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Inspection carried out on 13 April 2018

During a routine inspection

Heathcote Care Home is a residential care home for 17 people with dementia and mental health needs. The building offers accommodation over three floors with lift access to the first floor. People have access to communal lounge and dining areas, a conservatory and enclosed, accessible rear garden.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Some areas of the home were not clean during our inspection and there were some small areas of malodour. Some carpets also needed replacing and this was in progress.

People were protected from the risks of abuse and staff understood how to report any concerns. Risks people faced were understood and safely managed and people received their medicines as prescribed. There were enough, safely recruited staff to support people and staff were familiar to people. Where there were any accidents or incidents, these were recorded and any actions and learning shared with staff.

People had their needs assessed before moving to Heathcote and the information was used as the basis for care plans. Details about people’s spiritual, cultural and religious needs were understood and respected. People had choices about all aspects of their care and we observed staff seeking consent from people about their care and treatment. People were positive about the meal options available to them and had access to healthcare professionals where needed. The home used signage to help people to orientate around and there was access to a secure garden for people.

Staff were kind and compassionate in their approach and interactions were caring and tactile. Staff knew people well and several told us that they cared for people as if they were their own family. Visitors were welcomed and professionals involved with the service were positive about staff understanding of people’s needs and interactions. People had their privacy and dignity respected and were enabled to be as independent as they wished.

People were supported to spend time in a variety of social opportunities and technology was used with some people to support this. People and relatives were involved in decisions about their support and care plans were regularly reviewed. Feedback indicated that people and relatives would be confident to raise concerns if they needed to. End of life preferences were in the process of being recorded for each person.

People, relatives and staff were positive about the management of the home and feedback was sought through meetings and informally. Staff were positive about their roles and responsibilities and received regular supervision and training. Quality assurance processes were regular and used to discuss as a management team where changes and actions were required.

Further information is in the detailed findings below.

Inspection carried out on 18 January 2016

During a routine inspection

This unannounced inspection took place 18 January 2016. Heathcote care home provides care and accommodation for up to 17 people who have dementia or mental health conditions. At the time of the inspection 16 people were accommodated.

The service had a registered manager as is required. 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.

People’s risks were assessed and plans developed to ensure care was provided safely. A variety of risks were assessed which included risk of skin damage, falls and malnutrition. Where risks were identified there was a plan to manage the risk. There were enough staff to meet people’s needs. Feedback from relatives and people included, “Most of the time there are plenty of staff around.” We saw that staff were unhurried and staffing rotas reflected the staffing requirements as assessed by the registered manager.

Staff were aware of what constitutes abuse and the actions they should take if they suspected someone was being abused. Relevant checks were undertaken before staff started work. For example, checks with the Disclosure and Baring Service were undertaken to ensure that staff were not judged to be unsuitable for working with vulnerable people.

Medicines were managed safely. Medicine Administration Records (MAR) were signed to indicate that people’s prescribed medicine had been taken. We saw that staff remained with people and offered a drink when administering their medicines. Medicines were kept securely and staff with responsibility for medicine administration had training and were aware of the actions to take should an error occur.

Staff were aware of how to support people to make decisions. Staff told us how they supported people to make decisions, such as offering two alternatives, considering their prior wishes and consulting people significant to the person for their views. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). The service had made applications for DoLS authorisations for a number of people using the service.

People had access to healthcare when they needed. A healthcare professional told us that appropriate referrals were made and staff followed clinical advice. Peoples care records demonstrated contact with a variety of healthcare professionals.

People were supported to eat and drink. They were offered a choice of food and drink. However, people’s mealtime experience was not always as positive an experience as it could be as staff attention was not always on the person they were supporting.

People were treated with dignity and respect and their privacy was maintained. Staff responded patiently and positively to people and listened and reassured them. People were included and involved in decisions about their care.

People were supported to maintain relationships with people important to them. There was no restriction of visitors and contact with relatives was maintained through use of the telephone and video chat.

Staff knew people as individuals and had knowledge about them and their personal histories. Feedback from relatives and people included, “It’s homely and caring and the staff know their residents really well. They take the extra time to get to know the people.” People’s care records contained information about the person’s past life including family make up and previous occupation and significant life events. Staff were aware of people’s backgrounds which helped them have meaningful conversations with people about topics of personal interest.

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Inspection carried out on 11 February 2015

During an inspection looking at part of the service

During our inspection, we found improvements had been made to the maintenance of the building with a new reporting system in place.

Staff completed the relevant health, safety and maintenance documentation which the manager reviewed to identify and manage risks. The manager would ensure appropriate action had been taken to address issues reported, to prevent risk to people using the service.

We found the home to be in good decorative order throughout, and all areas were found clean and tidy with no obvious odours, with the exception of one toilet area which was clean but smelt strongly of urine.

Fire and security alarm systems were installed throughout the house, as well as electronic entry and exit systems, which all appeared to be in good working order.

There was good signage on bedroom doors, to help people find their rooms, and personal belongings were displayed in bedrooms, giving the place a homely atmosphere.

Inspection carried out on 5 July 2014

During a routine inspection

A single inspector carried out the inspection at Heathcote Care Home. At the inspection we spoke with the deputy general manager, care assistants and domestic staff. We also spoke with relatives of people who used the service. We were unable to ask all of the people their experience of the service because they had limited ability to communicate with us.

At our inspection we observed how staff delivered care and treatment and how they communicated with people who used the service. We looked at people�s assessments and support plans and their daily records.

We also used this inspection to answer our five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. However if you want to see the evidence that supports our summary please read the full report.

Is the service safe

The provider had a policies and procedures that explained how to identify and report safeguarding concerns. We looked at safeguarding concerns raised with the local authority and evidenced that staff had following the procedures. We spoke to relatives of people who used the service and they told us that they felt that Heathcote Care Home provided a safe and secure environment for their relative. Relatives also told us that they knew how to raise concerns and felt they would be taken seriously.

The provider showed us safeguarding concerns they had identified for people who used the service and the referrals they had made to the local authority safeguarding team. We evidenced that the referrals had been made in a timely manner and any actions needed to reduce the risk of harm and been put into place.

The care records we saw all contained an assessment of people's capacity in respect of the care and treatment they would agree to. We saw support plans that contained a risk assessment for each person. The risk assessments we looked at had been reviewed and were up to date. People�s relatives told us that people who used the service were treated with dignity and respect.

Within the care records there was an assessment of people�s dietary needs and preferences however we could not evidence that these were adequately shared with staff that were responsible for cooking. We could not evidence that there was a varied menu or choices of food offered to people. We told the registered manger this and they plan to implement a new menu soon.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The provider had recognised a deprivation of a person�s liberty and had made an application to the local authority. We looked at the application and saw that the provider had consulted the person�s relative and relevant professionals to discuss any changes that may have been needed to the care and support plan.

The provider had undertaken a service risk assessment. The assessment had looked at actions that needed to be taken in specific situations; for example, flood, fire, missing person and staff shortages. There were emergency plans in place for people who used the service. We looked at training records for staff and saw that they had received training on the policy and understood what to do in an emergency.

We found some areas of the home required maintenance. We found communal carpets to be badly stained and frayed at the joins. A compliance action has been set for this and the provider must tell us how they plan to improve the service.

Is the service effective

Relatives of people who used the service told us their relative�s care needs were being met and that they were included in assessments and reviews. We saw care plans were regularly reviewed and this included discussions with relatives, general practitioners, social workers and district nurses. The care plans included information about people's health conditions, wishes and preferences and advanced wishes.

We saw from the care records we looked at people were given choices about what activities they liked or disliked what they preferred to take part in. A relative of a person who used the service told us their relative enjoyed the activities and family and friends were invited to attend the activities with their loved ones. One relative told us �the range of activities on offer keeps people motivated and reduces their anxiety�.

Relatives told us that people who used the service are encouraged to be as independent as possible and that this included going out and being part of their community

Is the service caring

At our inspection we spent time observing the staff and their interactions with people who used the service and saw them talking calmly and sensitively to the people they cared for. We also observed staff offering choice to people and control over their care.

People received care and treatment from staff who were patient and attentive. We observed staff giving people one to one attention and giving them the time to make choices about their care. A relative of a person who used the service told us �many of the people at the home are confused and become easily upset, staff know this and give people the care and support they need to reduce their distress�.

Is the service responsive

People had a pre admission assessment and this was followed up with a further assessment to assess whether a person�s needs had changed. Each person who used the service also had their individual support plan reviewed every month. In the records we looked at we saw that support plans reflected people�s individual needs and had been updated monthly.

We saw the provider had a complaints policy and information had been given to relatives. We spoke with people�s relatives and they told us they knew how to make a complaint and it would be taken seriously. We also saw the minutes of residents meetings and saw that suggestions and ideas about the home had been discussed with them.

Is the service well led

The provider had a system for on-going monitoring of the service provided at Heathcote Care Home. The outcome of audits and actions required to improve the service were discussed with staff in team meetings. The staff we spoke with talked to us about the outcome of audits and actions assigned to individual staff needed to improve the quality of the service.

The provider supported staff to undertake national qualifications. Staff induction and on-going training was provided and staff had regular supervision. Staff told us that the management team were very supportive and provided all of the necessary training and support to ensure that they met the needs of people who used the service.

You can see our judgements on the front page of this report.

Inspection carried out on 27 September 2013

During a routine inspection

We used a number of different methods to help us understand the experiences of people using the service. This was because people using the service had complex needs which meant they were not able to tell us their experiences. We observed care being delivered to people, spoke with staff and looked at records related to care delivery.

We looked at four care plans and spoke with the relatives of two people. We also spoke with six members of staff, four of them were carers, the deputy manager and the registered manager. We saw that people�s care plans were clearly set out and people�s needs met.

We saw that people were treated with consideration and their privacy and dignity was respected. People were supported in promoting their independence and community involvement. We saw that people�s agreement was obtained before staff provided support.

Staff felt supported and received appropriate training and supervision. Staff were aware of the Mental Capacity Act and the Deprivation of Liberty Safeguards and had received training in these topics.

Inspection carried out on 15 January 2013

During an inspection looking at part of the service

Our inspection of 30 July 2012 found that the provider did not have suitable arrangements in place for obtaining, and acting in accordance with the consent of service users and that there was a risk people may have been unlawfully deprived of their liberty. During this inspection we found that improvements had been made.

We saw that people�s agreement was obtained before staff provided support. Staff were aware of the Mental Capacity Act and Deprivation of Liberty Safeguards and had received training in these topics. Staff were aware of how to support people to make decisions and the principles to follow when people did not have the mental capacity to make certain decisions.

Inspection carried out on 30, 31 July 2012

During an inspection looking at part of the service

We used a number of different methods to help us understand the experiences of people using the service. This is because the people using the service had complex needs which meant they were not able to tell us their experiences. We observed care being delivered to people, spoke with staff and looked at records relating to care delivery.

We saw that people were treated with consideration and their privacy and dignity was maintained. We saw a person who was distressed being supported by staff who took time to listen to their concerns and offered them pain relief.

The provider did not record the type of power of attorney held for people. There was a risk that decisions may have been made about people�s care and treatment by people who did not have the legal authority to do so.

The provider had a safeguarding policy and staff were aware of how to identify and escalate concerns about abuse. However, people were at risk of being deprived of their liberty as the provider had not made suitable arrangements to identify possible deprivations of liberty.

The provider had a number of policies relating to the prevention of infection and staff were aware of basic precautions. Hand washing facilities were accessible as were liquid soap and paper towels.

Staff felt supported and received appropriate training and supervision. Quality monitoring of the service was regularly undertaken and improvements made as a result.

Records were stored securely and retained for an appropriate period of time, however records did not always contain all relevant information in relation to the delivery of care and the management of the service.

During an inspection looking at part of the service

We had previously inspected this home on 27 October 2011. At this inspection visit we were concerned that people living at the home were not receiving effective, safe and appropriate care. Proper steps were not being taken to assess people�s needs and keep relevant information on their care up to date. Staff only had a knowledge and understanding of people�s basic care needs and failed to ensure that the planning and delivery of care was meeting people�s individual needs.

As a result of the inspection visit on 2011we issued a warning notice to tell the provider to improve standards in relation to the care and welfare of the people residing at Heathcote. We carried out this inspection visit to review if the warning notice had been complied with.

The people who used the service informed us that they felt the staff were kind to them and supported them with their day to day needs. They told us that staff support them how they want to be supported and that they are well looked after.

A visiting relative told us that they were very satisfied with the care and attention their relative received. The manager of the home showed us comments received from the relatives of the home which demonstrated that they considered that Heathcote was giving their relatives a high standard of care.

One visitor told us that the home keeps them regularly informed of any changes in their relative�s needs and that they were regularly asked for their thoughts into the care offered.

The interactions between the staff and people who lived at home were observed as positive and compassionate.

During a routine inspection

The people who use the service informed us that they felt the staff were kind to them and supported them with their day to day needs. One person told us that they got up when they liked and that there was always someone around to help. They told they chose their own clothes to wear and had plenty of choices offered to them.

A visiting relative told us that they were very satisfied with the care and attention their relative received. They also commented that they considered that people were well cared for and gave examples of how their relative received a good service such as always having clean clothes and help is always being available to encourage their relative to eat.

A visitor told us that they considered that the home keeps them regularly informed of any changes in their relative�s needs and that they are regularly asked for their thoughts into the care offered.

The interactions between the staff and people who live at home were observed as positive and compassionate.

We observed that the home was failing to take proper steps to ensure that there was a thorough assessment of people�s care needs, and people had experienced inappropriate and unsafe care.

Reports under our old system of regulation (including those from before CQC was created)