Background to this inspection
Updated
16 October 2019
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
This inspection was carried out by three inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
The Heights 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 had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
The inspection was unannounced and took place on 23 and 31 July 2019.
What we did
Prior to the inspection we reviewed all the information we held about the service including notifications received by the Commission. A notification is information about important events which the service is required to tell us about by law. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all this information to plan our inspection.
During the inspection
We spoke with six people who lived at the service and two visiting relatives. We observed staff interactions with people. We spoke with five care staff, two nurses, the activities co-ordinator, one member of the domestic staff and a visiting health care professional. We also spoke with the registered manager, the acting head of quality; the resident experience team manager, the regional manager; the managing director and the chief operating officer.
We looked at documentation related to the running of the service, including four people's care and support plans, risk assessments and progress records. We also looked at records of accidents, incidents, complaints and compliments, medicine records and staff files, including training and recruitment.
Updated
16 October 2019
About the service
The Heights is a residential care home providing personal and nursing care for up to 36 people, with a range of medical and age-related conditions, including arthritis, frailty, mobility issues, diabetes and dementia. The service is divided over two floors. On the day of our inspection there were 29 people using the service; 14 people were on the ground floor and 15 on the first floor.
People's experience of using this service and what we found
We have found evidence that the provider needs to make improvement across all areas. Please see the information in the sections of this full report.
We found people were at significant risk of harm from inadequate staffing levels. We received overwhelming feedback from people using the service, staff and relatives that there were not enough staff deployed to meet people’s identified care and support needs in a safe and consistent manner. Staff were unable to ensure people’s safety and welfare. Care plans contained evidence, in the daily notes, of the potential risk to individuals and the frustration of staff at the impact of inadequate staffing levels. Staff told us they did not have enough time to read care plans. They said they relied upon discussions with other staff and staff handovers. This has resulted in people not receiving the consistent care and support they required. There was not enough staff deployed to ensure people’s safety in the event of a fire and there was a lack of effective contingency measures in place to cover short notice staff absences. This placed people at risk of potential harm. Where accidents or incidents had occurred, lessons were not always learned to prevent the same thing happening again.
Medicines were stored, administered and disposed of safely by staff who were trained to do so. Systems and processes were in place to safeguard people from abuse. Staff understood the signs of potential abuse and how to respond appropriately.
We found people were at risk of dehydration. Food and fluid records did not indicate people had been provided with enough to drink. There was no documentary evidence of actions to be taken when fluid intake had been recorded as being very low. Staff did not always have the necessary training to meet people’s needs. Guidelines for staff followed best practice guidance and some staff had said they had received training, but this was inconsistent. We have made a recommendation with regard to the training.
People were not provided with adequate levels of personal care. Staff told us they did not always have time to support people with their personal hygiene. Furthermore, several records showed people had not been provided with assistance with oral care. Infection prevention and control measures were in place but not always adhered to and the premises were not clean in all areas.
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.
Staff did not always have time to spend with people which impacted on their caring approach, we did see kind, friendly and respectful examples of caring on the day. People were not provided with adequate levels of personal care. Staff told us they did not always have time to support people with their personal hygiene. Furthermore, several records showed people had not been provided with assistance with oral care.
Quality assurance systems were not consistently effective. The registered manager had not completed regular audits and quality assurance monitoring.
Despite concerns being highlighted and regularly brought to the attention of the registered manager, there had been no change and no improvement. This had resulted in a culture of despondency and frustration amongst staff, who told us they felt they were not listened to, supported or valued.
Rating at last inspection
Rated as Good, report published 3 February 2017.
Why we inspected
This was a scheduled inspection based on the rating at the last inspection.
Enforcement
We have identified breaches in relation to person centred care, safe care and treatment, staffing and leadership at this inspection. The provider took immediate action to mitigate the most serious risks we identified on our inspection. You can see the action we have asked the provider to take at the end of this full report.
Follow up
Immediately after our inspection, we wrote to the provider and asked them to take urgent action to address the most serious risks outlined in this report. In response, the provider developed an action plan detailing actions taken and planned, to make improvements and reduce risk. Additional resources were also immediately deployed to the service from other areas of the providers network. We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.