CQC report explained · a residential care home
What the CQC found at Heaton House Care Home
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
What inspectors found, September 2023
Rated Requires Improvement; inspectors found kind, respectful care but serious problems with medicines, staff training, premises and management oversight.
Inspectors visited on 21 June and 4 July 2023. They spoke with people, relatives and staff, observed care, and checked care records, medicines, staff rotas, safety information, complaints and management records.
The home was rated Good for caring. People and relatives said staff were kind, respectful and understood people's individual needs. Infection prevention arrangements were also found to be effective, and care plans and communication plans had improved since the previous inspection.
However, the overall rating remained Requires Improvement. Medicines were not always managed safely, staff training and induction were inconsistent, environmental risks had not been dealt with promptly, and complaints and safeguarding concerns were not always managed properly. Management audits had identified problems but these were often not followed up.
The home remained in breach of Regulations 12, 15 and 17. The CQC issued warning notices for safe care and treatment and good governance, and a requirement notice for premises and equipment. The CQC will ask for an action plan and monitor progress with the provider and local authority.
Kind and respectful care
People and relatives said staff understood individual needs and supported people's dignity, privacy and independence.
“People and their relatives felt care was provided by staff who understood how to meet their needs, promote their independence and dignity and protect their privacy.” from the report
Improved care planning
The new electronic care planning system improved the organisation and detail of care plans, especially communication and oral care information.
“People's communication plans had improved significantly since our last inspection.” from the report
Infection prevention
Inspectors were assured that the home had arrangements to prevent and manage infections, including safe visiting arrangements.
“We were assured the provider was preventing visitors from catching and spreading infections.” from the report
Medicine safety
seriousMedicines were not always given as prescribed or recorded correctly. Missing timings and incomplete guidance created a risk that people could receive the wrong dose or an overdose.
“Records showed medicines were not always given to people as prescribed and staff did not always follow the providers policy when recording the administration of medicines.” from the report
Management oversight
seriousAudits had not been completed by the provider or registered manager. Known problems in records, medicines, care plans and risk assessments continued for months without being resolved.
“The provider had implemented new auditing systems since our last inspection. However, we found none had been completed by the registered manager or provider.” from the report
Staff training and induction
seriousTraining records showed gaps, and staff had different experiences of induction and supervision. The systems did not assure inspectors that staff had the skills and competence needed for care work.
“The providers systems did not ensure staff providing care had the appropriate skills, experience, competence or qualifications.” from the report
Building safety
seriousEnvironmental risks had been identified but were not dealt with promptly. The provider could not show that actions from risk assessments had been completed.
“The provider had failed to implement systems which ensured the premises was properly maintained.” from the report
Activities and complaints
needs fixingPeople had limited access to varied activities. Several complaints were known to the provider or others but only one was recorded in the home's complaints log.
“People's access to meaningful and varied activities was limited.” from the report
- 01What changes have you made to ensure medicines are given, timed and recorded safely, including at night?
- 02How do you now check that every staff member has completed the required training, induction, supervision and competency assessments?
- 03Which building and fire safety actions were identified, and can you show that all of them have now been completed?
- 04How are complaints and safeguarding concerns recorded, investigated and used to improve care?
- 05What regular activities are now available, and how are they matched to each person's interests and choices?
This was a full inspection covering all five key questions, including infection prevention and control; the inspection activity ran from 21 June to 4 July 2023. This explanation was written from the published report of 9 September 2023 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, October 2022
Rated Requires Improvement; inspectors found warm, kind care, but weaknesses in medicines, records, activities and management.
This was the first inspection since the current provider registered the home. Inspectors visited twice without notice, spoke with people, relatives and staff, and checked care records, medicines, staffing, safety information and management records.
People were treated with kindness and dignity. Staff knew people well, supported their choices and provided person-centred care. The home was clean, and inspectors were assured about most infection control arrangements.
However, medicines systems, risk assessments, care records and quality checks were not reliable enough. Night staffing was not always ideal, activities needed more development, and people and relatives had not been consulted about reduced communal space. The overall rating and four of the five question ratings were Requires Improvement.
Kind and person-centred care
Staff knew people well and adapted their approach to individual preferences. Inspectors saw care that was warm, caring and attentive.
“Interactions we observed of staff supporting people were warm, caring and attentive.” from the report
Dignity and independence
Staff understood how to protect privacy, promote independence and respect people's choices, culture and identity.
“People were treated with dignity and respect.” from the report
Infection control
Inspectors were assured about the home's arrangements for preventing and managing infections. A later local infection control check found no major concerns.
“We were assured that the provider was responding effectively to risks and signs of infection.” from the report
Safeguarding awareness
Staff understood when to raise safeguarding concerns and who to contact. People and relatives generally felt the care was safe.
“Staff had a good understanding of when they should raise a safeguarding concern and who with.” from the report
Improvement work started
The new provider had identified several weaknesses and started new electronic records, audits, training and an action plan.
“The provider had worked proactively to identify areas of the service which needed improvement.” from the report
Medicines arrangements
seriousOnly trained and competent medicines staff were on duty during the day. At night, people might have to wait for on-call staff for medicines they needed, and audits did not cover all aspects of medicines handling.
“Staff trained and competent to administer medicines were only on duty during the day.” from the report
Incomplete records and checks
seriousCare plans, risk assessments, accident records and other records lacked detail or were not always completed accurately. Quality audits had not found or corrected these problems.
“Overall governance in relation to quality assurance was not robust and this caused the stated inconsistencies.” from the report
Reduced communal space
seriousThe layout had been changed to make a larger office, reducing space for people to socialise and take part in activities. People and relatives had not been consulted, and the impact on wellbeing had not been assessed.
“The provider had failed to seek and act on feedback in the carrying out of their regulated activity.” from the report
Staff training
needs fixingNot all staff had completed the new training programme, and some were unsure which training they had completed. CQC recommended continued monitoring of training compliance.
“Not all staff had completed this and some staff were unsure as to what training they had completed.” from the report
Activities and communication details
needs fixingActivities needed further development, and communication plans did not always explain when people wanted to use glasses or hearing aids or how these should be checked.
“The provider had identified activities needed further development.” from the report
Night staffing
needs fixingDay staffing was sufficient, but staff said night staffing was manageable rather than always ideal. Dependency assessments had not been completed when inspectors visited.
“Staffing levels while manageable were not always ideal at night.” from the report
- 01What changes have you made to ensure trained staff can give required and 'when required' medicines at night?
- 02How do you now check that medicines audits cover every part of medicines handling?
- 03Have all care plans, risk assessments and accident records been reviewed and completed with enough person-specific detail?
- 04What is the current staffing level at night, and has each person's dependency assessment been completed?
- 05What has been done about the loss of communal space, and how have people and relatives been involved in decisions about it?
This was an unannounced inspection covering all five key questions, prompted partly by concerns about neglect, medicines and night-time support; it was the first inspection of the newly registered service. This explanation was written from the published report of 26 October 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 Heaton House Care Home
5 rated inspections over 8 years: the service has held its Requires improvement rating throughout.
- September 2023Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- October 2022Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- April 2021Inspected but not ratedSafe: Inspected but not rated
- November 2019Requires improvementdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- March 2017Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- September 2015Requires improvementSafe: GoodEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Good
- May 2022
Registered with the Care Quality Commission on 6 May 2022.
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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At least 100 live-in carers within about an hour of Bolton
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Most charge £980 to £1,260 a week. 92 can care for a couple. 10 years' experience on average.
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“He developed a close affinity with Terence, spending time talking with him before he retired to bed and looking after his needs during the night.”
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