About the service Heathfield Residential Home is a care home providing personal and nursing care to 29 people at the time of the inspection, some of whom lived with dementia. The service can support up to 35 people.
The service was provided across two floors of one adapted building. Most of the people living at the service were permanent residents. However, the service also provided respite care to people who required it for short periods of time. At the time of the inspection no one was staying there for respite.
People’s experience of using this service and what we found
Feedback from people and their relatives was mixed. Although most people were happy with their care they did raise some concerns. One relative said, “If I was assessing them I would give them seven out of 10.”
Some measures to keep people safe were not always in place. Risk assessments had not been fully completed. This meant there was a lack of information for staff on how to keep people safe. Where there were risks, the actions planned to keep people safe were not always monitored. For example, where people were at risk of dehydration, records on how much the person had drunk were poor.
The service had systems and processes in place to safely administer, record and store medicines. However, these were not followed, and people were not getting their medicines as prescribed. Internal audits by the provider had identified several of the issues the inspection team saw on the day, but had not managed to rectify these and embed good practice around the safe and effective management of medicines.
Safeguarding incidents were not always reported to the local authority to review and investigate. Staff had not always completed safeguarding training to ensure they understood how to keep people safe from abuse. When incidents had occurred, they were not always reported and there was a lack of information about actions that had been taken to keep people safe. This meant opportunities to prevent these concerns from arising again were missed.
Staff had not always been recruited safely. For example, records did not include a full employment history, or a written explanation of any gaps in employment. On the first day of the inspection there was insufficient staff to support people and people had been left waiting for support. However, staffing levels were increased on the second day after we raised concerns.
When people moved to the service their needs were assessed. However, the assessment had not been used to effectively plan people’s support and ensure that there were sufficient staff with the skills they needed to support people. People’s emotional support needs had not been adequately considered and there had been no recorded efforts made to reduce anxious or emotional based behaviour.
Staff had not completed the training or induction they needed to provide people with effective support. There were times where staff had not provided good support to people. Staff were not well supported or supervised.
People’s capacity had been assessed. However, some people had variable capacity, and this had not been taken in to account. Legal safeguards were not always in place where people were not safe to leave the home unsupported. This meant some people were being deprived of their liberty without an appropriate assessment to determine if this was lawful or appropriate. Some people had been recorded as having capacity to make their own decisions, however decisions had also been recorded as having been taken on their behalf. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.
Support to maintain nutrition and hydration was not as effective as it could have been. Where people had been unwell and lost a significant amount of weight action had not been taken to support the person with nutrition. People had access to healthcare services. However, some people would have benefited from more support from health and social care professionals such as the occupational therapist to improve their care. There was a lack of support to maintain dental hygiene and people’s dental needs had not been fully assessed.
The service was clean, and the decoration well maintained. However, a number of people were living with dementia and there were areas where the decoration could be more dementia friendly.
There were areas where people could be treated with more dignity and respect. For example, some people would benefit from more support when they were eating. People’s privacy was not always well maintained as staff accessed people’s records on a computer in a public space and the screen was visible to people and their relatives. We made a recommendation about this.
There was a lack of person-centred information about what people could do for themselves. This meant there was a risk that people’s independence would not be promoted or maintained. We made a recommendation about this. There was a lack of information about people’s preferences and we saw some incidents were their preferences were not met. Care plans including end of life plans lacked detail. Care plans were confusing and difficult for staff to read and staff relied on verbal information. This meant there was a risk that changes to people’s care would not be identified by staff.
The service was not well managed. Communication between staff and management needed to be improved and staff were not regularly or effectively supervised. Checks on the quality of the service had not identified concerns and opportunities to improve people’s care had been missed.
The provider had not met their legal obligations to report notifiable events to CQC. Prior to the inspection the management team had recently started working with local authority and health professionals to make improvements. However, there had not been sufficient time for this to have impact.
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 on 28 January 2019). At the last inspection there were two breaches of the regulations.
At this inspection the service had deteriorated, and the provider was still in breach of regulations.
Why we inspected
The inspection was prompted in part due to concerns received about a number of areas including staffing levels, medicines management, non-reporting of concern and safeguarding incidents. A decision was made for us to inspect earlier than planned to examine those risks.
We have found evidence that the provider needs to make improvements in all sections of this full report.
Enforcement
We have identified breaches in relation to safe care and medicines, governance, person centred care, safeguarding people, consent, staff training, recruitment and notifying CQC.
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 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 work with the 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.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.