, they are so friendly and always let me know if there are any problems.' And, 'I honestly can't fault the place, my relative receives very good care, it's such a weight off my mind because I know they are well looked after.'

We observed care practices throughout the day and saw that staff were responsive to people's needs and wishes. We also observed a positive and friendly relationship between the staff team and visitors.

Records seen demonstrated that arrangements were in place to ensure that people who were unable to give valid consent were supported in their best interests.

The care plans seen reflected people's individual needs and took into account equality and diversity issues such as individual preferences and choices, religion and dietary needs.

Aids and adaptations were available and suitable to meet people's needs, including adapted cutlery, hoisting equipment, mobility aids, lifts, toilets and bathing facilities.

Capacity assessments were in place for people as required. This showed us that people's level of understanding in making day to day decisions and the support they needed to make those decisions was clearly recorded.

The training matrix demonstrated that staff training had been provided to staff that previously had gaps in training. Training booked for staff throughout 2013 was recorded on the training matrix. This demonstrated that staff were provided with training on an ongoing basis to ensure they worked to current practice and maintained their skills and knowledge.

We have been notified of incidents and events that affect the welfare of people using the service. This means that important events that affect people's welfare, health and safety have been reported appropriately to ensure action could be taken when needed.

People confirmed that staff treated them respectfully and ensured their dignity and privacy was maintained. We saw some good examples of people being treated with dignity and respect. Staff were polite and helped people in an unhurried way.

People that we spoke to appeared relaxed and comfortable and were able to move freely and safely around the communal areas of the home.

Comments from visitors were positive regarding the care and support provided to their relative. One visitor told us, 'I have peace of mind now that my relative is here, I know that they are looked after well. ' Another visitor told us that their relative had recently moved into the home, they said, ' so far everything seems good, the staff are friendly and always welcoming. ' This person confirmed that their relative always looked clean and well groomed when they visited. They said, 'they seem to have settled in well and I would know if they weren't happy.'