The provider, Care UK Community Partnerships Ltd, is registered to provide accommodation, personal care and/or nursing care for up to 60 older people at Heavers Court. This service specialises in supporting people living with dementia. However, the provider is only contractually obliged by the commissioning local authority to provide personal and nursing care to people. Another organisation maintains the premises and equipment and provides the cleaning, laundry and catering services. Notwithstanding this arrangement, as the registered provider, Care UK Community Partnerships Ltd retains overall responsibility for ensuring all the legal requirements are met in relation to the accommodation, care and support provided to people. At the time of this inspection there were 54 people using the service. This inspection took place on 17 October 2018. At our last comprehensive inspection of the service in September 2017 we gave the service an overall rating of ‘requires improvement’. This was because the mealtime service was not always tailored to meeting people’s needs. Some aspects of the environment were not tailored to support people living with dementia. At times, there was also not enough for people to do to meet their social and physical needs. We saw the range and quality of activities on offer was variable. Because of the issues we identified, we found the provider and the other organisation did not always work as well as they could to ensure people experienced good quality personalised care that met their needs
At this inspection we found the provider had taken on board our findings from the previous inspection and used this to drive improvement at the service. The provider was now working more proactively with the other organisation to meet the needs of people using the service. Communication between the two organisations about the timings of the meal service was better and meals were served promptly. The registered manager had driven improvements to the presentation and quality of meals so that these were attractive, well balanced and nutritious. Staff supported people to eat and drink enough to meet their needs.
Changes to the environment had been made to make this more suitable for people living with dementia. New flooring was put in to make it easier for people to move freely around. Memory boxes were used to help orientate people to their rooms. New signage was due to go up by the end of the year which would make it easier for people to find their way around the premises.
Activities provision at the service had improved. People had been involved in designing an activities programme that reflected the preferences, choices and needs of people using the service. There was a range of activities and events for people to participate in to meet their social and physical needs. People’s families and friends were encouraged to take part in events and activities at the service to help them feel included in the lives of their loves ones.
Staff continued to be well supported to safeguard people from the risk of abuse and knew when and how to report any safeguarding concerns about people to the appropriate person and agencies. Staff were provided with up to date information about the risks posed to people and knew how these should be managed to keep people safe from injury or harm. The provider used learning from accidents and incidents to take appropriate action when things had gone wrong. At this inspection we saw improvements had been made following an incident involving a person to help reduce the risk of a similar incident reoccurring.
The provider maintained arrangements to monitor the safety of the premises and the equipment. They sought assurances from the other organisation, responsible for the premises and equipment and the cleaning, laundry and catering services, that they had appropriate measures in place to check these aspects of the service did not pose unnecessary risks to people’s safety. The provider’s staff followed good practice to ensure risks to people were minimised from poor hygiene and cleanliness when providing personal care and when preparing and serving food. Medicines were stored safely and securely, and people received them as prescribed.
There were enough staff at the time of this inspection to meet people’s needs and keep them safe. The provider maintained a robust recruitment and selection process and carried out appropriate checks to verify staff's suitability to support people.
People’s needs were assessed to determine the level of support they required. Staff continued to receive relevant training to help them meet people's needs. Staff had work objectives that were focussed on people experiencing good quality care. These were monitored and reviewed by managers through supervision and appraisal. Staff knew people well and understood people’s needs, preferences and choices.
People and their relatives remained involved in planning the support people required. Senior staff reviewed the support provided to people monthly and when changes to people’s needs were identified, records were updated promptly so that staff had the latest information about how to support people appropriately. People were supported to keep healthy and well and helped to access healthcare services when needed. Staff referred any concerns they had about a person’s health or wellbeing promptly to the relevant health professionals.
Staff were caring, patient and considerate. They asked people for their consent before care was provided and prompted people to make choices. Staff ensured people's privacy was maintained when being supported with their care needs. People were encouraged by staff to be as independent as they could be. Staff only took over when people could not manage and complete tasks safely.
Staff were aware of their responsibilities in relation to the Mental Capacity Act 2005 (MCA) and supported people in the least restrictive way possible. The policies and systems in the service supported this practice.
People, relatives and staff were asked for their views about the quality of care and how this could be improved. If people were unhappy and wished to make a complaint, the provider had arrangements in place to deal with their concerns appropriately.
The registered manager was approachable and supportive. The registered manager had good understanding and awareness of their registration responsibilities particularly with regards to submission of statutory notifications about key events that occurred at the service.
The provider continued to maintain arrangements to monitor and assess the safety and quality of the service. When these checks highlighted aspects of the service that fell below required standards the registered manager responded accordingly to make the required improvements. Records relating to people, staff and to the management of the service were accurate, up to date and well maintained. The provider worked in partnership with others to continuously improve the delivery of care at the service.
Further information is in the detailed findings below.