Heatherdene Nursing Home

Heatherdene Nursing Home is a nursing home providing personal and nursing care for up to 27 older people. The service was supporting 24 people at the time of inspection in one adapted building.

People’s experience of using this service and what we found

People were kept safe by well trained staff who had been safely recruited and were available when people required support. Staff received training, supervision and appraisals to give them the skills and knowledge to do their job. People were supported with their medicines in the appropriate way following prescription guidelines. Staff were aware of how to keep people safe from infection and good processes and policies around this were in place. The systems for assessing and monitoring risk were designed to keep people safe from avoidable harm. When things had gone wrong, such as accidents and incidents, the service had investigated, learned lessons and acted to reduce further incidents.

People were supported to have maximum choice in their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practise. People were supported to maintain their health and wellbeing and there were thoughtful activities taking place within the home. People were supported to eat and drink enough to meet a suitable nutritional diet and food and fluid charts were kept for people at high risk of UTIs (Urinary Track Infections).

People were supported by kind and caring staff. People were comfortable and had a good rapport with staff, who showed good knowledge in people’s individual needs. People were encouraged to socialise and keep valuable relationships. People’s right to privacy, dignity and independence were promoted and they felt listened to and included in decisions about their care and support.

People’s care plans were personalised to advise staff on how to provide person-centred care. Relatives told us that staff knew and respected their family member’s preferred routines, likes and dislikes and provided care and support they wanted. Staff responded well to any concerns raised and addressed them through a competent complaints procedure. People felt listened to and regular feedback was sought by the registered manager.

Staff and people found the registered manager approachable and easy to speak to. People and relatives told us that the communication between people, staff and the management was good and the home was run well which led to a nice atmosphere in the home for everyone. Staff told us they felt supported by their colleagues and the registered manager and spoke positively about the care they provided.

There were quality assurance processes in place to ensure oversight of the safety and quality of the service at management and provider level.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 26 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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.

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.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

People were safe. People spoke positively of the service and commented they felt safe. Our own observations and the records we looked at reflected the comments people had made, however we identified some areas that require improvement.

Everyone we spoke with was happy with the food provided and people were supported to eat and drink enough to meet their nutritional and hydration needs. Despite communal dining experience being available, it was not seen as a social event. We also saw that choices of food were minimal, for example, fish and chips or fish pie. Feedback in respect of the quality of food, temperature of food and choice of food was varied

There were a range of audits in place to monitor the quality of care delivery. Whilst accidents were recorded there was a lack of recorded actions documented or root core analysis of the possible cause. Resident meetings were held but there was no feedback to people or evidence of what action was taken in response to people’s suggestions to improve the service such as menu choices, activities and weekend staffing.

Activities were available five days a week from 10:30 am until 1pm. However feedback about activities, for example timing and duration of activities was not always positive. One person said, "I'm still waiting to get washed and dressed when activities happen.” Another said, “If I'm a little bit later getting down, I might miss out.”

Care plans contained information on people’s likes, dislikes and individual choice. Information was readily available on people’s life history and there was evidence that people and families had been involved regularly in their care planning.

Care plans and risk assessments, reflected people’s assessed level of care needs, action for staff to follow and an outcome to be achieved. Care plans were in the process of being changed and ‘This is me’ documents introduced. We saw the new documentation that had been prepared and ready to share with people at the next resident’s meeting. People’s medicines were stored safely and in line with legal regulations and people received their medicines on time and from an appropriately trained care staff member.

Staff received training on the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and they had a good understanding of the legal requirements of the Act. They were aware of restrictions imposed on some people in the home and why they were in place.

Staff felt supported by management, said they were well trained and understood what was expected of them. There was sufficient day to day management cover to supervise care staff and care delivery. The current management staffing structure at the service provided consistent leadership and direction for staff.

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 they had built rapport with people and they responded well to staff.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

We found that the environment was safe, clean and hygienic. There was a safety gate at the top of the stairs and the equipment we saw had been well maintained and was serviced regularly. The use of bed rails had been appropriately risk assessed and consent sought before being used. Medicines were checked, signed for and stored safely in a locked room with locked cupboards and fridges.

There were 26 people living in the home and we spoke with two of them and two of their relatives. We also spoke with six members of staff and the activity coordinator. We found that they were a well-trained, conscientious team. Four of them raised a query about the dual role of the manager in the mornings. This was when the manager was also required to act as the second nurse on duty. We found that the service was safe, but the manager was very busy covering both managerial and clinical duties at this time. The manager said that, where there was a conflict, the clinical duties took priority. The provider may wish to reconsider the staffing arrangements for this busy morning period.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. The manager had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People told us that "the quality of service is very good here" and a member of staff said "we are very proud of what we do, people tell us that we are doing well." We found that staff had received appropriate training to meet the needs of the people who lived in the home and were keen to use the most effective practices to treat pressure sores, for example, and we saw some of the guidance they had been using. We also found evidence of staff seeking advice, where appropriate, from the GP or social services.

Is the service caring?

One relative we spoke with said, that there was a "feeling of care" in the home and that relatives were able to visit at any time. We saw that the staff were kind and sensitive and took time so as not to rush the people who were able to do things at their own pace. We observed high levels of respect and people were treated with consideration and dignity. Staff knocked on doors and waited to be invited in. We asked members of staff if they would be happy for one of their own relatives to live at the home and they all said that they would be.

We spoke with two people who lived in the home and both were positive about the care they received. One said "the carers are excellent, all of them are lovely; I can’t fault them."

Is the service responsive?

People’s needs were assessed before they moved into the home and detailed care plans and risk assessments were maintained and reviewed regularly. We saw that the staff monitored weight, nutrition and hydration and maintained body charts for pressure sores. Call bells were answered according to the home’s procedure and people had access to an activities coordinator several times a week. They were able to choose dishes from the menu and the chefs were happy to provide for special diets and additional options as requested. People who lived in the home also engaged with the manager and staff at regular meetings where they could express their views about all aspects of life at the home. They told us that their feedback was listened to and acted upon by the manager.

Is the service well-led?

Staff had a good understanding of the ‘dignity challenge’ commitment of the home that we saw displayed on the notice boards. The clinical and managerial policies were reviewed regularly and were kept up-to-date. The providers visited regularly and conducted an audit of drugs, for example, or of the paperwork.

People told us they were asked for their feedback on the service and their feedback was acted upon. We saw copies of the questionnaires completed by the people who lived in the home and their relatives. We saw that one concern had been raised in writing about the food and it had been responded to appropriately. The accidents and incidents were reported and we saw that the reason for a number of recent falls had been investigated and appropriate measures implemented as a result.

Relatives we spoke with felt that people were well cared for with their needs understood by staff. One said their relative was, “Getting very good care.” Another told us that the staff were very helpful.

We found good medicine management processes in place with support for people where required. A process was in place to calculate staffing numbers and staff training was planned and monitored.

During our inspection we found that people using the service and/or their representatives were involved in decisions about their care and treatment. However, training for staff was not up to date, and some infection control issues were noted.