CQC report explained · a nursing home
What the CQC found at Heatherley - Care Home with Nursing Physical Disabilities
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- People were generally protected from abuse and risks were managed. However, there were gaps in records for topical creams, and some directions for applying them were unclear.
- Effective?
- Requires improvement
- People received healthcare, food and support with their choices, but not all care plans had been reviewed and fluid records did not always show whether targets were being met.
- Caring?
- Good
- This question was not inspected during this visit. Inspectors described staff as kind and respectful.
- Responsive?
- Good
- This question was not inspected during this visit. The report described more activities, greater flexibility and people's views being listened to.
- Well-led?
- Requires improvement
- The new manager had made a positive difference and the culture was described as positive. However, audits had not identified some incomplete records, and partnership working with health professionals was mixed.
What inspectors found, July 2022
Requires Improvement; inspectors found better care and leadership, but medicines, records and some systems still needed work.
This was an unannounced follow-up inspection on 20 May 2022. Inspectors spoke with people living at the home, relatives and staff. They reviewed care records, medicines records, staff files and management records.
The home had improved from its previous Inadequate rating. It was no longer breaching the regulations identified at the last inspection. However, some improvements were still new and had not yet become established.
People were treated with kindness and respect. Staffing had improved, people had more activities and choices, and risks were generally managed. Inspectors still found gaps in topical medicine records and fluid charts, some care plans needing review, and quality checks that had not found these problems.
The overall rating was Requires Improvement. Safe, Effective and Well-led were each rated Requires Improvement. The report does not give new ratings for Caring or Responsive.
Kind and respectful care
People were treated with respect and their rights were promoted. Staff understood how to recognise and report abuse.
“People were supported by a kind and caring staff team who treated them with respect.” from the report
Improved staffing
Inspectors found enough staff on duty to provide safe care. People said they did not have to wait long for support.
“Staffing levels had been reviewed and there were sufficient numbers of staff on duty to provide safe care.” from the report
More choice and activities
People had more regular access to activities and trips out. The home was becoming more flexible about supporting people's wishes.
“People had access to meaningful activities including regular trips out and organised activities at home as well.” from the report
Positive new leadership
People, relatives and staff gave positive feedback about the new manager. Staff described a more positive working culture.
“There was a positive culture at the service and staff told us they enjoyed their work.” from the report
Topical medicine records
needs fixingRecords for two people did not show clearly whether topical creams had been applied. Directions for applying creams were also unclear in two records.
“There were gaps in the application records for two people, so it was not always clear whether the creams had been applied or not.” from the report
Fluid monitoring
needs fixingOne person's fluid target was not being reached, and daily totals were not added up. This made it harder to analyse whether the person was drinking enough.
“The fluid intake was not added up for each day making effective analysis more difficult.” from the report
Quality checks and care plans
needs fixingSome care plans still needed review. The home's audits had not identified incomplete fluid and topical cream records.
“These had not identified that some fluid charts and topical cream records had not been completed fully.” from the report
Communication with professionals
minorFeedback from health professionals was mixed. One professional said communication was still difficult and appointments were not always confirmed.
“Communication is still difficult, they still don't confirm whether appointments are OK.” from the report
- 01How do you now check that topical creams are applied and recorded for every person?
- 02How do you monitor and act when a person's daily fluid target is not reached?
- 03Which care plans still need reviewing, and when will all reviews be completed?
- 04How are you checking that new staff training is completed before staff support people?
- 05What has changed to make sure appointments and information are confirmed with health professionals?
This was a follow-up inspection of Safe, Effective and Well-led; the other key question ratings were not inspected and the previous ratings were used for the overall rating. This explanation was written from the published report of 26 July 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, February 2022
Heatherley was rated Inadequate and placed in special measures; inspectors found serious risks from low staffing, poor care planning, nutrition and weak leadership.
The inspection was unannounced and took place on 3 November 2021. Inspectors spoke with six people using the service, one relative and 11 staff. They observed care and reviewed care plans, medicine records, food and fluid records, training information and audits.
The home had too few staff. People were sometimes left alone for long periods, left in bed or waited for call bells, baths and showers. Inspectors also found unsafe support with eating, poor monitoring of weight and fluids, gaps in cream records, and equipment that was not always suitable.
Staff did not always follow health professionals' advice or understand people's needs. The home did not consistently follow the Mental Capacity Act, provide meaningful activities or support people's community links. Inspectors found that quality checks and leadership had not dealt with known problems.
The overall rating was Inadequate. Safe, Effective and Well-led were each rated Inadequate. Caring and Responsive were not rated in this report. The rating had fallen from Good at the previous inspection, published in February 2019.
Some safety equipment was maintained
Hoists were available in suitable numbers and had been serviced. The home also had seizure protocols and personal emergency evacuation plans.
“There were adequate numbers and selection of hoists to assist staff to support the people requiring transfer that had been regularly serviced.” from the report
Healthcare access
Inspectors saw evidence that GPs and other health professionals were involved in people's care. One relative gave positive feedback about healthcare arrangements.
“We saw the GP regularly visited the service and health reviews were requested for people.” from the report
Infection control arrangements
Inspectors were assured about several infection prevention arrangements, including the use of protective equipment and visiting arrangements.
“We were assured that the provider was using PPE effectively and safely.” from the report
Too few staff
seriousLow staffing left people waiting, sometimes in bed or alone in their rooms. Some people waited more than 10 minutes for call bells.
“There was a shortage of staff which placed people at risk of harm.” from the report
Unsafe care and neglect risks
seriousStaff did not always follow guidance about safe eating, positioning and equipment. Some people were not receiving regular baths or showers and were left isolated or in bed.
“People were not protected from the risk of neglect.” from the report
Poor nutrition and hydration support
seriousWeight loss was not monitored promptly, fluid records were incomplete and people did not always receive suitable food choices or snacks.
“People at risk of malnutrition were not always being supported in an appropriate way.” from the report
Consent and choice
seriousStaff sometimes made decisions for people who had capacity. Records did not always show capacity assessments, best-interest decisions or consideration of less restrictive options.
“Where people had capacity to make decisions this was not always being considered by staff who were at times making decisions for them.” from the report
Limited activities and community access
seriousPeople, particularly younger adults with learning disabilities, had limited meaningful activities and limited access to the community. The home had not fully considered whether it was the right setting for them.
“There was limited access to meaningful activities for people with a learning disability which was known to the provider before the people were moved in.” from the report
Weak quality checks
seriousAudits and meetings identified repeated problems, but the home did not take effective action. Care records and handovers were not always accurate or detailed.
“The audits undertaken by the provider were not effective in identifying shortfalls.” from the report
- 01What are the current staffing numbers on each shift, and how do you cover sickness or agency staff not arriving?
- 02How do you now monitor people's weight, fluid intake, choking risks and meal support?
- 03What training have staff received about learning disabilities, the Mental Capacity Act and people's individual health needs?
- 04How do you make sure health professionals' advice is written into care plans and followed by every member of staff?
- 05What meaningful activities and community access are now available, and how are people involved in choosing them?
This was an unannounced focused inspection prompted by concerns about staffing and safe care; it rated Safe, Effective and Well-led, while Caring and Responsive were not rated. This explanation was written from the published report of 18 February 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Heatherley - Care Home with Nursing Physical Disabilities
5 rated inspections over 7 years: the service has held its Requires improvement rating throughout.
- July 2022Requires improvementcurrent ratingup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
Read what inspectors found at Heatherley - Care Home with Nursing Physical Disabilities →
- February 2022InadequateSafe: InadequateEffective: InadequateWell-led: Inadequate
Read what inspectors found at Heatherley - Care Home with Nursing Physical Disabilities →
- September 2021Inspected but not ratedSafe: Inspected but not rated
- February 2019Goodstayed GoodSafe: GoodEffective: GoodWell-led: Good
- February 2017Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- May 2015Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- August 2014
Report published without a new overall rating.
- February 2014
Report published without a new overall rating.
- April 2013
Report published without a new overall rating.
- May 2012
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 12 January 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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