CQC report explained · a nursing home
What the CQC found at Heightside House Nursing Home
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 generally felt safe, staffing levels were considered appropriate and risks were assessed. However, medicines were not always managed safely or given as prescribed, and some staff did not use PPE correctly on the first inspection day.
- Effective?
- Good
- This question was not inspected during this focused inspection.
- Caring?
- Good
- This question was not inspected during this focused inspection.
- Responsive?
- Good
- This question was not inspected during this focused inspection.
- Well-led?
- Requires improvement
- The home had an open culture and people felt management had improved. However, audits did not identify many medicines problems, and action was not always recorded when shortfalls were found.
What inspectors found, November 2022
Rated Requires Improvement; people generally felt safe and well cared for, but medicines management and oversight still put people at risk.
This was an unannounced focused inspection on 27 and 30 September 2022. Inspectors spoke with people, relatives, staff and health and social care professionals. They reviewed care records, medicines records, staff files, policies and audits.
People said they felt safe and did not usually wait long for support. Staffing levels, risk assessments, safeguarding systems, accident checks and the home environment were generally managed well. However, medicines were not always given as prescribed or at the right time, and records for applying creams were incomplete. Some staff also did not use masks correctly on the first inspection day.
The home was rated Requires Improvement overall. Safe and Well-led were both rated Requires Improvement. The previous rating was also Requires Improvement, and the breaches relating to medicines and governance continued.
Staffing and support
Inspectors found staffing levels were appropriate for people's needs. People said they did not experience delays when they needed help.
“We observed that staffing levels were appropriate to meet people's needs.” from the report
Risk and safeguarding
Risk assessments were in place and reviewed. Staff understood how to protect people from abuse, and the home investigated safeguarding concerns.
“Risk assessments were in place to guide staff on how to support people safely and were reviewed and updated regularly or when people's needs changed.” from the report
Positive management changes
People, relatives and staff said the home had improved under the new manager. Staff described clearer communication and accountability.
“People and relatives we spoke with were happy with how the service was being managed and felt that the home had improved under the new registered manager.” from the report
Meals improved
The home had acted on an earlier recommendation about meals. New menus were created with people's involvement and feedback was positive.
“The registered manager had recruited a new head chef, new menus had been created in consultation with people and feedback about the changes was very positive.” from the report
Medicines were not always safe
seriousSome medicines were not given as prescribed or at the correct time. Records did not always show that creams had been applied, which meant inspectors could not be sure people's skin was cared for properly.
“Staff did not always ensure that people's medicines were given to them as prescribed, placing them at risk of harm.” from the report
Weak medicines oversight
seriousAudits failed to identify many of the medicines problems found by inspectors. Where problems had been identified, the action taken was not always recorded.
“Many of the shortfalls we found during our inspection relating to medicines processes and practices had not been identified.” from the report
PPE was not always used correctly
needs fixingOn the first inspection day, several staff were not wearing masks or were wearing them under their chins. This improved on the second day, but the CQC made a recommendation about PPE.
“On the first day of the inspection we noted a number of staff not wearing a mask or wearing their mask under their chin.” from the report
- 01How are you ensuring that medicines are given at the prescribed times, especially medicines that must be given before food?
- 02How do you record and check that creams and other topical treatments have been applied?
- 03What changes have been made to medicines audits since this inspection, and how do you know they are finding problems?
- 04How are you checking that all staff wear PPE correctly during visits and infection outbreaks?
- 05What progress has been made against the action plan requested by the CQC?
This was an unannounced focused inspection of Safe and Well-led, mainly checking earlier Warning Notices; the other key-question ratings were not inspected and carry over from the last inspection. This explanation was written from the published report of 3 November 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, July 2021
Rated Requires Improvement; inspectors found ongoing medicines and oversight failures, with warning notices issued.
This was an unannounced focused inspection on 10 June 2021. An inspector and a medicines inspector spoke with people, relatives, staff, managers and health and social care professionals. They reviewed care records, medicines records, recruitment files, policies and audits.
The main concern was medicines. Some doses were missed because medicines were not available. Records did not always show that medicines, creams or thickeners had been given correctly. Information for staff about 'when required' medicines, diabetes care and medicines with different possible doses was sometimes missing or unclear. The report says nobody was found to have been harmed, but people were placed at risk.
The systems used to check quality and safety had not led to enough improvement. The home had regular audits and an improvement plan, but medicines errors continued and it was not always clear what action had been taken. People generally said they felt safe, were happy with staff and believed there were enough staff, although one unit was sometimes understaffed according to the home's staffing tool.
The overall rating remained Requires Improvement. Safe and Well-led were both rated Requires Improvement. The other three areas were not assessed during this focused inspection, so their previous ratings were used for the overall rating.
People felt safe
People told inspectors they felt safe and could speak to staff if they were worried.
“People felt safe living at the home and when staff supported them.” from the report
Risk support
Risk assessments and care plans were regularly reviewed and gave staff guidance about supporting people's health, safety and mental health needs.
“Staff supported people to manage risks to their health, safety and wellbeing effectively.” from the report
Infection control
Inspectors were assured about the home's arrangements for preventing and managing infections, including the use of PPE and visiting arrangements.
“We were assured that the provider was using PPE effectively and safely.” from the report
Kind and individual care
People, relatives and professionals described staff as supportive, nurturing and person-centred.
“Everyone we spoke with was happy with the support provided by staff and how the service was being managed.” from the report
Medicines were not consistently safe
seriousSome medicines were unavailable, records were incomplete and instructions for some medicines were missing or not personalised. Inspectors said this placed people at risk of harm.
“Medicines records failed to show that all medicines were given as prescribed.” from the report
Quality checks did not deliver improvement
seriousAudits identified some problems, but unsafe medicines practices and errors continued. The home could not always show what action had been taken to correct shortfalls.
“However, unsafe medicines practices and medicines errors continued at the home.” from the report
Feedback about meals
needs fixingPeople had raised concerns about meals at several meetings, but it was difficult to see what had changed. The CQC made a recommendation about acting on people's food preferences and needs.
“It was difficult to see what action had been taken or improvements made in response to this feedback.” from the report
Occasional staffing shortfall
needs fixingOne unit was sometimes below the staffing level indicated by the home's own staffing tool. Management said another staff member had been recruited and staff from another unit provided support when needed.
“one of the units was sometimes understaffed, according to the staffing tool used by the home.” from the report
- 01What has changed since the inspection to make sure every person's medicines are available and given as prescribed?
- 02How do you check that 'when required' medicines, diabetes instructions, creams and thickeners are clearly recorded and managed?
- 03What evidence can you show that the warning notices about medicines and quality monitoring were met by 5 August 2021?
- 04What action has been taken in response to repeated concerns about meals, and how are people's food needs and preferences now checked?
- 05How do you make sure each unit has enough staff when the staffing tool shows a shortfall?
This was a focused inspection of Safe and Well-led only; the other ratings were carried over from the previous comprehensive inspection. This explanation was written from the published report of 24 July 2021 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 Heightside House Nursing Home
7 rated inspections over 7 years: the service has held its Requires improvement rating throughout.
- November 2022Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
Read what inspectors found at Heightside House Nursing Home →
- July 2021Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Requires improvement
Read what inspectors found at Heightside House Nursing Home →
- February 2020Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Requires improvement
- January 2019Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- April 2018Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Inadequate
- April 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- October 2015Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- October 2013
Report published without a new overall rating.
- June 2013
Report published without a new overall rating.
- November 2012
Report published without a new overall rating.
- August 2012
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 18 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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Most charge £980 to £1,260 a week. 78 can care for a couple. 11 years' experience on average.
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