About the service:

Heathercroft Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection. Heathercroft is set in its own grounds in the Woolston area of Warrington. The registered provider is Ashberry Healthcare Limited.

The home is registered to provide nursing and personal care for up to 88 older people. There are currently two units within the home: Heathercroft unit for people with nursing and personal care needs and Ashberry unit for people living with dementia. On the day of our inspection there were 74 people living in the home.

People’s experience of using this service:

People who used the service were happy about the service being delivered to them. We received mixed comments from relatives regarding staffing levels, use of agency staff, activities and care charts not always being completed.

Staff noted they had on-going problems with the recording and managing of their electronic system for ordering and recording of medications. We identified a breach of regulation regarding safe care and treatment and management of medications.

Support plans described the support people needed. People were referred to appropriate health and social care professionals when necessary. However, we found various issues with the lack of accurate updates regarding people's records which created risks in managing accurate care planning. We identified a breach of regulation regarding to good governance.

Quality assurance processes were detailed and regularly carried out to show actions and improvements to the service in the last 12 months. However on-going concerns regarding poorly maintained records and staff competencies to improve records continued to be an issue highlighted by both the local authority contracting team and within the inspection. There was a continued breach of regulation relating to good governance.

Staff were knowledgeable of local safeguarding procedures. The service had learnt from recent safeguarding incidents however improvements were still needed in the recording and delivery of care to those people cared for in their bedroom.

Health and safety systems provided regular oversight and support to consistently manage safe processes at the service. We noted some areas of wear and tear that the registered manager advised was part of their ongoing maintenance and decorating programme.

The home was clean and staff used appropriate techniques to prevent the spread of infection. One room had an unpleasant smell and staff took action to improve this room.

Staff and visiting members of multidisciplinary teams noted improvements to the service since the registered manager commenced in post. Staff felt supported and listened to.

Staffing was supported by agency staff to cover for vacancies and sickness. The registered manager advised they were recruiting and advertising posts and had recently recruited a new activities organiser. People living at the service and visiting relatives were unsure how many staff they could expect to see on duty each day.

People told us they enjoyed the food and drink provided. We observed mealtimes and saw that people had a choice of meals. Mealtimes were noisy at times with staff busy in various departments and could be heard carrying out their work while dining room doors were left open.

We noted some personal records accessible and unlocked throughout the inspection to the ground floor office. This highlighted potential concerns about people being able to access confidential information.

We have made a recommendation that the service review storage of confidential information.

Rating at last inspection: Requires Improvement (published 25 May 2018).

Why we inspected: This was a planned inspection based on the previous rating. We had received information of concern prior to the inspec

We undertook an unannounced comprehensive inspection of Heathercroft Care Home on 16 and 17 April 2018.

Heathercroft Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Heathercroft is set in its own grounds in the Woolston area of Warrington. The registered provider is Ashberry Healthcare Limited.

The home is registered to provide nursing and personal care for up to 88 older people. The facility includes a 28 bedded unit for people who have dementia. There are currently two units within the home: Heathercroft unit for people with nursing and personal care needs and Ashberry unit for people living with dementia. On the day of our inspection there were 58 people living in the home.

The home does not have a registered manager. The manager in post who assisted with this inspection is applying to be registered with the Care Quality Commission. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The last comprehensive inspection took place on 7 and 8 August 2017. At that inspection we identified six breaches of the relevant regulations in respect of the safe management of medicines, staffing, consent, person centred care, record keeping and governance. We served a notice asking the provider to be compliant with the regulations by 31 January 2018.

A further responsive inspection took place on 10 January 2018 following concerns raised about a specific incident. This inspection looked at the safe and well-led domains. We rated the provider inadequate and placed the service into special measures. We found the provider to be in breach of four regulations in respect of risk assessments, staffing, safeguarding and governance.

At this inspection, we found that there had been significant improvements and the provider had met the conditions of the warning notice. The provider is no longer in special measures. We did however find that the provider remained in breach of two regulations in relation to staff training and governance.

We asked staff members about training and supervision. Staff told us they received regular training and supervision throughout the year, however when we checked the records, we found there were significant numbers of staff where their training was out of date. Staff had been contacted by the provider and advised that this needed to be addressed. Supervisions were taking place, but there was still scope for improvement in this area.

The provider had a quality assurance system in place and regular audits were being completed, however we found inconsistencies in the standard of the audits. We found some where it was clear who was responsible for taking action and the timescales involved, whereas others did not contain this information. This meant that it was not always clear to see whether the actions identified had been completed.

We found that care plans provided clear guidance to staff on how to support the people living at Heathercroft. We saw most plans were updated regularly and were clear, however we saw that there was scope for improvement as a couple of plans had not been evaluated robustly when changes had occurred. Where additional monitoring of people’s needs was required, records were consistently kept.

We found that the arrangements for the administration, storage and disposal of medication were safe. However, there were issues with the electronic recording system. The electronic system was in operation for administering all medication with the exception of homely remedies, which were done via a paper reco

We undertook an unannounced focused inspection of Heathercroft Care Home on 10 January 2018. This inspection was carried out following concerns which had been raised about a specific incident at the home. The team inspected the service against two of the five questions we ask about services: is the service safe and is the service well led.

Heathercroft is a purpose built care home set in its own grounds in the Woolston area of Warrington. The registered provider is Ashberry Healthcare Limited.

The home provides nursing and personal care for up to 88 older people. There are currently three units within the home: Heathercroft unit for people with nursing and personal care needs; Ashcroft unit for people with nursing needs living with dementia and Ashberry unit for people living with dementia. On the day of our inspection there were 73 people living in the home.

The home does not have a registered manager. The manager in post who assisted with this inspection is applying to be registered with the Care Quality Commission. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The last inspection took place on 7 and 8 August 2017. At that inspection we identified six breaches of the relevant regulations in respect of the safe management of medicines, staffing, consent, person centred care, record keeping and governance. We also found that the provider was not always appropriately notifying CQC of incidents. At this inspection, we found that there were some improvements in the safe management of medicines; however the provider remained in breach of five regulations in the safe and well-led domains.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Risks to people were not managed safely and there was no clear guidance for staff on how to reduce the risks identified. There was no oversight or learning from incidents and accidents that happened in the home.

We found instances where safeguarding incidents had not been adequately recorded. Furthermore they had not been appropriately referred to the local safeguarding and related statutory notifications had not been sent to the Commi

This inspection was unannounced and took place on the 7 and 8 August 2017.

Heathercroft Care Home was previously inspected in November and December 2014 when it was found to be meeting all the regulatory requirements which were inspected at that time.

The home provides accommodation, personal and nursing care for up to 89 older people, some of whom have dementia care needs. The home is located in Woolston, a suburb of Warrington in Cheshire. The service is provided by Ashberry Healthcare limited. At the time of our inspection the service was accommodating 77 people.

Heathercroft Care Home is a purpose built, ground floor level home. One of the units within Heathercroft accommodates people in need of nursing or residential care. There is also another unit within Heathercroft for people living with dementia who have nursing needs. The home has a separate two storey extension named ‘Ashberry House’ which accommodates people living with dementia.

At the time of the inspection there was no registered manager at Heathercroft Care Home as the manager had resigned from post during June 2017. A new home manager had been appointed who was due to apply for registration with the CQC. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

During the inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 related to: person centred care; staffing and training; records and medicine management; need for consent and governance. We also found a breach of the Care Quality Commission (Registration) Regulations 2009 as the registered person had not always notified the Commission of incidents or allegations of abuse. You can see what action we told the provider to take at the back of the full version of the report.

There were not always enough staff on duty to ensure people received appropriate levels of care and support.

The management of medicines was in need of review to ensure adequate protection from the risks associated with unsafe medicines management and safeguarding records and processes were in need of review to ensure the welfare of people using the service was fully protected.

We found that best interest decision making processes and associated records had not always been completed in accordance with the Mental Capacity Act.

Staff training and development was in need of review to verify and evidence that staff had completed all the necessary training relevant to the work they are required to undertake.

People using the service did not always receive personalised care and support that was responsive to their needs and ensured they were treated with dignity and respect.

Care plan records, risk assessments and supporting documentation were in need of review to ensure the information recorded was up-to-date. Furthermore, governance systems and processes to ensure the quality of the service delivered required attention.

People using the service had access to a choice of menu and received wholesome and nutritious meals that were well presented and took into consideration each person's dietary needs.

Records showed that people also had access to a range of health care professionals subject to individual need.

This visit was undertaken as part of a themed inspection programme looking at the quality of dementia care. A team of three compliance inspectors, a compliance manager, an expert by experience and a specialist advisor looked at the outcome for people in relation to care and welfare, cooperating with other providers and assessing and monitoring the quality of service provision. The visit took place between the hours of 0910 and 1900hrs.

We gathered information from a number of sources which included speaking with people who use the service and relatives of people who use the service. We also spoke with the manager of the service, the clinical lead, the cook and staff providing support to people during our visit. Comment cards were also made available to people who use the service, visitors and staff for them to tell us their experiences.

In addition to the themed inspection programme we also looked at how outcomes for people who use the service in relation to consent to care and treatment, nutrition and complaints. We included these outcome areas as we had received concerns in relation to the service sometime prior to our visit.

We observed staff speaking to people with dementia with respect and kindness and an awareness of individual’s needs in relation dementia care.

We saw that people with dementia had good access to health care professionals such as their GP and speech and language therapists.

We looked at how people with dementia had their care planned. We saw that the documents were not always person centred and did not demonstrate that individuals had been involved in the planning of their care.

Audits of care provision were carried out by the staff supporting people with dementia however, we saw that improvements needed to be made in relation to how the provider measured the quality of the service delivered.

People using the service at Heathercroft confirmed that they were treated with respect and their dignity was maintained. People spoken with also told us that they were generally satisfied with the standard of care provided and were of the opinion that staff understood their needs.

For example, comments received from people using the service included:

“I am treated well”; “I can’t complain about the care I receive. All the staff are lovely”; “I’m treated exceptionally well”; “The food is great. I get two options each day”; “The care I receive has generally been good. I have no complaints and there are activities that we can participate in”; “It’s taken me a while to settle in but I’m quite happy and the carers are very kind”; “The personal care provided is good in my opinion” and “There is no place like home but the staff do their best to make you comfortable.”

Two people reported that there had been occasions when they had waited a short period for staff to respond to their call bells or needs. For example, one person reported: “In my opinion there are enough staff. Very occasionally the staff may take a little longer to respond but they do their best” and “On the whole the response times are good. Sometimes attendance can take a while but I would not wish to complain.” This feedback has been brought to the attention of the provider to monitor.

No concerns, complaints or allegations were received from the people using the service during our visit to Heathercroft.

People spoken with reported that they were generally satisfied with the standard of care and treatment provided at Heathercroft, that their views were sought regarding the service and were of the opinion that staff understood their needs. Comments received included: “I like it here”; “The staff treat me well and try their best” and “I am quite satisfied. I don’t worry about anything here.”

People informed us they felt safe living at Heathercroft and were observed to be relaxed in their home environment and in the company of the staff team. Comments received included; “All the girls (staff) are lovely”; “The staff are very good” and “I have no concerns about the way I am cared for.”

This inspection took place on 24 November and 5 December 2014 and was unannounced. At our last inspection in December 2013 the service was meeting most of the regulations inspected. However, we found that the registered provider was in breach of Regulation 9 and Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These regulations are in respect of how care and treatment is planned and how the registered provider assesses and monitors the quality of the service. We found that the quality assurance system had not always been effective to monitor the quality of dementia services that people received. We noted improvements to the home during this inspection and evidence to show the compliance actions had been met.

The home did not have a registered manager with CQC as the registered manager had recently retired from the service. However the registered provider had appointed a new manager to commence working at the service in December 2014 and in the interim the deputy manager was responsible for managing the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated regulations about how the service is run.

Heathercroft nursing home provides nursing care and accommodation for 88 older people. The service was full at the time of our visit. The service is owned by Ashberry Healthcare Ltd. The home is purpose built and includes a 25 bedded facility for people who have dementia. There is a large accessible car park provided for visitors.

People living at the home, relatives and staff were very positive about Heathercroft especially about the activities on offer and the management of the service.

We observed how staff spoke and interacted with people and found that they were supported with dignity and respect.

We found the staff had a good understanding of supporting people when they lacked capacity, including the requirements of the Deprivation of Liberty Safeguards. Staff took appropriate actions to fully support people who lacked capacity to make decisions for themselves.

We found care plans to be detailed and focused on the individual person. They contained guidance to enable staff to know how to support each person’s needs and requests. Staff had a good understanding and knowledge of each person’s preferences and people’s individual care needs.

We noted the service had a complaints procedure and people were confident that they could raise their opinions and discuss any issues with senior staff.

The service operated safe recruitment of staff and ensured that staff employed were suitable to work with people living at Heathercroft. Appropriate pre-employment checks were being carried out and application forms were robust to enable the management of the home to have adequate information before employing staff.

Staff had received regular formal supervision and training to assist them in their job roles and in their personal development. The provider offered a lot of development training to all of their staff teams to ensure they fully understood people’s needs including those people living at Heathercroft who had been diagnosed with dementia.

Various audits at Heathercroft were carried out on a regular basis by the deputy manager and registered provider to help ensure that appropriate standards were maintained throughout the home.