Archived: The Heights Care Home

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.

The previous inspection was carried out on the 8 and 13 April 2015, when shortfalls were identified and the service was found to require improvement regarding person centred care and staff support and training. Following that inspection, we asked the provider to send us an action plan to say how they would address these issues. During our latest inspection we found the necessary improvements had been made.

There was a registered manager in post, although not able to be present on the day of the 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.

Staff training was inconsistent and did not always ensure staff had the necessary knowledge, confidence and competence to effectively meet people’s needs. People were not consulted or consistently involved in decisions regarding what they eat or drink.

There were policies and procedures in place to assist staff on how keep people safe and individual risk assessments were kept up to date. Staff told us they had completed training in safe working practices. We saw people were supported with patience, consideration and kindness and their privacy and dignity was respected.

Staff were deployed in sufficient numbers to ensure people received safe and personalised care and support. Staff received one-to-one supervision meetings with their line manager. Formal personal development plans, such as annual appraisals, were in place.

People’s needs were assessed and their care plans provided staff with clear guidance about how they wanted their individual needs met. Care plans were person centred and contained appropriate risk assessments. They were regularly reviewed and amended as necessary to ensure they reflected people’s changing support needs. People were able to access health, social and medical care, as required.

Thorough recruitment procedures were followed and appropriate pre-employment checks had been made including evidence of identity and satisfactory written references. Appropriate checks were also undertaken to ensure new staff were safe to work within the care sector.

Medicines were managed safely in accordance with current regulations and guidance by staff who had received appropriate training to help ensure safe practice. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). In accordance with the principles of the MCA, people were supported to make decisions in their best interests.

People were provided with appropriate food and drink to meet their health needs and were happy with the food they received. People’s nutritional needs were assessed and records were accurately maintained to ensure people were protected from risks associated with eating and drinking. Where risks to people had been identified, these had been appropriately monitored and referrals made to relevant professionals, where necessary.

There were quality assurance audits and a formal complaints process in place. People were encouraged and supported to express their views about their care and staff were responsive to their comments. Satisfaction questionnaires were used to obtain the views of people who lived in the home, their relatives and other stakeholders.

Is the service safe?

People were treated with dignity and respect by the staff. Safeguarding procedures were robust and staff understood how to safeguard the people they supported. Systems were in place to ensure that managers and staff learnt from incidents such as accidents. This reduced the risks to people and helped the service to continually improve. People were protected against the risks associated with the unsafe use and management of medicines.

The home had policies and procedures in relation to the Mental Capacity Act, (MCA) 2005 and Deprivation of Liberty Safeguards, although no applications had been submitted since our last inspection. All staff had been trained to understand when an application should be made, and how to submit one. The MCA documentation was available in people's care files and there was evidence of best interest meetings being held to ensure people were being safeguarded.

Staff had received up to date training in all mandatory areas, as well as those specific to their job role. Staff recruitment procedures were thorough and in accordance with the provider's policy. Staffing levels were determined based on the individual needs of each person. Policies and procedures were in place to make sure unsafe practices were identified and people were protected.

Is the service effective?

Staff had the skills and knowledge to meet people's needs. Managers gave effective support to staff including induction training, supervision and a substantial training programme. We saw that staff were continuously assessed to make their skills and knowledge met the needs of the people living in the care home. The care home worked effectively with other agencies and services to ensure a co-ordinated approach to people's care.

Is the service caring?

People living in the care home were supported by kind and attentive staff. They were cared for sensitively and given encouragement. People's preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

The complaints procedure was understood by staff, people living in the care home and relatives. The registered manager was offering encouragement to relatives to become further involved in voicing their opinions about the care offered.

Is the service well led?

There was a quality assurance process in place. Records showed that any adjustments needed were actioned promptly. This enabled the quality of the service to continually improve. Staff told us they were clear about their role and responsibilities. All of the staff we spoke to said they were strongly supported by the managers.

We spoke with two people who live at the care home. They told us that: 'The staff are very nice, everyone is very friendly, and if I need any help, I just need to ask.' Another person said: 'I can't complain, I've got a nice rom, and I'm very comfortable. The staff are all very nice, and the food is lovely'

We carried out a Short Observational Framework for Inspection (a SOFI) during this inspection visit. This involved us sitting in the dining room and observing for an hour over the lunch period. This enabled us to see how the staff spoke with people who live at the home, and how they offered help and support. This observational technique is also very useful for identifying issues relating to privacy, dignity and respect. Our observations showed that people were treated with respect, and that staff had good relationships with the people who live at the care home. We saw staff offering support and encouragement in a pleasant, friendly and helpful manner.

We looked at eight outcomes from the Health & Social Care Act (2008). We found the staff to be knowledgeable, and our observations showed staff to be caring and focussed on the people who live at The Heights.