We carried out a review of the data available to us about Heather View on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Heather View, you can give feedback on this service.
Heather View is a residential care home that provides personal and nursing care for up to 74 people. At the time of inspection, 62 people were living at the service. People were aged 65 and over and lived with a range of health and physical health needs including degenerative conditions and dementia.
The building is purpose built over four floors. The reception was on the ground floor and there was a floor for each of the three specialist support units. These are older persons, nursing care and people living with dementia.
People’s experience of using this service:
¿People and their relatives spoke positively about staff and the care they received. People were treated with dignity and compassion by a kind, caring staff and management team who understood people's individual needs, choices and preferences well. One relative said, “Everything is spot on, I couldn’t wish for the care to be better, (name) is happy here and we are delighted with the consistent and high quality of care (name) has received over the years”.
¿The service was homely and welcoming, and people told us that they felt safe. They said that there were enough staff to look after them and they were listened to and treated with kindness. Staff were trained and understood how to report safeguarding or other concern’s they may have.
¿People were involved in decisions about their care and staff sought appropriate consent and asked people what help they needed. People received care that respected their privacy and dignity as well as promoting their independence whenever possible.
¿Training, supervision and observations of staff practice by managers, ensured that staff were competent in their roles.
¿People received their medicines safely including; medicines that were prescribed on an ‘as and when required’ basis.
¿The provider had systems of quality assurance to measure and monitor the standard of the service and drive improvement. These systems also supported people to stay safe by assessing and mitigating risk and ensuring that people’s care was personalised and met their needs.
¿People told us that the meals were very good and there was plenty to eat and drink. The service employed a chef and meals were freshly prepared and cooked. People who had dietary needs such as allergies or required specialist diets were catered for. One relative said, “we bring in a fish and chip supper once a week and eat in the café downstairs which is really nice”.
¿The service was led by a dedicated management team who demonstrated compassion and commitment to the needs of the people who used the service, and the staff who worked for them. The management team worked professionally with other agencies outside of the service and ensured a transparent, honest and open approach to their work.
¿People had access to meaning full occupation and stimulation and there was a varied programme of activities. People told us there was plenty to do, their comments included “sometimes someone comes in with a guitar, the pop violinist gets everybody dancing and I like it when the pets come in”, and “On a Wednesday the toddler group runs in the café, I really enjoy joining the mums and children”. A relative told us “(Name) joins in all the activities; animals come in including chickens, a Shetland pony, a goat, sheep and dogs. There is a choir, exercise class and a church comes in regularly”.
Rating at last inspection:
Good. (Published 21 September 2016)
Why we inspected:
We inspected the service as part of our inspection methodology for ‘Good’ rated services.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
People were accommodated in three different units. Ashdown unit provided residential dementia care on the ground floor; Broadstone unit provided nursing care and Chelswood unit provided residential care, on the first floor and second floor. These units were connected via stairs and three passenger lifts.
There was a manager in post who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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.
Staff knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or make sure people were protected from harm. Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced.
There was a sufficient number of staff deployed to meet people’s needs. Thorough recruitment procedures in place which included the checking of references.
Medicines were stored, administered, recorded and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records that were accurate.
At our last inspection in July 2015, we had identified shortfalls relevant to laundry processes. At this inspection we found that all necessary improvements had been implemented.
Staff knew each person well and understood how to meet their support and communication needs. Staff communicated effectively with people and treated them with utmost kindness and respect. People were able to spend private time in quiet areas when they chose to.
Staff received essential training, additional training relevant to people’s individual needs, and regular one to one supervision sessions.
The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people’s freedom had been submitted and the least restrictive options had been considered. Staff sought and obtained people’s consent before they helped them. People’s mental capacity was assessed when necessary about particular decisions. When applicable, meetings were held to make decisions in people’s best interest, as per the requirements of the Mental Capacity Act 2005.
The staff provided meals that were in sufficient quantity and met people’s needs and choices. People told us they enjoyed the food and their meal times. Staff knew about and provided for people’s dietary preferences and restrictions.
At our last inspection in July 2015 we had identified shortfalls in regard to people’s care planning. At this inspection, we found that improvements had been implemented. People’s individual assessments and care plans were person-centred, reviewed monthly or when their needs changed. Clear information about the service, the facilities, and how to complain was provided to people and visitors. Relatives told us that staff and management were “excellent at communication.”
Staff developed a positive rapport with people and placed their wellbeing at the heart of their practice. Great attention was paid by staff to details about how to enhance their comfort and make people’s experience in the home pleasurable. A relative described staff general attitude towards people as “exceptionally caring”.
People were promptly referred to health care professionals when needed. Personal records included people’s individual plans of care, life history, likes and dislikes and preferred activities. The staff promoted people’s independence and encouraged people to do as much as possible for themselves.
At our last inspection in July 2015, we identified a lack of meaningful activities. At this inspection, we found that improvements had been implemented and that a wide range of meaningful activities and outings were provided. People were involved in the planning of activities that responded to their individual needs.
Staff told us they felt valued and supported by the registered manager, the management team and the provider. The registered manager was open and transparent in their approach. They placed emphasis on continuous improvement of the service and promoted links with the community.
There was a robust system of monitoring checks and audits to identify any improvements that needed to be made. The management team acted on the results of these checks to improve the quality of the service and care.
This inspection took place on 9 and 12 June 2015. It was unannounced. There were 57 people living at Heather View when we inspected. People cared for were all older people. They were living with a range of complex needs, including diabetes, stroke and heart conditions. Some people were also living with dementia. Some of the people living with dementia could show behaviour which may challenge others. Many people needed support with their personal care, eating and drinking and mobility needs. The registered manager reported they provided end of life care when required. No one was receiving end of life care at the time of our inspection.
Heather View was purpose-built as a care home. It provided accommodation, treatment and care for up to 74 people, over four floors. Accommodation for people was provided on three floors. The top floor provided accommodation to people who had residential care needs. The second floor provided nursing and care to people who had nursing care needs. The first floor provided care to people who were living with dementia, who had residential care needs. Each floor had its own sitting and dining areas. The ground floor provided further communal areas for people, the offices and support facilities like the laundry. A passenger lift was provided between floors. There was an enclosed garden area, which was wheelchair accessible. Heather View was situated close to the centre of Crowborough. The provider was Care UK Community Partnerships Ltd, a national provider of care.
Heather View had a registered manager. 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 there were not enough activities provided. We observed some activities taking place but most of the people, particularly people who did not go out of their rooms, had little to occupy them. People’s care plans relating to activities did not focus on activities which benefited them. Management had identified that action was needed and a new activities worker was in the process of being appointed.
People’s care and treatment plans were mixed. We saw occasions where people’s care needs were not documented and where people’s care plans did not clearly document what their needs were. This meant staff who were unfamiliar with the person would not know about all of people’s needs. Such matters had not all been identified during audit. Other care plans were clear and documented care that staff told us about and we observed being provided.
Many people’s clothes were unmarked so were not returned to them. Domestic workers did not have evidence of regular supervision, so areas for action had not been identified and addressed. Other staff felt supported in their roles by their line manager but said they did not always receive supervision. Each head of department had their own ways of recording supervision so there was not a consistent system, to ensure all staff were received supervision.
All of the staff we spoke with showed a clear understanding of their responsibilities for safeguarding people from risk of harm. Staff also showed a clear understanding of their responsibilities under the Mental Capacity Act 2015 and the Deprivation of Liberties Safeguards.
People said there were enough staff on duty to meet their needs and staff responded quickly when they needed them. The provider had standard systems to ensure prospective staff were fully assessed for their suitability to work with people, prior to employment. Recently employed staff described their induction as “Very effective.” Staff were positive about the training. Staff supported people in an effective, safe way, including people who were living with dementia.
People said Heather View was a caring place. Staff supported people in a caring way, seeking their permission before they supported them and involving them in decisions about how they wanted to be cared for. Staff were always polite to people and clearly knew them as individuals. People’s relatives said they were involved in supporting staff to care for their loved ones and people’s independence was encouraged. Staff practice ensured people’s privacy and dignity.
Heather View had relevant environmental risk assessments. All people also had individual risk assessments to ensure their safety. There were regularly reviewed. Heather View complied with national guidelines when ensuring people’s safety. The registered manager had clear systems for auditing accidents and incidents. They took action where matters were identified.
Heather View had safe systems for administration of medicines. These systems were regularly reviewed and audited, to ensure staff followed the provider’s policies. People said their medical needs were met. A GP said staff worked effectively with them to ensure people’s medical needs were promptly reported to relevant external professionals.
All of the people we spoke with made positive comments about the meals. Meals were attractively presented. People were able to make choices about what they wanted to eat and drink. Staff were readily available to support people with eating and drinking if needed.
The registered manager followed the provider’s complaints policy. Records of complaints were clearly documented, together with actions taken. People and their relatives were regularly consulted about quality of care provision.
People told us they thought Heather View was well managed. The registered manager and provider had established systems for auditing the quality of the service. Where matters were identified, action was taken. For example action had been taken to replace old furniture.
Staff said they were consulted and informed. Regular meetings took place. These were minuted so staff could review matters raised. Staff were aware of Heather View’s managerial structure and aims and values. One member of staff summed Heather View’s values up by saying their role was to “Make sure the care to everyone is person-centred.”
Heather View is a large purpose built modern home which can provide nursing and care for up to 74 older people. At the time of this inspection there were 49 people using the service. There are three floors where staff provide care for people with different needs.
People and their relatives told us they found the staff were very kind and met their needs well. One person said, “I’m very happy, they’re wonderful, I’d rather be home of course, but they are keen to look after you.”
The manager had been in post since February 2014 and they had submitted their application to register with the Care Quality Commission (CQC) at the time of this inspection. This application is in the process of being considered prior to the manager’s registration being confirmed. 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.
The provider and the manager had effective systems in place which ensured peoples’ safety. These included assessing the risks associated with people’s needs and ensuring that staff took action to minimise these risks.
The staff had a good understanding of people’s individual needs and this included the requirements related to people’s mental capacity under the Mental Capacity Act 2005 and protecting people from unnecessary restrictions to their movement and liberty. The staff and manager had a system in place which they had used in practice if people had required referral to the appropriate authorities for best interest decisions under the deprivation of liberty safeguards.
We found that people received their prescribed medicines on time by staff trained to manage their medicines safely.
People told us that they could express their views about their care. There were regular relatives’ meetings and the new manager had started to introduce residents’ meetings. We asked people if they would be happy or comfortable to raise any issues, they said, “Definitely.”; “I would tell my daughter, she’s on the Committee.” and “I would if I could think of something to moan about.” One other person made positive comments about the effectiveness of the new manager including, “There is an open door policy.”
During the day we observed staff continually asked people if their care was suitable and if there was anything else they could do for them. The care plans we saw demonstrated that some people or their relatives had been involved in their assessments and care reviews but it was not always clear if everyone who had been assessed as having the capacity to contribute had been involved.
People and their relatives all commented on how kind and caring the staff were. Our observations confirmed that the staff displayed a caring attitude towards people and their relatives. We saw examples of staff compassion including staff getting down to people’s level to speak with them, showing people appropriate affection and touch and speaking kindly to ensure people had everything they needed. The staff we spoke with were enthusiastic about the care they provided. One member of staff said, “I love the residents here.” Another member of staff said, “It is a real privilege working with the residents here in a safe environment.”
People and their relatives told us that the staff knew their individual needs really well. Four relatives all said that they never had to prompt the staff to contact other health care professionals. One relative said, “We never have to ask, the staff pick up on everything.” We found that people’s care and nursing needs were recorded in detail and effectively communicated to the whole staff team. Where we did identify gaps in the information available to staff the manager was aware of these and had a detailed plan to continue to improve the care planning process.
People and their relatives commented that the service could improve if there were more activities tailored to people’s interests. We found that although there was a variety of group activities and some individual activity on offer there was a need to develop the availability of useful daily occupation.
People, their relatives and the staff we spoke to all made positive comments about the new registered manager and the improvements they had made to the service. We found that the manager and the provider provided effective leadership to the staff and had taken the required action to improve the service and meet the needs of people since the previous inspection which took place in August 2013.
People told us there were enough staff to meet their physical needs but not to always be available to spend time with them and talk. The relatives we spoke with agreed with this view. One relative said; “No, I don’t think they have adequate staff or enough time to sit and chat especially those with no visitors”. We found that new staff had been recruited since March 2014 and the use of agency staff had decreased. Staff told us that although they were sometimes rushed they were able to meet people’s physical needs and find some time to spend with people.
There were 49 people who used the service at the time of our inspection. People at the service were assessed as having a wide range of needs and includedg people who had complex dementia and behaviours that challenge.
People had variable experiences depending upon which unit they resided. Positive feedback was given about the residential respite unit by people who stayed there and their relatives. One relative commented, 'I looked at 10 care homes and this was the only one I liked and I was right. The care my mum receives here I think is very good.' Another relative said, 'We have used Heather View for respite for several years and we are extremely pleased with the service. My Mother likes the food and enjoys her stays here'.
People who lived on the other units told us: 'It can be quite frightening when some of them start shouting, there is one lady who is very aggressive'. A relative told us how the complex needs and level of noise created by some people meant that their relative was apprehensive about mixing with other people.
Where people did not have the capacity to consent to complex decisions about their care and treatment, processes were not always followed to ensure that people's rights were protected to make decisions about their care and treatment.
Care and treatment was not always planned and delivered in a way that ensured people's safety. The service was not always effective in managing skin integrity, wound care and accident prevention. However, records indicated that people's weights were monitored regularly and appropriate action was taken if weight loss had been noted. Much consideration had been paid towards meeting the social needs of people with a comprehensive range of activities provided. We saw that staff used safe ways of working such as when they assisted people to mobilise. A relative told us that 'Any little concern they have responded to and dealt with it.'
We saw staff taking time to explain to people what their medicines were for. However not all medicines were safely administered, such as the administration of medicines which were prescribed to be taken 'when required'. This placed people at risk of unsafe medication practices.
Care staff were described by people and their visitors as 'Very helpful,' 'Kind' and 'Attentive.' However we received consistent feedback there were insufficient staff to meet the needs of people. A relative told us, 'The staff can get a little stretched at times it just means that mum has to wait a bit longer for things.' A person told us, 'Staff are extremely helpful but there is simply not enough of them, they are always running around, sometimes they have to tell me they will come back and help me as they are busy at the time.'
There was not always sufficient clinical staff on duty to be able to safety meet people's needs. We also noted that there were no staff trained in mental health needs. Clinical staff did not receive appropriate clinical direction and support to ensure that people received appropriate or safe care.
Records, including care records and staff records, were not always accurate and fit for purpose. This placed people at risk of receiving inappropriate care.
Most of the evidence was collated on the first day of our inspection by the second day the provider had started to put into place many of the actions needed to begin to address the areas of concern that had been identified.
We found that the quality of care and support had improved since the new manager started. People were encouraged to be involved in the service and had their assessed needs met. One person commented that they were happy living there.
People liked the food they were offered and were given sufficient amounts to eat and drink. Those people that needed special diets were catered for.
Staff told us that they were supported in their role and had seen improvements in the home over the last two months.