heron house care home - care quality commission · accommodation, support and care, including...

| Inspection Report | Heron House Care Home | October 2014 www.cqc.org.uk 1

Inspection Report

We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards.

Heron House Care Home

Coronation Close, The Avenue, March, PE15 9PP

Tel: 01354661551

Date of Inspection: 23 September 2014 Date of Publication: October 2014

We inspected the following standards to check that action had been taken to meet them. This is what we found:

Care and welfare of people who use services Action needed

Meeting nutritional needs Met this standard

Management of medicines Action needed

Staffing Met this standard

Supporting workers Action needed

Assessing and monitoring the quality of service provision

Action needed

Records Met this standard


Details about this location

Registered Provider Four Seasons Homes No 4 Limited

Registered Manager Miss Catherine Louise Tero

Overview of the service

Heron House Care Home is registered to provide accommodation, support and care, including nursing care, for up to 92 people, some of whom have mental health needs.

Type of service Care home service with nursing

Regulated activities Accommodation for persons who require nursing or personalcare

Diagnostic and screening procedures

Treatment of disease, disorder or injury


Contents

When you read this report, you may find it useful to read the sections towards the back called 'About CQC inspections' and 'How we define our judgements'.

Page

Summary of this inspection:

Why we carried out this inspection 4

How we carried out this inspection 4

What people told us and what we found 4

What we have told the provider to do 6

More information about the provider 7

Our judgements for each standard inspected:

Care and welfare of people who use services 8

Meeting nutritional needs 10

Management of medicines 12

Staffing 14

Supporting workers 15

Assessing and monitoring the quality of service provision 17

Records 19

Information primarily for the provider:

Action we have told the provider to take 20

About CQC Inspections 22

How we define our judgements 23

Glossary of terms we use in this report 25

Contact us 27


Summary of this inspection

Why we carried out this inspection

We carried out this inspection to check whether Heron House Care Home had taken actionto meet the following essential standards:

• Care and welfare of people who use services• Meeting nutritional needs• Management of medicines• Staffing• Supporting workers• Assessing and monitoring the quality of service provision• Records

This was an unannounced inspection.

How we carried out this inspection

We carried out a visit on 23 September 2014, observed how people were being cared for, checked how people were cared for at each stage of their treatment and care and talked with people who use the service. We talked with carers and / or family members, talked with staff and were accompanied by a pharmacist.

What people told us and what we found

Background

On 23 April 2014 we carried out an unannounced inspection and found that people living at Heron House Care Home needed to have a better quality of life. We also found that the management of the service was not as good as it should have been.

Since our last inspection, we had received a number of concerns from the public, includingrelatives of people living at the care home, and from the local authority in relation to the standard and quality of people's care. The concerns also included those in relation to the management of the service. The purpose of the inspection of 23 September 2014 was, therefore, to assess how people were being looked after and if improvements had been made following our last inspection of 23 April 2014.

An adult social care inspector, a pharmacist inspector and an inspection manager carried out this unannounced inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

We spoke with a number of people who used the service, but most of these were unable totell us what it was like living at the care home, because of their complex communication needs. We also spoke with representatives of the owner of the care home, Four Seasons Homes No 4 Limited, and spoke with seventeen members of staff, which included nursing and care staff, housekeeping, maintenance and catering staff. In addition we spoke with three visiting relatives.


We looked at records in relation to the management of the service and eight out of eighty-two people's care records and twenty people's medications. We observed activities taking place throughout the care home; this also included observations of the lunch time activitieson Wendreda and Eastwood units. We reviewed the information that we have received about the care home since our last inspection.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

If you wish to see the evidence supporting our summary, please read the full report.

Is the service safe?

People told us they felt safe because the staff had treated them well.

Health and safety risk assessments had been carried out. However, some people remained at risk of harm to their health in relation to choking developing pressure ulcers and not having direct access to their call bells. We have asked the provider to take action in relation to care and welfare.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to careservices. An application had been submitted and work was in progress to submit other applications to the relevant authorities. Policies and procedures were in place in relation tothis matter.

The management of medicines failed to protect people from harm. We have asked the provider to take action in relation to the management of medicines.

There was a sufficient number of trained staff employed to provide people with safe support and care. Arrangements had been made to recruit more permanent nursing and care staff.

Records were now being kept safe and secure and records were maintained for fire safety and temperatures of hot water. Not all care records were kept up-to-date. This meant that people were at risk of unsafe support and care, especially with the high number of agency staff working at the home. We have asked the provider to take action in relation to quality assurance.

Is the service effective?

We found that effective measures had been taken to promote the healing of people's pressure ulcers.

At our last inspection we found that there was a lack of meaningful activities provided and this situation remained the same. We saw people had minimal stimulation to keep them from falling asleep or 'looking into space'. Where people were provided with stimulation, this was not always in line with the principles of good dementia care.

Quality improvements were needed so that people could make choices from the menu options and at the time of when their meal was being served. A range of food options was available to meet people's individual dietary likes and dislikes. People were given enough to eat and drink to keep them healthy.


Members of staff had not received one-to-one supervision sessions to monitor their work performance or assess their individual training needs. However, work was in progress to provide members of staff with supervised support. Staff members told us that they felt an increased level of support since the changes had been made with the current leadership ofthe home.

is the service caring?

People who we spoke with said that they had no concerns about how they were being looked after. We observed that they were looked after by caring and respectful members of staff. However, the culture of care was task driven when staff missed opportunities to engage with people when helping them with their eating, drinking and moving and handlingneeds. We have asked the provider to take action in relation to how people are looked after to maintain and promote their health and wellbeing.

Is the service responsive?

People's needs, choices and personal preferences had not been assessed or recorded. Therefore, we found it was difficult to know if these had been acted on. However, people who were able to tell us said they were satisfied with how their needs were responded to.

Is the service well-led?

Following our last inspection of 23 April 2014, we had received an action plan which told us that remedial action would be taken to become complaint with the regulations. The action plan was ineffective and failings in safe and quality care remained. There were inadequate monitoring and reviewing systems in place in relation to the management of staff, records and audits.

A registered manager was in post. In their current absence, there had been temporary arrangements made to manage the service. Since these management changes had been put in place, people's relatives and staff said that they felt listened to and supported.

Members of staff told us that they had training to do their job. However, they said that they had not had the support or leadership to enable them to enjoy their work or to work as a joined up team. Some staff members indicated that they had become demoralised. However, since the temporary management changes, they said that they felt more supported and encouraged to do their job.

We found that there had been a lack of timely action to replace emergency lights in Heron Court unit. We noted that these had been found to not be working when they had been tested during July 2014. This lack of action meant that people may not be fully protected during fire safety evacuation procedures.

We have asked the provider to take action in relation to the quality and safety of people's support and care.

You can see our judgements on the front page of this report.

What we have told the provider to do

We have asked the provider to send us a report by 24 October 2014, setting out the action


they will take to meet the standards. We will check to make sure that this action is taken.

Where providers are not meeting essential standards, we have a range of enforcement powers we can use to protect the health, safety and welfare of people who use this service(and others, where appropriate). When we propose to take enforcement action, our decision is open to challenge by the provider through a variety of internal and external appeal processes. We will publish a further report on any action we take.

More information about the provider

Please see our website www.cqc.org.uk for more information, including our most recent judgements against the essential standards. You can contact us using the telephone number on the back of the report if you have additional questions.

There is a glossary at the back of this report which has definitions for words and phrases we use in the report.


Our judgements for each standard inspected

Care and welfare of people who use services Action needed

People should get safe and appropriate care that meets their needs and supports their rights

Our judgement

The provider was not meeting this standard.

Care and support was delivered in a way that failed to ensure people's safety and welfare.

We have judged that this has a moderate impact on people who use the service, and havetold the provider to take action. Please see the 'Action' section within this report.

Reasons for our judgement

At our inspection of 23 April 2014, we found the provider was not compliant with the regulation associated with this standard. The provider wrote to tell us what remedial action had been taken to become compliant by 01 September 2014. We found insufficient evidence to support this.

At our last inspection we found that people were not provided with meaningful activities to maintain and promote their sense of wellbeing. During this inspection of 23 September 2014, we found there had been minimal improvements in relation to the provision of activities. We saw that there was an activity for the manicure and painting of (females') nails. However, we found that there were no other activities provided other than televisionswere on and music was playing.

We found that where music was playing in the unit of Eastwood, this was loud and was notnecessarily in keeping with the principles of good dementia care. People living with dementia may find noise disturbing, confusing and distressing. We also saw people sitting in Heron Court's lounge area, asleep or staring 'into space'. The television was on but none of the people were watching this or showed signs of wellbeing. Minutes of a relatives'and relatives' meeting, which was held during 05 June 2014, and from speaking with visiting relatives, we also found that people had not been provided with meaningful activities before our inspection. We heard that people had experienced a sense of boredom. Boredom can have a negative effect on people's experiences and their sense of wellbeing.

We saw that members of staff were caring in some, but not all aspects, of their work. We saw people were supported when walking in corridors and when being spoken with. We noted, however, members of staff had missed opportunities to engage with people in a meaningful and caring way. This included when supporting people with their food and drink


but were not actively talking to them. We also saw two staff members walk in and leave a person's room (to complete their care records) without speaking with them. We then spokewith the person, who was happy to hold a conversation with us and had smiled when doingso.

We saw when a person was being supported with their moving and handling needs, by means of a hoist and sling, that the two staff members had failed to speak to the person throughout the procedure. We saw that the person showed signs of being withdrawn; a state of being that fails to promote a sense of wellbeing.

During this inspection people who were able to tell us, said that they were satisfied with how they were being looked after. One person said, "I'm feeling alright. I'm comfortable." Another person told us that they were comfortable and pain-free. They also told us that they were satisfied with how their pressure ulcer had been treated. Their care records showed that the pressure ulcer had been effectively treated and was now healed, with the support and advice from the community tissue viability nurse (TVN).

On 11 September 2014, a community TVN had left written instructions for staff to replace aperson's pressure-relieving mattress, as the TVN had found the mattress not to be efficiently working. We, too, found the setting for the pressure-relieving mattress was set higher than the prescribed level and was not effectively working. We were advised that no action had been taken in response to the TVN's request. The person had been treated for a preventable pressure ulcer that had been acquired whilst living at Heron House Care Home.

We found that some people were placed at risk of choking. In one person's care records we found written instructions from a speech and language therapist (SALT). The SALT hadinstructed that the person was to be given a drink but not with the use of straw. When we spoke with the person we saw that they had, on their bedside table, a half glass of water with a straw in place. During our lunch time observation on Wendreda unit, we saw a person, in one attempt, swallow the contents of their meal from their bowl into their mouth. These actions were unsafe as they posed an increased risk of choking.

Before our inspection we received a concern in relation to call bells being out of reach. On entering two people's rooms we found that the call bells were on the floor and were out of the person's reach. We found that both people had high levels of care, including nursing care, needs. They were able to demonstrate to us how they would effectively use their call bells, when they had a need to use them.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to careservices. An application had been submitted and work was in progress to submit other applications to the relevant authorities. Policies and procedures were in place in relation tothis matter.


Meeting nutritional needs Met this standard

Food and drink should meet people's individual dietary needs

Our judgement

The provider was meeting this standard.

People were protected from the risks of inadequate nutrition and dehydration.


People who we spoke with said that they always had enough to eat and drink and described the food as being, "Alright." We found that the majority of food and drink charts had been completed and showed that people were given adequate amounts of food and drink.

Menus demonstrated that people were offered a choice from the menu, which included cooked breakfasts and alternatives of hot and cold food and drinks throughout the day.

The catering staff had information to hand in relation to people's individual dietary needs. This information was communicated from the nursing and care staff to the catering staff. We were advised that there had been improvements regarding the standard of this communication about people's dietary needs. People who required a soft or pureed diet were served this. We also saw that people were supported and encouraged to eat and drink their food, when this level of support was needed.

The catering staff had direct access to records of people's weights. These indicated where people had unintentionally gained or lost body weight. A catering member of staff told us that food was fortified with added dairy and sugar products. In addition, there was a reviewin progress regarding menus and the times of the day when meals were to be served. Thisreview had been carried out in response to people's food intake and to maintain healthy weights.

Our last inspection noted that improvements were needed regarding people's dining experiences. We found that quality improvements were still needed. This included the presentation of dining tables and the availability of menus in formats that would meet people's individual communication needs.

During our lunch time observation on Eastwood unit (where people living with dementia are looked after) we saw that people had been given their plates of food and were told what this was. However, the provider may find it useful to note that it was unclear how people living with dementia were enabled to make valid choices of what they would like to eat at the time of their meal. We found that there was no visual or photographic presentation of the menu options available, to enable people to effectively make their mealchoice.


We saw improvements had been made for the provision of salt and pepper pots on individual tables. However, the provider may find it useful to note that we saw no member of staff had asked people if they wanted to have pepper and salt added to their food.


Management of medicines Action needed

People should be given the medicines they need when they need them, and in a safe way

Our judgement


People were not protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.



Prior to this inspection we received information of concern which indicated people were notgiven their medicines as prescribed. During our inspection in April 2014 we found that there was a minor deficiency in relation to medication.

We found that some medicines were not stored securely. On one unit we found the room used to store medicines was not locked and some medicines were not locked away within this room. This meant that medicines could be access by unauthorised people. This was also not in line with the service's own policy which stated, "All medication… will be stored in locked cabinets and/or medication trolleys." We also saw in one area that there was a record made of the temperatures of the areas used to store medicines but that this had notbeen completed since 23 September 2014 and in another area, the temperature was not monitored at all. The records we looked at showed that the temperatures had been outsideacceptable limits. The temperature of the fridge used to store medicines in one unit had also been recorded outside the recommended temperature and no action had been taken to investigate the performance of the fridge or the quality of the medicines stored there. Therefore we were not assured that medicines had been stored in a way which would maintain their quality.

We found arrangements were in place to record when medicines were received into the service, when they were given to people and when they were disposed of. We looked at these records for 20 of the 82 people who used the service on the day of our inspection. Ingeneral, these records were in good order, provided an account of medicines used and demonstrated that people were given their medicines as prescribed. But we found a few discrepancies between the quantity of medication in stock and what should have been if the records were accurate. We were therefore not assured that people were always given their medicines as prescribed. We also saw that when medicines were given to people at different times to those on the printed medication record form, the actual time it was given was not recorded. This could result in people being given medicines too close together.

Some people received their medicines in the form of a skin patch. We looked at the


records made when these patches were applied and found that the site of application was recorded. This meant that the risk of damage to a person's skin if the same site is used repeatedly was minimised.

Where people were prescribed medicines on a 'when required' basis, for example for pain relief, or when they were prescribed in variable doses, for example 'one or two tablets', we found there was insufficient guidance for staff on the circumstances these medicine were to be used. We were therefore not fully assured that people would be given medicines to meet their needs.

We found some people were given their medicines hidden in food or drink. We did not find any documented evidence that this had been agreed with all interested parties that this was in the person's best interests. The service's policy stated that, "There must be a broadan open discussion amongst carers, relatives, advocates, general practitioners, pharmacist, and agreement that this approach is required." We found this policy was not being followed and were not assured that the best interests of the person were considered in these circumstances.

We observed medicines being given to some people during the day and saw that this was done with regard to people's dignity and personal choice. We heard people being asked if they wanted pain killers or their inhaler before these were administered. We also saw that the care worker stayed with the person while they took their medicines.

Senior care workers told us that all staff authorised to administer medicines had been trained and assessed that they were competent to do so. We saw a completed competence assessment for one staff member but we were unable to verify that this was the case for all staff authorised to handle medicines. Before the inspection the provider told us that "medication competencies [would] be reviewed" and that they would be completed by 01 September 2014. We did not find evidence to support that this had been done. We were therefore not fully assured that people were given their medicines by suitably qualified and competent staff.


Staffing Met this standard

There should be enough members of staff to keep people safe and meet their health and welfare needs

Our judgement


There were enough qualified and experienced staff to meet people's needs.


Before our inspection, we had received a number of concerns in relation to insufficient staffing numbers. During this inspection we found no evidence to support this.

People who we spoke with said that they did not have to wait for staff to attend to their needs. One person told us that there was enough staff on duty but added, "They have to spread themselves out thinly."

Members of staff told us that improvements had been made so that they were now able to work in one area of the home. They said that this had helped them get to know the individual needs of people. Staff also told us that there had been an increase in staffing numbers, which they said had helped them look after people living at Heron House Care Home.

We were advised that there had been a high turnover of staff and this was believed to be due to lack of job satisfaction. One member of staff told us, "A lot of the old staff have left, but they (the management team) are trying to bring it around)."

A high number of agency staff had been supplied to the home as a result of staff vacancies. When we visited there were six agency staff members working. One permanentmember of staff told us, "This place has gone to pot as working with agency staff has beendifficult because they don't know the people. When you work with regular staff it is really good."

We were advised that there was active recruitment to fill staff vacancies, with dates of interviews of candidates arranged and checks were in progress of successful job candidates.

We found that people's care and nutritional needs had been met and staff worked in an unhurried way.


Supporting workers Action needed

Staff should be properly trained and supervised, and have the chance to develop and improve their skills

Our judgement


People were cared for by staff who were not always supported to deliver care and support safely and to an appropriate standard.

We have judged that this has a minor impact on people who use the service, and have toldthe provider to take action. Please see the 'Action' section within this report.


Before this inspection we had received concerns that people were looked after by staff who were not supported to safely do their job. We found some evidence to support this.

People who we spoke with believed that they were looked after by competent and skilled members of staff.

Members of staff told us that they had found the leadership style of the home had improved since there had been temporary management changes made. Staff said that they had now felt listened to, were now supported and now had been encouraged to safelydo their job.

Staff members had reported to us that they had not received a one-to-one supervision session since they had completed their probationary period, which had been in excess of five months. This was confirmed by the management team for the care home. We were advised that the provider's policy on the frequency of staff one-to-one supervisions were totake place at least six times each year.

We saw three examples of one-to-one supervision records. We found the records demonstrated that the supervision sessions had failed to identify staff members' individual training and work related needs. We found that the one-to-one supervision sessions had been inappropriately used as part of the staff disciplinary procedures.

In response to our last inspection, which we carried out in April 2014, members of staff hadattended supervisory sessions to remind them of their roles and responsibilities in maintaining care records held in people's bedrooms. We found the majority of these records had been accurately maintained.

Induction training programmes were in place. Some of the agency staff told us that they had received induction training and found information shared during the handover session had been very thorough. However, this was not always the case. We found that one


agency member of staff had not been given adequate induction to the home; for instance, they were unable to tell us where the fire exits were situated.

Members of staff were trained and knowledgeable regarding safeguarding people from abuse and understanding the needs of people living with dementia. Staff members told us that they had found the training had increased their awareness of the individual usual needs of people with dementia care needs.



Action needed

The service should have quality checking systems to manage risks and assure the health, welfare and safety of people who receive care

Our judgement


The provider had an ineffective system in place to identify, assess and manage risks to thehealth, safety and welfare of people who use the service and others.



At our last inspection of 23 April 2014, we found that there was non-compliance with the regulation associated with this standard. The provider wrote to tell us what remedial action was to be taken to be compliant by 22 May 2014. During this inspection of 23 September 2014 we found some evidence to support this. Records were kept secure and people's confidential information was protected.

The provider's action plan also had stated that remedial action would be taken to comply with the regulations associated with standard four by 01 September 2014. We found insufficient evidence to demonstrate that this action plan was effective. This was because we had found evidence of non-compliance in relation to activities, safe usage of medication and people's dining experiences.

We were advised that medication administration record sheets were being audited on a regular basis. We looked at the records of these audits completed in September 2014 and found these identified numerous stock discrepancies. There was no action recorded to suggest these errors were investigated. We were therefore not assured that there were suitable arrangements in place to identify any medication errors promptly.

Following this inspection, the provider sent us a copy of an audit in relation to nutrition and people's dining experiences. We saw a person, who was seated in a wheelchair, had to reach up to the table to eat from their plate of food. Their position at the table had made it difficult to use their cutlery; we saw that they ate their lunch of liver, bacon, vegetables andgravy with their hands. This failed to maintain the person's dignity. In addition, the person'scare records noted that the person was independent with their eating although there was insufficient information about how they independently ate their food. We found other less than positive experiences when people were eating their lunch. Therefore the audit of nutritional and people's dining experiences was ineffective based on our inspection findings.


Although the provider's action plan stated that care records would be kept up-to-date and completed before our inspection of 23 September 2014; we found that this was sometimes, but not always the case. Minutes of a staff meeting, which had been held during 01 September 2014 for staff working on Heron Court, showed that staff members were reminded of their responsibilities in completing people's food and drink charts. We found that the food and drink charts for this area of the home had been completed.

However, on Wendreda unit we found that records, which included some food and drink charts and care records, were not up-dated or accurately maintained, even when they had been reviewed. This included records for checks on people's safety, moving and handling needs, food and drink charts and repositioning records for when people were in bed. Members of staff told us that they had supported people with these needs but confirmed that they had not completed the records. In addition, the staff knew most but not all of the people's individual needs. For instance, members of staff were unaware of the reasons for checking the whereabouts of a person.

Relatives had told us that they had a low level of confidence in the permanent management arrangements of the home. One person told us that they felt there had been a lack of communication between the staff and management teams. Other people told us that they had tried to make their concerns and complaints known, but had found this had been difficult for them to do so. They said that this was because they either felt not listenedto, or the management team had not been available. Although temporary changes in the management of the home had been recently made, people said that they felt Heron HouseCare Home was better managed and they now felt listened to.

Minutes of a relatives' and residents' meeting, which was held on 05 June 2014, showed that those present were enabled to raise their concerns and suggestions about the standard and quality of the service provided at Heron House Care Home. One person, for instance, had described the appearance of the gardens as, "Disgusting." We found that the gardens were inadequately maintained with overgrown grass and weeds. We were advised that action had been taken to improve the presentation of the gardens.

Records had been maintained for temperatures for hot water in baths and showers and forfire alarm tests. The records showed that people who used the service, staff and visitors were safe from harm regarding these areas.

Emergency light tests had been carried out each month. The record of this test for July 2014 showed that there was a failure of eleven emergency lights on Heron Court. We noted that this issue had been reported to the provider but the eleven emergency lights had not been replaced. This meant that there was a risk to people's safety in the event thatthe emergency lights were required to operate.

The quality and standard of care varied between each of the units. Members of staff told us that they had lacked leadership and direction, although they said things had slowly and recently improved. A member of care staff said, "What we need are people to direct us, we need leadership and we haven't always had this".


Records Met this standard

People's personal records, including medical records, should be accurate and kept safe and confidential

Our judgement


People's personal confidential information was kept secure.


Following our last inspection the provider wrote to tell us what remedial action was to be taken and by when to be compliant with the regulation associated with this standard. We found evidence to support this.

During this inspection we found that people's care records and staff records were kept secure and their personal information was kept confidential.

This section is primarily information for the provider


Action we have told the provider to take

Compliance actions

The table below shows the essential standards of quality and safety that were not being met. The provider must send CQC a report that says what action they are going to take to meet these essential standards.

Regulated activities Regulation

Accommodation for persons who require nursing or personal care


Regulation 9 HSCA 2008 (Regulated Activities) Regulations 2010

Care and welfare of people who use services

How the regulation was not being met:

There was a failing to protect people from the risks of unsafe andinappropriate care. There was also a continued failing to provide support and care to meet people's individual support and health care needs. Regulation 9(1)(b)(i)(ii).




Regulation 13 HSCA 2008 (Regulated Activities) Regulations2010

Management of medicines


People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place for the safe storage, recording or safe administration of medicines. There was insufficient guidance for staff on the use of some medicines. Regulation 13.


Accommodation for persons who require


This section is primarily information for the provider


nursing or personal care


Supporting workers


Staff had not received the level and frequency of supervision or support as set out in the provider's supervision policy and procedure guidance. Regulation 23 (1)(a).







The auditing, reviewing and monitoring of people's care and support failed to protect people from the risks of harm to their health and safety. Regulation 10(1)(a)(b). There was inadequate recorded information and records were not completed. Regulation 10(2)(b)(iii).

This report is requested under regulation 10(3) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

The provider's report should be sent to us by 24 October 2014.

CQC should be informed when compliance actions are complete.

We will check to make sure that action has been taken to meet the standards and will report on our judgements.


About CQC inspections

We are the regulator of health and social care in England.

All providers of regulated health and social care services have a legal responsibility to make sure they are meeting essential standards of quality and safety. These are the standards everyone should be able to expect when they receive care.

The essential standards are described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. We regulate against these standards, which we sometimes describe as "governmentstandards".

We carry out unannounced inspections of all care homes, acute hospitals and domiciliary care services in England at least once a year to judge whether or not the essential standards are being met. We carry out inspections of other services less often. All of our inspections are unannounced unless there is a good reason to let the provider know we are coming.

There are 16 essential standards that relate most directly to the quality and safety of care and these are grouped into five key areas. When we inspect we could check all or part of any of the 16 standards at any time depending on the individual circumstances of the service. Because of this we often check different standards at different times.

When we inspect, we always visit and we do things like observe how people are cared for, and we talk to people who use the service, to their carers and to staff. We also review information we have gathered about the provider, check the service's records and check whether the right systems and processes are in place.

We focus on whether or not the provider is meeting the standards and we are guided by whether people are experiencing the outcomes they should be able to expect when the standards are being met. By outcomes we mean the impact care has on the health, safety and welfare of people who use the service, and the experience they have whilst receiving it.

Our inspectors judge if any action is required by the provider of the service to improve the standard of care being provided. Where providers are non-compliant with the regulations, we take enforcement action against them. If we require a service to take action, or if we take enforcement action, we re-inspect it before its next routine inspection was due. This could mean we re-inspect a service several times in one year. We also might decide to re-inspect a service if new concerns emerge about it before the next routine inspection.

In between inspections we continually monitor information we have about providers. The information comes from the public, the provider, other organisations, and from care workers.

You can tell us about your experience of this provider on our website.


How we define our judgements

The following pages show our findings and regulatory judgement for each essential standard or part of the standard that we inspected. Our judgements are based on the ongoing review and analysis of the information gathered by CQC about this provider and the evidence collected during this inspection.

We reach one of the following judgements for each essential standard inspected.

Met this standard This means that the standard was being met in that the provider was compliant with the regulation. If we find that standards were met, we take no regulatory action but we may make comments that may be useful to the provider and to the public about minor improvements that could be made.

Action needed This means that the standard was not being met in that the provider was non-compliant with the regulation. We may have set a compliance action requiring the provider to produce a report setting out how and by when changes will be made to make sure they comply with the standard. We monitor the implementation of action plans in these reports and, if necessary, take further action.We may have identified a breach of a regulation which is more serious, and we will make sure action is taken. We will report on this when it is complete.

Enforcement action taken

If the breach of the regulation was more serious, or there have been several or continual breaches, we have a range ofactions we take using the criminal and/or civil procedures in the Health and Social Care Act 2008 and relevant regulations. These enforcement powers include issuing a warning notice; restricting or suspending the services a provider can offer, or the number of people it can care for; issuing fines and formal cautions; in extreme cases, cancelling a provider or managers registration or prosecutinga manager or provider. These enforcement powers are set out in law and mean that we can take swift, targeted action where services are failing people.


How we define our judgements (continued)

Where we find non-compliance with a regulation (or part of a regulation), we state which part of the regulation has been breached. Only where there is non compliance with one or more of Regulations 9-24 of the Regulated Activity Regulations, will our report include a judgement about the level of impact on people who use the service (and others, if appropriate to the regulation). This could be a minor, moderate or major impact.

Minor impact - people who use the service experienced poor care that had an impact on their health, safety or welfare or there was a risk of this happening. The impact was not significant and the matter could be managed or resolved quickly.

Moderate impact - people who use the service experienced poor care that had a significant effect on their health, safety or welfare or there was a risk of this happening. The matter may need to be resolved quickly.

Major impact - people who use the service experienced poor care that had a serious current or long term impact on their health, safety and welfare, or there was a risk of this happening. The matter needs to be resolved quickly

We decide the most appropriate action to take to ensure that the necessary changes are made. We always follow up to check whether action has been taken to meet the standards.


Glossary of terms we use in this report

Essential standard

The essential standards of quality and safety are described in our Guidance about compliance: Essential standards of quality and safety. They consist of a significant numberof the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. These regulations describe theessential standards of quality and safety that people who use health and adult social care services have a right to expect. A full list of the standards can be found within the Guidance about compliance. The 16 essential standards are:

Respecting and involving people who use services - Outcome 1 (Regulation 17)

Consent to care and treatment - Outcome 2 (Regulation 18)

Care and welfare of people who use services - Outcome 4 (Regulation 9)

Meeting Nutritional Needs - Outcome 5 (Regulation 14)

Cooperating with other providers - Outcome 6 (Regulation 24)

Safeguarding people who use services from abuse - Outcome 7 (Regulation 11)

Cleanliness and infection control - Outcome 8 (Regulation 12)

Management of medicines - Outcome 9 (Regulation 13)

Safety and suitability of premises - Outcome 10 (Regulation 15)

Safety, availability and suitability of equipment - Outcome 11 (Regulation 16)

Requirements relating to workers - Outcome 12 (Regulation 21)

Staffing - Outcome 13 (Regulation 22)

Supporting Staff - Outcome 14 (Regulation 23)

Assessing and monitoring the quality of service provision - Outcome 16 (Regulation 10)

Complaints - Outcome 17 (Regulation 19)

Records - Outcome 21 (Regulation 20)

Regulated activity

These are prescribed activities related to care and treatment that require registration with CQC. These are set out in legislation, and reflect the services provided.


Glossary of terms we use in this report (continued)

(Registered) Provider

There are several legal terms relating to the providers of services. These include registered person, service provider and registered manager. The term 'provider' means anyone with a legal responsibility for ensuring that the requirements of the law are carried out. On our website we often refer to providers as a 'service'.

Regulations

We regulate against the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009.

Responsive inspection

This is carried out at any time in relation to identified concerns.

Routine inspection

This is planned and could occur at any time. We sometimes describe this as a scheduled inspection.

Themed inspection

This is targeted to look at specific standards, sectors or types of care.


Contact us

Phone: 03000 616161

Email: [email protected]

Write to us at:

Care Quality CommissionCitygateGallowgateNewcastle upon TyneNE1 4PA

Website: www.cqc.org.uk

Copyright Copyright © (2011) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with thetitle and date of publication of the document specified.

heron house care home - care quality commission · accommodation, support and care, including...

Documents