CQC report explained · a residential care home
What the CQC found at Heyberry House
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Requires improvement
- Inspectors were assured that the home used PPE safely, followed shielding and social-distancing rules, tested people and staff, and had systems to prevent or manage outbreaks.
- Effective?
- Good
- Does the care work? Training, consent, food and drink, working with GPs and nurses.
- Caring?
- Good
- Are people treated with kindness and dignity?
- Responsive?
- Good
- Is care built around the person? Care plans, activities, complaints.
- Well-led?
- Good
- Is the home run well? The manager, the culture, how problems get found and fixed.
What inspectors found, February 2021
Heyberry House was inspected but not rated; inspectors found good infection control during a coronavirus outbreak.
This was an unannounced, targeted inspection on 25 January 2021. It looked at infection prevention and control because the home had a coronavirus outbreak.
The home had closed to visitors during the outbreak. Before this, visitors used a designated area, had an on-site negative test and wore masks. The home also arranged other ways for people to keep in touch with loved ones.
Inspectors were assured about testing, PPE, social distancing, shielding, safe admissions, cleaning and managing infection outbreaks. Staff had enough supplies and enough staff to support people without agency workers.
The service was inspected but not rated. This means the visit did not give an overall care-quality rating or a full rating for all five areas.
Visitor safety
Before the outbreak closure, the home had a designated visiting area, testing and face masks to help visitors see their relatives safely.
“there was a designated area for visitors to visit their loved ones; they were required to have a negative Coronavirus test on site and wear a facemask.” from the report
Maintaining family contact
The home considered the effect of visitor restrictions on people’s emotional wellbeing and arranged visits in bedrooms or contact through social media where appropriate.
“the provider had acted proactively to ensure that visitation was facilitated as much as possible to protect people's mental health.” from the report
Infection control
Inspectors were assured about the home’s PPE, testing, hygiene, social distancing and arrangements for preventing or managing outbreaks.
“There were systems in place to maintain good infection control standards and regular checks were undertaken.” from the report
Staffing during the outbreak
The home had enough staff to support people without agency workers. Staff returning after isolation were risk assessed and supported.
“The provider had sufficient staff to support people living in the home without the use of agency staff.” from the report
Inspectors raised no specific concerns in this report.
- 01What is the home’s current overall CQC rating, given that this inspection was not rated?
- 02What visitor arrangements are in place now, and how are visits managed if there is an infection outbreak?
- 03How often are staff and residents tested for infections now?
- 04How does the home support residents to keep in touch with family if in-person visits are restricted?
- 05How does the home maintain staffing levels when staff are isolating or absent?
This was a targeted, unannounced inspection of infection prevention and control during a coronavirus outbreak; it was not a full inspection and the service was not rated. This explanation was written from the published report of 10 February 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.
What inspectors found, May 2018
Rated Good overall, but inspectors found that safety records and some risk information required improvement.
Inspectors visited the home without notice on 20 March 2018. They spoke with people living there, relatives, staff and managers. They looked at care records, medicines, staff files, training, the building and management records.
The home was rated Good overall. Care was described as kind, respectful and responsive. People had enough food and drink, medicines were managed safely, activities were available and relatives spoke positively about the staff.
Safe was rated Requires Improvement. Some health risks did not have enough detail for staff, and food, fluid and personal care records were not always accurate or properly reviewed. The Mental Capacity Act was being used in some areas but needed to be applied more consistently. There was no registered manager at the visit, although a new manager was applying to register.
Kind and respectful care
People and relatives spoke very positively about staff. Inspectors saw warm, respectful interactions and support given at people's own pace.
“We observed that staff treated people kindly, with respect and supported them at their own pace.” from the report
Safe medicines
Checks found that medicines in the trolley matched the records. People told inspectors they received the medicines they needed.
“Medicines were managed safely and people received the medication they needed.” from the report
Activities and social life
The home offered a wide range of activities. Inspectors saw people joining in and enjoying quizzes, exercise, singing and creative activities.
“There were a range of social and recreational activities provided.” from the report
Staff training and support
Staff had a broad training programme, induction and regular supervision arrangements. People and relatives spoke highly of the staff team.
“Staff had training and support to do their job role.” from the report
Food and healthcare
People had enough to eat and drink, and mealtimes were sociable. Records showed access to routine and specialist health services when needed.
“People had access to a range of health and social care professionals in support of their needs including routine health appointments such as GP visits, dentists and opticians.” from the report
Incomplete risk information
seriousSome medical conditions and pressure care needs were not described in enough detail for staff. One person's food and fluid records were difficult to understand, which could make hydration harder to monitor.
“Staff did not always have sufficient information on people's specific medical conditions and information about people's pressure area care was not always documented.” from the report
Care records were not always reliable
needs fixingDaily records for food, fluids and personal care had not always been reviewed properly or matched each other. Managers said these issues would be addressed without delay.
“Some people's personal care charts did not tally with their daily records with regards to the support they had received to maintain their personal hygiene.” from the report
Mental capacity practice needed development
needs fixingThe Mental Capacity Act was used properly for some decisions, but inspectors said it was not yet applied consistently.
“The implementation of this legislation however required further development to ensure that it was consistently applied.” from the report
Complaints information was incomplete
minorThe complaints policy was easy to follow, but it did not give local contact details for the Local Authority Complaints Department or the Local Government Ombudsman.
“It did not include local contact details for the Local Authority Complaints Department or the Local Government Ombudsman” from the report
Some issues were missed by audits
needs fixingThe home's checks had not identified some gaps in medical information and daily care records. A few environmental matters were also not dealt with as quickly as they should have been.
“The provider's care plan audits had not identified that information about people medical conditions required more detail or that people's day to day care records had not always been reviewed.” from the report
- 01What has been done since the inspection to add clear information about people's medical conditions and pressure care needs?
- 02How are food, fluid and personal care records now checked for accuracy and reviewed promptly?
- 03How do you make sure Mental Capacity Act assessments and best-interest decisions are completed consistently?
- 04Who is the current registered manager, and has the new manager's registration with CQC been completed?
- 05Have the environmental issues and complaints contact details identified by inspectors now been corrected?
This was an unannounced inspection covering the overall quality and safety of the home and all five key questions. This explanation was written from the published report of 16 May 2018 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 Heyberry House
2 rated inspections over 2 years: the service has held its Good rating throughout.
- February 2021Inspected but not ratedcurrent ratingSafe: Inspected but not rated
- May 2018Goodstayed GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- March 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- May 2014
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.
- February 2012
Report published without a new overall rating.
- November 2010
Registered with the Care Quality Commission on 25 November 2010.
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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