Heffle Court

Heffle Court is a purpose built care home providing residential and nursing care for up to 41 older people. People had a range of health and mobility problems. Some people were also living with dementia and memory loss. There were 37 people living at the home at the time of the inspection.

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

Quality assurance systems were in place. This included checks to review and assess the care provision and documentation. However, these needed to be developed to ensure that observations were carried out to identify bruising and to ensure that this information had been robustly recorded and fed back to staff. There was an overreliance on verbal sharing of information and staff needed to ensure information was clearly documented, for example if a bruise was noted during personal care. This was fed back to the regional and registered manager during the inspection and immediate action was taken. Risk was also mitigated as staff knew people well and we have been assured that improvements have been introduced for documentation and quality assurance.

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 received their medicines safely. Nurses and care staff trained to give medicines ensured medicines were stored, administered and disposed of safely. Clear documentation was in place to support people who required their medicines being given covertly.

Risk assessments were completed to maintain people’s safety. People told us they felt safe living at Heffle Court. One person told us, “Staff cannot do enough for you.” People spent their time in the way they chose. Staff told us about peoples likes, dislikes and preferences. For example, one person liked to sit in the lounge at times, however, staff were aware that they would leave and return to their room or to find a quiet spot to sit if things got lively or noisy.

People, relatives, staff and visiting professionals were encouraged to share their views and feedback was used constructively to facilitate on going improvement. People told us the manager had an open-door policy. Relatives told us communication was good and they were kept informed and updated of any changes. If people had any concerns they told us they would be happy to discuss these with staff or management.

There were safe systems to support effective infection prevention control. The home was open to visiting and COVID-19 measures were reviewed regularly in line with current government guidance.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 18 April 2019).

Why we inspected

The inspection was prompted, in part, due to concerns received about the provider’s approach to visiting, responding to concerns and risk of a closed culture. A decision was made for us to inspect and examine the concerns across a range of Caring Homes services. We had also received specific concerns regarding Heffle Court in relation to peoples nursing and care needs, medicines, staffing and communication with families.

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.

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 remained as good, based on the findings of this inspection. However, we have found evidence that the provider needs to make improvements. The provider has taken action to mitigate this risk. Please see the well led section of this full report.

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

Follow up

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.

The provider had purchased several Chromecasts and iPads for the service to use. People were supported to use these to watch musicals, see virtual tours, play quizzes and attend virtual church services, as well as keeping in touch with relatives.

There were clear visitor policies for relatives. There was the facility for garden and indoor visits to take place in designated areas of the home. These areas were able to be accessed through the garden gate and were disinfected after each use. Visits to the home were dependent on the home’s current COVID-19 status.

The registered manager had identified an area of the home to be used to isolate people, should an outbreak occur. This area of the home was an extension to the main building with its own living room, kitchenette and bedrooms. The registered manager told us that this area would have its own designated staff team if in use.

The provider had set up a closed social media group for staff. This enabled staff across the provider’s care homes to communicate with each other, get support and ideas as well as keep up to date with best practice guidance. The regional manager told us this had been created to support staff to feel part of the organisation and to be able to raise any concerns during the pandemic.

Further information is in the detailed findings below.

Heffle Court is a residential care home. There were 37 people living there at the time of the inspection. The service specialises in providing nursing and care to older persons who are living with dementia, some of whom may show challenging behaviours. Some of the people were also living with a range of care needs, including arthritis, diabetes and heart conditions. Most people needed support with their personal care and mobility.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

People’s experience of using this service:

• Staff had a good understanding of the risks associated with the people they supported. Risk assessments provided further information for staff. People were protected from the risks of harm, abuse or discrimination. Staff ensured they considered a range of areas to reduce people’s risk of harm. This included making sure people’s arms were fully protected when moving people using hoist slings and by making sure people sat on their own pressure relieving cushions in the lounge.

• If a person did have an accident or was involved in an incident, records were clear and, where relevant, there was 24-hour follow-up to review how they were.

• People were supported to take their medicines when they needed them. Records relating to medicines were clear, this included where people where prescribed medicines like Warfarin, where the dose can vary over time.

• There were enough staff on duty to ensure people received the support they needed. For example, the activities worker told us there were enough staff deployed to ensure people received the support they needed when they took people out on trips in the service’s minibus.

• Staff were supported and provided with the skills they needed to meet people’s needs, this included recent training in reporting and recording skills.

• People were supported in the way they needed to eat and drink. All meals, including liquidised meals, were attractively presented. All staff had been trained in supporting people who needed textured foods.

• Staff followed national guidelines on meeting people’s needs and had good relationships with GPs and other external professionals. For example, all staff on the residential floor had a good understanding of supporting people who were living with diabetes, this also included training and supervised practice on giving people insulin injections.

• Staff were aware of their responsibilities under the Mental Capacity Act (MCA) and Deprivation of Liberties Safeguards (DoLS).

• Staff were very aware of the importance of gaining consent from people before they supported them. For example, one person was leaning to one side in their chair and looked uncomfortable. The member of staff sought their permission to place a cushion on that side of their body, so they were not leaning too far. The also explained what they were doing and why.

• There was a relaxed atmosphere, with people who were able to, walking about as and when they wanted, choosing where to sit in sitting rooms.

• People had positive interactions with staff. For example, one member of staff was sitting with two people at a table, there was lots of laughter and engagement between the three of them and all three clearly enjoying each others' company.

• Staff were always polite to people. One person came out of their room suddenly, the member of staff who was passing the person’s room pushing a trolley, stopped and said, “Did I startle you, I am sorry.”

• One person was confused about where they were, the time and day of the week. A member of staff held a calm relaxed conversation with them, orientating them to what was happening and where they were.

• People had clear care plans which outlined how their needs were to be met, in a person-centred way.

• Staff sought people’s permission to be involved with activities and supported them with engagement.

• The registered manager was keen to develop a range of ways to receive people’s opinions about the care they received.

• The registered manager was experienced in their role and open to new ideas. Her values included the promotion and improvement in the lives of people who were living with dementia in a way that suited each individual.

• The registered manager was supported by senior staff who were keen to innovate and develop care practice; they also actively supported more junior staff.

Rating at last inspection:

Good (report published 16 September 2016)

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

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.

Accommodation was provided over two floors, with lifts to support people in getting between floors. There were lounges and dining rooms on each floor. The first floor provided nursing care, and the ground floor residential care, each had a deputy manager in charge. The home was situated close to the middle of the Heathfield in East Sussex.

Heffle Court had 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 providers for the service were Caring Homes Healthcare Group Limited, a national provider of care.

Heffle Court was last inspected on 30 March 2015. It was rated as Requires Improvement. At that inspection we found three breaches in the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and made one recommendation. The provider had addressed all three breaches and most of the recommendation, with only one part of the recommendation still to be addressed.

At the last inspection we recommended that further guidance was sought with regard to signage making the environment more user friendly and comfortable for people living with dementia. The registered person had provided signage across the home. The registered person had identified that the building needed up-grading both internally and externally and had developed a two year plan about this. However their plan did not identify how they would follow guidelines on making the environment more user friendly and comfortable for people who were living with dementia. The registered manager had identified deteriorated furniture in their last three audits, the provider had not responded to their audit to outline how these matters identified by the registered manager were to be actioned.

At the last inspection, we identified that the registered person had not ensured there were always sufficient numbers of suitably qualified, skilled or experienced persons employed. This had been addressed in full. People and staff reported there were enough staff, with the necessary skill mix to meet their needs. This was confirmed by our observations, which included busy times of day, like lunch times.

At the last inspection the registered person had not ensured that care had been provided in a safe way for people. This had been addressed in full. People had full assessments of risk, these were updated regularly. People had care plans, which staff followed, to ensure risk for them was reduced. Information from audits such as accident returns were used to reduce people’s risk. There were safe systems for supporting people in taking their medicines, and full records were maintained.

At the last inspection, the registered person had not ensured there was adequate assessment and monitoring of the quality of service provision. This had been addressed in full. The registered manager had full systems for assessment and monitoring of service provision, this included feedback from people and audit of services provided. Audits included maintenance, hygiene and documentation. The registered manager ensured action was taken where issues were identified during their audits.

People had full assessments of their mental capacity. These were decision specific, in accordance with the Mental Capacity Act 2005 (MCA). Staff followed the principals of the MCA when they supported people. Where people needed to be deprived of their liberties, they were referred as required under deprivation of liberties safeguards (DoLS), and relevant records were in place.

People said they liked the meals. Staff used a range of different ways to ensure people who were living with dementia could choose what they ate. People received the support they needed to eat and drink. Where people were at risk of malnutrition or dehydration, this was assessed and full records were in place.

Staff always treated people with respect. They showed an empathetic response to people when they supported them. People’s privacy and dignity were ensured by staff. Staff encouraged people’s independence and involvement.

Staff responded effectively to people’s needs, including their dementia and healthcare needs. Staff regularly reviewed people’s care plans with them or their advocate to ensure their current needs were met in the way they wanted. There were a wide range of different activities provided to support people. People were actively supported in bringing up issues with management if they wanted. Where formal complaints were made, the registered manager responded in an open way.

Staff were positive about the training and support they received. The provider’s training programme ensured staff provided effective care to people, taking into account their different needs. Staff knew how to ensure people were safeguarded from risk of abuse. All staff were recruited in a safe way, to ensure they were suitable to look after the people living in the home.

We found that people or their representatives had expressed their views and were involved in making decisions about their care and treatment. There was an outstanding programme of activities and a commitment to promoting people's involvement with their community. One relative told us, "The activities are second to none".

We found that people were provided with written statements specifying terms and conditions in respect of fees. A relative told us, "Everything was quite clear from the start".

People's care was delivered in line with their assessed needs. A person who lived in Heffle Court told us, "The staff are taking very good care of me". A relative of a person who used the service said, "I rate this home as 100 out of 100 for the quality of care they provide".

We found that the service took appropriate steps to ensure there were sufficient numbers of suitably qualified, skilled and experienced persons employed. People were not rushed and their requests for assistance were addressed without delay. The regional manager told us, "We staff to 120%".

We saw that a robust system of audits was in place to ensure that good quality of care was delivered and risks to people who used the service were identified and minimised. The regional manager had been in their post only three weeks and had already carried out an extensive appraisal of the service to monitor its efficiency. They told us, "The system is reliable".