Archived: Heversham House

Heversham House 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.

Heversham House accommodates up to 13 older people. It is situated in a village close to the market town of Milnthorpe on the edge of the Lake District. The home is a detached Georgian house with many original features and has been adapted for its current purpose. There is an attractive and private walled garden.

There was a registered manager at the home. 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 told us they felt safe at the home and were “very happy” and “very satisfied” with the care and support they received. One person told us, “Nowhere is home but I think this is as good as it can be." We saw people who lived at the home were clean and well dressed and all spoke well of the management and staff. They looked relaxed and comfortable in the care of staff supporting them.

The service had a safeguarding policy and staff had undertaken safeguarding training and could explain the process. Staffing levels were consistent and flexible and staff recruitment was robust.

Health and safety records were in place and regular checks had been undertaken. Arrangements were in place for contingency planning for foreseeable emergencies and for moving people in the event of fire. Accidents and incidents were recorded and there were individual and general risk assessments in place for people and covering the premises. We looked around the home and found it had been maintained and was a clean, homely and a safe place or people to live. We saw that equipment in use had been serviced and maintained as required.

Medicines management systems were safe and staff had undertaken appropriate training in medicines administration. Staff were being appropriately trained for their roles and well supported by the registered manager. Systems were in place to give staff the opportunity to discuss their work and have appraisals.

We observed regular snacks and drinks were provided between meals to help make sure people received adequate nutrition and hydration. People who lived in the home told us they were happy with the variety and choice of meals being provided and that there was always a choice.

People who lived at Heversham House and their relatives knew how to raise a concern or to make a complaint. The complaints procedure was available and systems in place to manage complaints.

The registered manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they worked within the law to support people who might lack capacity to make some of their own decisions. People living in the home were supported to have maximum choice and control of their lives, and staff supported them in the least restrictive way possible, and the policies and systems in the service support this practice.

Quality assurance surveys were used to seek the views of people who used the service and there were a number of audits in care being carried out to monitor systems. We found people had access to healthcare professionals and their healthcare needs were being met.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

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

Is the service safe?

We saw that risk assessments had been carried out to help make sure that people who lived there received safe and appropriate care. We saw that the premises were clean and homely and the grounds were being well maintained and were accessible to the people living there.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The home had appropriate policies and procedures regarding The Mental Capacity Act 2005. The manager of the home was knowledgeable about the Mental Capacity Act 2005 and the Mental Capacity Act Codes of Practice. This meant people could have confidence that their rights would be protected.

Staff had received training on safeguarding vulnerable adults. Staff we spoke with were clear about the procedures to use in reporting any concerns. There were sufficient staff working in the home with a range of skills and they had received training relevant to their roles.

We looked at a sample of the records the service held, including care, training, maintenance work, safety checks and staff rotas and these were in good order and securely stored.

Is the service effective?

We found that people's health and care needs had been assessed with them and they were involved in deciding the care and life styles they wanted. One person told us, 'If I need anything they (staff) get it for me, they know me well enough by now'.

We saw records that showed staff had undertaken training to give them the skills and knowledge to look after people properly. This training included caring for people at the end of life and staff had received training on supporting people at that time.

Care plans in place showed the aids and equipment needed to support people and how they wanted this support to be provided.

Is the service caring?

We saw that the staff were kind and considerate in how they treated people. People were given choices about their lives and the support they received. We observed friendly and respectful interactions between the staff and people in the home. The information we looked at about the people using the service was written in a holistic and positive way.

In the care plans we looked at we saw information about individuals that provided personalised information about their preferences, likes and dislikes. This gave staff a background on the person themselves.

The staff we spoke with showed that they knew people's preferences about their lives and how they wanted to be supported. We observed they spent a lot of time interacting with people in a supportive and respectful way and giving people the time they needed to express themselves.

Everyone we spoke with made positive comments about the staff employed at this home. One person told us, 'The staff are so very kind and patient with me' and another said, 'It's nice here place, I am well looked after'.

Is the service responsive?

We saw that the registered manager had developed positive relationships with training and research bodies in order to keep up to date with best practices in dementia care. This helped to make sure that people received appropriate care and support.

People were able to take part in activities they wanted to inside and outside the home and to decide for themselves how they spent their time. We saw that where necessary people had been referred to other services. This was to make sure they received appropriate treatment and support for their needs and conditions.

We looked in detail at a sample of four care plans. We saw that the plans of care and support were subject to evaluation, review and alteration in response to changes in people's needs and preferences.

Is the service well led?

The agency had quality assurance and monitoring systems in place. This helped to identify any areas where there were gaps or that needed to change. There were policies and procedures in place and subject to regular review to guide staff practices.

Staff told us that they were well supported with supervision and training and that the manager was 'Dedicated to getting the best training for us and to help us develop'. We were also told that the manager and provider were 'Always open to listening to our ideas and suggestions to help us work better'.

Staff confirmed that they met regularly with the manager for team and supervision meetings. They also told us that they had confidence in her to support them should they raise in any concerns about practice matters.

People told us they had not needed to make a complaint and they had confidence in the manager to support and help them. One person told us, "Its so very friendly here" and that there was "A lovely family atmosphere." From our observations and conversations with people we found they got the support they wanted and needed and were given choices about their care and their daily and social activities.

We saw that staff encouraged people to maintain their independence and control over their lives and people told us the staff supported them to keep their independence where they could. More than one person told us that they appreciated this and were told "The staff are a good help and don't go too quick for me, they let me have a go myself."

We found that staff working there had received appropriate training to support people and understand different conditions. Walking around the building we saw that people had been able to personalise their rooms with their own pictures and personal items. People living there and visiting the home commented on its "homely" feel.

Visitors to the service told us they believed people who lived in the home were well cared for. They said the staff included them in decisions about their relatives' care and made them feel welcome in the home. One person told us 'It has a real family feel."

One person told us, "All the staff are very good, I am happy and have never had to complain." They told us that if they needed to complain they would "Speak to the manager, she's very good." People who lived in the home told us that the staff who worked there were 'Grand' and "Very good indeed" and said they were 'Easy to chat to." People we spoke with told us they liked their rooms and said they were supported to do the things they enjoyed and wanted to do. All those we spoke with gave positive feedback about how their privacy and dignity were maintained and how they felt involved in their care because staff asked them what they wanted.