Archived: Glen Heathers

Since our last inspection a new manager had become registered with CQC. 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.

Glen Heathers has a history of breaching legal requirements. Following an inspection in March 2015 multiple breaches of regulations were identified and CQC took appropriate enforcement action and placed the service in special measures for having an overall Inadequate rating. Some improvements were seen during a focused inspection in June 2015 and further improvements were found at the comprehensive inspection in November 2015 when the service was rated overall Requires Improvement and came out of special measures. However, they remained in breach of Regulation 17, Good governance. During the next comprehensive inspection in November 2016, we identified multiple breaches of the regulations related to providing safe care and treatment, safeguarding, staffing, person centred care and good governance systems. The overall rating following the November 2016 inspection decreased to Inadequate and the service was placed into special measures again. At our last inspection in May 2017 we found improvements had been made again and only one breach of regulation was found, relating to the governance of the service. The overall rating was Requires Improvement, however the key question of well led remained Inadequate and as such the service remained in special measures. CQC took enforcement action and imposed a condition on the registered provider. This condition meant the registered provider was required to undertake certain audits and to provide CQC with monthly reports about these audits.

At this inspection we found that the improvements previously made had not been sustained and we identified multiple concerns about the safety of people who lived in the service.

We found that people were at times placed at risk of harm because appropriate assessments of risk had not been carried out; staff knowledge of some risks and the management of these was not sufficient to ensure they could provide safe care; people were placed at risk because the checking of equipment used to prevent injuries was not accurate; where factors for people indicated concerns to their health, they had not been followed up and appropriate checks were not always undertaken following unwitnessed falls.

Where people had been losing weight, appropriate action had not been taken to ensure they were receiving the nutritional support they needed.

In addition, people were placed at risk because good infection control and maintenance measures were not in place. Several items of equipment were worn or ripped meaning they could not be sufficiently cleaned. There was a lack of schedules in place to ensure cleaning of some equipment. Some areas of the home smelt strongly of urine and we could not be confident that when housekeeping staff had signed to confirm they had cleaned an area, that this had been done.

Following the inspection, we asked for an action plan to address the immediate concerns we had for people’s safety. We also referred our concerns to the local authority.

Staffing levels were sufficient to meet the personal care needs of people but they did not support staff to provide any social or emotional engagement and support. Care planning was not always personalised and was not fully responsive to people’s changing needs. End of life care planning was in place for some people but needed further development.

People did not always receive effective care and support because staff had not received some training to help them meet people’s needs. Where training was provided in a specific areas staff competency had not been assessed to ensure they understood the area of need. People and their relatives provided positive feedback about staff. However, our observations showed that not all staff provided support in a respectful and dignified way.

There was a process in place to deal with any complaints or concerns if they were raised. However, when feedback via alternative formats such as surveys suggested concerns these were not investigated and acted upon. This meant we could not be confident the systems in place to seek feedback and address concerns were used effectively to ensure a safe and quality service was provided and drive improvements.

Despite knowing that there had been a problem with care plans and risk assessments, there had been a failure on the provider’s behalf to follow this up in the home and ensure people’s safety and a quality service was provided. The senior management team, provider and registered manager did not have an effective system to ensure they had good oversight of the safety and quality of the service.

Medicines were managed safely. Staff felt supported and were receiving supervisions to support them in their roles.

Prior to people moving into the home, assessments were undertaken to ensure the home and staff could meet the person’s needs. Staff were aware of the need to treat people as individuals and ensure care reflected their individual needs. Where applicable mental capacity assessments had been undertaken and we consistently saw and were told people’s permission was sought before staff provided care.

Some efforts had been made to adapt the environment to meet people’s needs but more work could be done to develop this further.

People were protected against abuse because staff had received training and understood their responsibility to safeguard people. Concerns were reported and investigated. The provider’s recruitment process included appropriate checks to ensure staff suitability to work in the home.

Communication with the kitchen staff needed to improve. The registered manager had defined staff roles and was open to suggestions and feedback. Staff felt supported by the registered manager and able to raise concerns at any time. They were confident these would be addressed. People and their relatives were confident to raise concerns if they needed to and spoke positively about the registered managers approach.

The overall rating for this service is ‘Inadequate’ and the service remains 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.”

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. CQC are considering what regulatory action to take in response to the serious concerns found during the inspection. Full information about CQC’s regulatory response is added to reports after any representations and appeals have been concluded.

Glen Heathers is a registered care home and provides accommodation, support and nursing care for up to 53 people, some of whom live with dementia. Support is provided in a large home that is across two floors. Communal areas include two lounges and a dining room. At the time of our inspection there were 22 people living at the home.

The service did not have 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. The previous registered manager had left employment following our last inspection. A new manager had been recruited and commenced this role on 27 March 2017. They advised us they intended to make an application to become the registered manager which we received following the inspection. Throughout the report we refer to this person as the manager.

The service has a history of breaching legal requirements. Following an inspection in March 2015 multiple breaches of regulations were identified and CQC took appropriate enforcement action and placed the service in special measures. Some improvements were seen during a focused inspection in June 2015 and further improvements were found at the comprehensive inspection in November 2015 when the service was rated overall requires improvement and came out of special measures, although they remained in breach of Regulation 17, Good governance. During the next comprehensive inspection in November 2016, we identified multiple breaches of the regulations which related to providing safe care and treatment, safeguarding, staffing, person centred care and good governance systems. The overall rating following the November 2016 inspection was inadequate and the service was placed into special measures again.

At this inspection we looked at the whole service, reviewed their compliance with the regulations and their rating. Whilst we found some improvements and the overall rating for this service is ‘Requires improvement’, the service remains inadequate in well led. Services must remain in special measures if any question is inadequate at the next inspection after they were placed into special measures. Therefore, this service remains in Special Measures.

Improvements have been found at this inspection and some previously breached regulations were no longer in breach. However, the provider’s history demonstrates that they have been unable to sustain improvements in the past at this service and we were unable to see sustainability at this inspection due to the time scale since the last inspection. Whilst changes had been made to the systems used to monitor and assess the safety and quality of the service, these still required some review to ensure they were fully effective and truly embedded in practice. We found some concerns about these systems and their ability to fully analyse the service and ensure information for staff was clear so as not to pose any potential risks to people.

People told us they felt safe at the home and staff had a good understanding of their roles and responsibilities in protecting people from abuse. They knew what to look for and the action to take if they were concerned. Changes had been made to the system which monitored people for any potential injuries and where injuries such as bruising or skin tears had occurred these were now being investigated and action taken.

The identification of risks for people and implementing plans to reduce the risks had improved, although further improvements were needed to ensure equipment was used safely. The management of medicines had improved. Medicines were stored safely and were available when needed, however guidance for topical creams needed to be clearer. A system of regular audits meant that there was a process in place to promptly identify medication errors and ensure that people received their medicines as prescribed. A safe and effective recruitment system was operated and staffing levels during the inspection met the needs of people.

Staff received support and training to work safely and effectively with people, although the frequency of supervisions had been inconsistent and not all staff had received these. The manager had an improvement plan in place which identified the need for these to take place with all staff more regularly and had begun to do so. In addition, the manager had started to introduce a system to assess staff competency and was aiming to develop their skills and introduce champion roles.

Staff understood the importance of assuming a person can make their own decisions and sought their consent before providing care by asking the person first. Where needed, mental capacity assessments had been undertaken and best interests decision made involving people’s representatives.

People and relatives spoke positively about the staff. They were consistently described as kind and caring. One person felt they had never been so well looked after. We were told staff offered choices and respected people’s privacy. People and their families felt involved and the manager had ensured they had met with them and planned to do this regularly. They had also planned for relatives to attend reviews of care plans with people, where appropriate and were working with relatives to aid their communication with people. People were supported to maintain a balanced diet and their risk of malnutrition was monitored. Changes had been made to the process of this and we saw that when concerns about weight loss were identified action plans were promptly implemented. Staff responded to changing needs and referrals to other professionals were made as needed.

Some changes to the environment had been made which everyone was very happy with. The manager had used a recognised tool to assess the need for any other changes to promote an environment which would support people living with dementia more effectively. There were no immediate plans to make significant changes but the manager told us this would be kept under review.

We found an ongoing breach of Regulation 17 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 the report.

Glen Heathers is a registered care home and provides accommodation, support and care, including nursing care, for up to 53 people, some of whom live with dementia. The home is separated into three wings across two floors, with access to communal areas. At the time of inspection there were 26 people living in the home.

At this comprehensive inspection a registered manager was in place. A registered manager is a person who has registered with the Care Quality Commission (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 and associated Regulations about how the service is run.

The service has a history of non-compliance with the legal requirements. In March 2015 we identified multiple concerns and took enforcement action, including serving the provider with three warning notices in relation to standards of care and welfare for people who used the service, the unsafe management of medicines, the manner in which people were treated and a failure to ensure consent was gained and where appropriate the Mental Capacity Act 2005 was being applied correctly. These warning notices required the provider to meet the legal requirements by 4 June 2015. In addition, a condition was placed on the registration of the provider for this home stopping them from allowing any new admissions to the home without CQC’s prior permission. At this inspection the overall rating was inadequate and we placed the service in special measures.

In June 2015 we undertook a focused inspection to check the provider had taken action to meet the legal requirements in relation to the three warning notices served. Some improvements had been made but they had failed to make sufficient improvements regarding the manner in which people were treated and in providing safe care and treatment. We served two further warning notices for the same breaches and required the provider to become compliant with these regulations by 14 August 2015.

In November 2015 we undertook a further comprehensive inspection. Improvements had been made and they had met the warning notices. At this inspection the service was rated as requires improvement. Two breaches of regulations were identified in relation to the cleanliness of the premises and the accuracy of care records. These were judged to have a minor impact on people. Due to the improvements made the service was taken out of special measures.

At this inspection we found areas which had previously improved but had since deteriorated again.

The overall rating for this service is now ‘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.

Whilst staff understood their responsibilities in relation to safeguarding people at risk, the registered manager was unaware of some unexplained injuries in the home and no action had been taken to investigate these. Risks associated with people’s needs had not always been assessed and plans developed to reduce these risks. Medicines were not always stored safely and prescribed medicines needed in an emergency were not available.

Recruitment checks were carried out to ensure staff were suitable to work with people. Staffing levels were appropriate to meet people’s needs. Improvements had been made to the environment which was now much cleaner.

Training and supervision was available for staff, although their competency was not always assessed and their training was not always up to date.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Consent was sought where the person could provide this. Mental capacity assessments had been carried out but not always reviewed. Deprivation of Liberty Safeguards (DoLS) care plans had been implemented to guide staff following authorisation of the application, except for one person who had a care plan detailing how they were being deprived but no application had been made. We have made a recommendation about this.

People were supported to access other health professionals and received support to eat their meals.

People were treated with dignity by staff who were kind, caring and respectful. We have recommended the provider and registered manager review the process used to ensure people are involved in decision making about their care and the home.

Preadmission assessments were not consistently carried out and then used to develop personalised plans of care.

A complaints policy was in place and people knew how to make a complaint. Records were not always clear about the action that had been taken following receipt of a complaint.

The provider, their senior management team and the registered manager had not identified the concerns we had through their quality assurance processes. Records remained inaccurate.

We found five 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.

The provider sent us an action plan detailing how they would work to improve this. At this inspection we reviewed the progress the provider had made in taking action to ensure compliance in the area of concern. We found that the provider had taken appropriate measures to achieve compliance. We found that maintenance issues were being reported, recorded and any works requiring action were acted upon promptly.

We found that before people moved into the service the person and/or their representative was provided with appropriate information to make an informed decision about moving there. We found that people’s privacy and dignity was maintained and staff were aware of how to ensure this.

People’s needs were assessed and care plans developed that included people's needs and personal wishes.

People that we spoke with told us they were happy with the care and support being provided. Comments included, “The staff are wonderful, they come round regularly and ask if I’m ok, they know what they are doing. I’m very well looked after”.

We found that the home had effective systems in place for managing the risks associated with medicines and their administration to people.

We found that the home had sufficient numbers of skilled and experienced staff to meet the needs of people. One person told us, “When I fell in my room, they came as soon as I called them.”

We looked at the environment and equipment used in the home. We found that some areas were not suitably maintained and there were not effective systems in place for identifying and prioritising works. This meant that people may have been at risk from the use of unsafe or unsuitable equipment.

Comments included. “The staff are lovely, they look after you well. If you are ill they get the doctor. I visited the home before I moved in and the whole feel of the place was good.”

There were detailed, person centred plan of care in use that included people’s individual care needs and personal wishes. The plans also contained clear information regarding staff supporting people’s emotional and social wellbeing.

In order to meet people’s individual needs, the home’s staff worked with a variety of healthcare professionals including physiotherapists and mental health teams. We were show that specialist consultants were used where appropriate.

People were protected from risk of abuse or harm by there being safeguarding polices and procedures in place and by staff knowing how and when to use them.

Evidence we saw showed us that people were supported by a caring, experienced staff team. The staff team were well supported and trained.

There was a regular cycle of quality audits undertaken to ensure that the home was kept under review.

Comments from four family members that spoke with us included. “I have no experience of other homes but this one seems really happy. My relative gets on really well with the carers."