Heathbrook House Care Home

Heathbrook House Care Home is a care home and is registered to provide personal and nursing care for up to 45 older people, including people living with dementia. At the time of the inspection 25 people lived at the home.

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

Managerial oversight of the service had improved since our inspection in April 2022. However, some of the provider’s systems and processes to monitor the quality and safety of the service were not yet fully effective. Action was taken in response to our feedback to drive improvement and plans were in place to continually improve and learn lessons. More time was needed to demonstrate improvements made were embedded into practice and sustained over time as occupancy at the home increased.

People thought their home was well managed. Relatives shared mixed views on the leadership of the home. Management changes had occurred since our last inspection and staff explained how those changes had made them feel unsettled and unsupported. Plans were in place to further improve staff morale to ensure staff felt listened to and valued.

People received their medicines when they needed them which demonstrated improvement had been made in this area. Action to ensure current best practice medicine management guidance was followed by staff was taken after our visit.

The home was clean, and staff knew how to manage risks. Action taken since our last inspection had started to improve risk management. Staff were recruited safely, and enough staff were on duty to meet people’s needs. Relatives and staff spoke positively about staffing levels. People felt safe and relatives shared that viewpoint. Staff had completed safeguarding training and knew how to protect people but the providers processes to keep people safe were not consistently followed.

Feedback from people and their relatives was welcomed and listened to. The management team were open and honest during our visit and they used our feedback to focus their improvement activities. Staff knew the people they cared for well and most people’s care records contained enough information to help staff provide safe and responsive care. Further information was added to some people’s care records the day after our visit.

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.

People were supported to maintain relationships that were important to them and they were happy with the social activities available to occupy their time. People knew how to complain and a process was in place to respond to complaints.

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 16 May 2022). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found some improvements had been made and the provider was no longer in breach of 2 regulations. The provider has remained in breach of 1 regulation.

Why we inspected

This inspection was prompted by a review of the information we held about this service. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.

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 inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Heathbrook House Care Home on our website at www.cqc.org.uk.

Enforcement

We have identified a continued breach in relation to governance at this inspection. 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 how they will continue to make improvements. We will work alongside the provider and local authority to monitor progress and continue to monitor information we receive about the service, which will help inform when we next inspect.

Heathbrook House Care Home is a care home and is registered to provide personal and nursing care for up to 45 older people, including people living with dementia. At the time of the inspection 37 people lived at the home. Two of those people were in hospital at the time of our inspection visit.

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

Some areas of the service continued to require improvement to ensure people consistently received safe, quality care. Whilst some aspects of medicines safety had improved in the two months since our last inspection the management of people’s medicines was not consistently safe. Despite our findings most people told us they received their medicines when they needed them. Clear plans were in place to further improve the safety of medicines.

Other areas of risk management required further improvement. Not enough action had been taken since our last inspection to ensure people always received safe care and treatment. For example, staff continued not to follow some instructions to manage risks associated with people’s care. The management team told us they needed more time to implement changes and embed improvements.

Staffing levels had increasing since our last inspection. However, we received mixed feedback from people and their relatives about staffing levels. The manager was in the process of implementing new ways of working to ensure people always received personalised care. Staff felt there was enough of them and the recruitment of new staff was ongoing.

The management team were in the process of developing their oversight of the care provided to people. Just prior to our visit a new clinical services manager had been employed to support this development and achieve good outcomes for people. The use of some of the provider's audits and checks needed to be strengthened to ensure they were effective.

The prevention and control of infection had improved since our last inspection and the providers systems demonstrated visits took place safely in line with government guidance. People felt safe living at Heathbrook House. The manager and staff understood their responsibilities to protect people. 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.

Most people knew who the manager was. Staff spoke positively about the manager and confirmed the culture at the home had started to improve under their leadership. However, relatives shared mixed feedback when we asked them if they thought the service was well-led. Plans were in place to build trusting relationships between the service and relatives. The management team welcomed our inspection. They understood their responsibility to be open and honest and demonstrated commitment to learn lessons when things had gone wrong.

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 23 March 2022).

The provider sent us an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Why we inspected

This inspection was carried out 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.

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

Enforcement and Recommendations

We have identified continued breaches in relation to safety and governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will request an action plan from them to understand how they will make improvements. We will work alongside the provider and local authority to monitor progress and continue to monitor information we receive about the service, which will help inform when we next inspect.

Heathbrook House Care Home is a care home and is registered to provide personal and nursing care for up to 45 older people, including people living with dementia. At the time of the inspection 41 people lived at the home.

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

The quality and safety of the service had deteriorated since our inspection in February 2020. Low staffing levels negatively affected people's day to day experiences and their safety. This meant people did not consistently receive good quality safe care. Medicines were not safely managed in line with the provider’s procedures and national guidance. Risks associated with people's care and the environment, including fire safety were not always identified, assessed and well-managed. Despite our findings most people felt safe in the home and the manager and staff understood their responsibility to protect people.

The prevention and control of infection was not always managed safely and in line with government guidance. Quality monitoring systems had failed to identify the COVID-19 vaccination status of all staff working at the home had not been checked in line with requirements. Immediate action to address the concerns we identified was taken during and following our inspection to keep people safe.

The lack of provider and management level service oversight meant previously demonstrated standards and regulatory compliance had not been maintained. The provider’s governance systems had not been operated in line with their expectations and had not been effective to ensure people always received safe, good quality care and support. Most staff did not feel the culture at the home was open and transparent. Plans were in place to address this to benefit both people and staff.

Rating at the last inspection

The last rating for this service was good (published 12 March 2020).

Why we inspected

We received concerns in relation to low staffing levels resulting in people receiving unsafe care. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. The provider took effective action to mitigate risks. Please see the safe and well-led key question sections of this full report.

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

Enforcement and Recommendations

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 will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safety, staffing and governance at this inspection. Please see the action we have told the provider to take at the end of this report.

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

We found the following examples of good practice.

A visitor room divided with a window was accessible from outside. There was a booking system for visits and cleaning took place between uses. This meant that people could see their loved ones in a safe and comfortable environment.

A daily and weekly COVID-19 tool was completed to monitor infection control practices. This included observing staff hand hygiene techniques and use of Personal Protective Equipment (PPE).

A designated room was used for COVID-19 testing which was cleaned after each use. Seating was arranged to promote social distancing and signage indicated how many people could use the room safely.

Equipment was cleaned after each use and paper labels were displayed to detail when the item was last sanitised.

The provider organised pharmacy talks with staff to gain information about the COVID-19 vaccination. This supported staff to address any questions or concerns they had.

Heath Brook House is registered to provide accommodation, nursing and personal care for up to 45 older people, including people living with dementia. At the time of our inspection visit there were 41 people living at the home. Bedrooms were across two floors with communal areas and a main dining area on each floor. People had their own ensuite bedrooms and access to an outdoor area.

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

People were safe because staff protected people from known risks and poor practice. People and relatives raised some concerns about staffing numbers, however our observations showed there were enough staff on duty. Staff told us staffing levels were sufficient, but the shifts were not always managed effectively which impacted on their responsiveness. Staff followed safe principles for infection control which meant the potential for cross infection risk was minimised.

Staff knew people well, what their preferences were and staff understood how their approach needed to be tailored to each person, especially those living with a cognitive impairment. Staff training was monitored by the provider and was up to date.

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. People’s records included a decision specific mental capacity assessment and best interest decisions were recorded. Staff knew how to support people in line with those choices.

People said staff were respectful, kind and caring. People had individual care plans and assessments that met their health and social needs and they were supported by other health professionals. A visiting healthcare professional told us overall standards of care at the home had improved.

People were involved in pursuing their interests and hobbies. People’s life history information was used to inform staff about their hobbies and interests. Care plans were clear and they provided staff with the information and guidance they needed to support people in line with their individual care needs. Staff supported people who were at end of life and people’s advanced wishes and preferences were discussed and followed.

People and relatives were provided opportunities for feedback on the service. The manager had an open-door policy and because they worked ‘on the floor’, frequent opportunities were taken to seek their views and opinions.

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 good (published 11 August 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received, we may inspect sooner.

People told us they were support by the staffing team to remain safe in the home. All staff understood the potential for risk of abuse and told us about how they kept people safe. During our inspection people were supported by enough staff that were available, offered guidance or care that reduced people’s risks. People told us they received their medicines and nursing staff looked after this for them. People were able to request additional medicines for pain relief or other medicines as needed. The nursing team were able to asses and know when a person may need these if they had not been able to communicate themselves.

People told us they received the care needed from care and nursing staff who looked after them well. All staff told us the training was useful in support of their role and understanding the needs of the people they looked after at the home. The nursing staff were supported by clinical supervision and practice discussions.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People told us there was always a choice of meals and drinks which they enjoyed and kept them healthy. People had access to other healthcare professionals that provided treatment, advice and guidance to support their needs.

People were comfortable with the staff that supported them and chatted happily. All staff knew people’s individual care needs and respected people’s dignity and independence and were considerate when providing care and support in the communal lounges. People received support to have their choices and decisions respected with their day to day care.

People’s care needs were reviewed and assessed regularly and care planned and delivered to meet those needs. People and where requested families had been involved in the planning of their care. Relatives told us they were asked for their opinions and input. Dedicated members of staff offered encouragement and supported for people to be part of the home’s community and offered a variety of things to do.

People had the opportunity to raise comments or concerns and these were addressed. There were processes in place for handling and resolving complaints and guidance was available to people in the home.

The management team were approachable and visible within the home which people and relatives liked. The registered manager and provider had completed regular checks to monitor the quality of the care that people received. Any improvements or changes had been included in the homes improvement plan for action.

Further information is in the detailed findings below.

People told us that they were happy at Heathbrook House. One relative told us: 'I am very satisfied that the staff here understand my mum's needs. When she is upset they communicate with patience and in a respectful manner.'

We saw positive interactions between staff and people with lots of chatter and laughter during the day. We saw that staff offered people assistance with their personal care discreetly and people chose what they wanted to do on the day.

We found that before people came to live at the home their needs were assessed by a range professionals alongside a member of the nursing team from Heathbrook House. This ensured that people with dementia had care tailored to meet their individual needs when they came to live at the home.

We found that staff knew the likes and dislikes of people with dementia, and that people's wishes were respected. We saw that staff spent individual time with people and provided care and support in a gentle way when people's behaviour needed to be supported. This showed that staff had developed positive practices when they supported people with dementia with their emotional and psychological needs.

The provider had responsive systems in place to monitor and review people's experiences and complaints to ensure improvements were made where necessary.

The people living at the home and relatives that we spoke with told us that they were happy with the standards of care and support from staff to meet their needs.

We observed that there were enough staff to meet people's care and support needs. The manager explained how they ensured staffing levels met the individual needs of people who lived at the home and told us how they kept these under review.

The quality monitoring processes that were employed in the home ensured people received a good standard of care. We found that improvements had been made following our inspection in January 2012. This included care delivery ensuring people's needs were met in a timely way by sufficient numbers of staff. This showed that where improvements were needed these were listened to with actions taken.