Heatherdene Nursing Home is a care home with nursing located in Bexhill on Sea. It is registered to support a maximum of 28 people. The service provides personal care and support to people with nursing needs, some of whom were living with dementia. There were 26 people living at Heatherdene Nursing Home during our inspection.
A registered manager is in post. 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.
We carried out an unannounced comprehensive inspection at Heatherdene Nursing Home in February 2016 and the service was rated as requires improvement overall. This was because improvements were required as the meal time was not always enjoyable for people and there was a lack of choices of food available. Improvement was also required to ensure people and staff felt listened to and that actions were taken to address suggestions and minor complaints..
This unannounced comprehensive inspection was carried out on the 31 March 2017 to see if the required improvements had been made and sustained. This inspection found that improvements had been made.
People spoke positively of the home and commented they felt safe. Our own observations and the records we looked at reflected the positive comments people made.
People, relatives and staff felt listened to. The registered manager ensured that resident and family meetings and staff meetings were documented with agreed actions noted, and then shared with everyone in the service. At the next meeting these would be discussed and evaluated as to whether the actions had worked.
The meal time experience was enjoyed by people and they were supported to have enough to eat and drink to maintain their health and well-being. People had access to drinks throughout the day. One person said, “They’re good about making sure you have drinks, I’ve always got a drink here on my table.” Another person said, “Good tasty food.”
The registered manager had progressed quality assurance systems to review the support and care provided. Audits had been developed including those for accidents and incidents, care plans, medicines and health and safety. Maintenance records for equipment and the environment were up to date, such as fire safety equipment and hoists. Policies and procedures had been reviewed and updated and were available for staff to refer to as required. Staff said they were encouraged to suggest improvements to the service. Relatives told us they could visit at any time and, they were always made to feel welcome and involved in the care provided.
A new activity person had commenced work since the last inspection. A range of activities were available for people to participate in if they wished and people enjoyed spending time with staff. Activities were provided throughout the whole day, five days a week and were in line with people's preferences and interests. People told us that they enjoyed the activities especially the bingo and cinema sessions.
The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The provider, registered manager and staff had an understanding of their responsibilities and processes of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.
Staff and relatives felt there were enough staff working in the home and relatives said staff were available to support people when they needed assistance. The provider was actively seeking new staff, nurses and care staff, to ensure there was a sufficient number with the right skills when people moved into the home. The provider had made training and updates mandatory for all staff, including safeguarding people, moving and handling, management of challenging behaviour, pressure area care, falls prevention and dementia care. Staff said the training was very good and helped them to understand people's needs.
All staff had attended safeguarding training. They demonstrated a clear understanding of abuse; they said they would talk to the management or external bodies immediately if they had any concerns, and they had a clear understanding of making referrals to the local authority and CQC. Pre-employment checks for staff were completed, which meant only suitable staff were working in the home. People said they felt comfortable and at ease with staff and relatives felt people were safe.
Care plans reflected people’s assessed level of care needs and care delivery was based on people's preferences. Risk assessments included falls, skin damage, behaviours that distress, nutritional risks including swallowing problems and risk of choking and moving and handling. For example, cushions were in place for those that were susceptible to skin damage and pressure ulcers. The care plans also highlighted health risks such as diabetes and Parkinson’s. Visits from healthcare professionals were recorded in the care plans, with information about any changes and guidance for staff to ensure people's needs were met. Staff had received training in end of life care supported by the organisations pastoral team. There were systems in place for the management of medicines and people received their medicines in a safe way.
Registered nurses were involved in writing the care plans and all staff were expected to record the care and support provided and any changes in people's needs. The manager said care staff were being supported to do this and additional training was on -going. Food and fluid charts were completed when required and showed people were supported to have a nutritious and varied diet.
Staff had a good understanding of people's needs and treated them with respect and protected their dignity when supporting them. People we spoke with were very complimentary about the caring nature of the staff. People told us care staff were kind and compassionate. Staff interactions demonstrated staff had built rapport with people and they responded to staff with smiles. People were seen in communal areas for activities, meetings and meal times and were seen to enjoy the atmosphere and stimulation.
Staff said the management was fair and approachable, staff handover meetings were held every morning to discuss people's changing needs and how staff would meet these. Staff meetings were held monthly and staff were able to contribute to the meetings and make suggestions. Relatives said the management was very good; the registered manager was always available and, they would be happy to talk to them if they had any concerns.