Halden Heights Care Community

Halden Heights Care Community is registered to provide accommodation, personal and nursing care for up to 101 older people, including those living with dementia. Accommodation is located in five units over three floors with a lift available to access each floor. One floor provided rehabilitation care (where people required assessment and support to return to their own home following hospital admission). The rehabilitation treatment is provided by NHS employees whilst personal and nursing care is provided by Halden Heights Care Community staff. There were 75 people living in the service at this inspection.

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

People and their relatives gave positive feedback about the service. Comments from people included, “It feels quite good living here, the atmosphere is calm and peaceful” and “The staff are excellent.” Comments from relatives included, “It’s absolutely lovely. I am very pleased and I can’t recommend it highly enough” and “The service is excellent it is not like home but I accept that, I find everyone caring.”

People told us they felt safe with the staff. People were comfortable with each other and the staff.. People approached staff when they wanted support and were given the emotional reassurance when this was required. Staff knew what their responsibilities were in relation to keeping people safe from harm and potential abuse.

Medicines were stored and administered safely by registered nurses. Staff were trained to meet people’s needs and registered nurses were supported to keep their registration up to date with the Nursing and Midwifery Council (NMC). Nurses and care staff received continuous support and supervision from the management team.

Staffing levels were based on people’s needs. There were enough care staff and nurses to meet people’s needs. Staff were recruited safely.

People received support to keep healthy and had access health care professionals as required. Daily handovers discussed any changes in people’s needs and referrals to relevant health care professionals were promptly made. Potential risks to people’s health and welfare had been assessed and action taken to reduce the risks. There were close links with the local pharmacy and GP who visited the service weekly. People’s health was closely monitored with the support of health care professionals. Some people were supported to regain and maintain their independent living skills.

People’s needs were assessed before coming to the service to make sure they could meet their needs. People’s care plans were person-centred and informed staff how the person wanted to be supported. People were supported to have maximum choice and control of 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 practice.

People were supported to maintain their nutrition and hydration with a healthy balanced diet and access to fluids. People’s weight was monitored and support was sourced from the relevant health care professionals when required.

The staff were caring, and knew people, their preferences, likes and dislikes well. Staff understood the importance of protecting people privacy whilst promoting their dignity. Staff sought people’s consent prior to any care or support tasks.

People’s, relatives and staff’s feedback was sought and acted on. People’s views were listened to and investment was made to improve people’s comfort and well-being. People were supported to access a range of activities within the service.

People’s wishes for care at the end of their life were recorded and respected. Nurses and care staff worked in partnership with the local hospice team and GP to support people to have a dignified death.

The management team were committed to improving the quality of the service people received. The registered manager had developed links with external companies to promote best practice and improve outcomes for people. Audits highlighted any areas for development or improvement, which were acted on quickly.

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 19 January 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.

This unannounced inspection took place on 17 November 2016.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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.

People told us that they felt safe living at the service. Staff were knowledgeable about the procedures to ensure that people were protected from harm. Staff were also aware of whistleblowing procedures and would have no hesitation in reporting any concerns. People received their medication as prescribed.

There were sufficient numbers of suitably qualified staff employed at the service. The provider’s recruitment process ensured that only staff who had been deemed suitable to work with people at the service were employed.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We found that the registered manager was knowledgeable about when a request for a DoLS application would be required. Applications had been submitted appropriately to the relevant local

Staff respected and maintained people’s privacy. People were provided with care and support as required and people did not have to wait for long periods of time before having their care needs met. This meant that people’s dignity was respected and that their care needs were met in a timely manner.

People’s assessed care and support needs were planned and met by staff who had a good understanding of how and when to provide people’s care whilst respecting their independence. Care records were detailed and up to date so that staff were provided with guidelines to care for people in the right way.

People were supported to access a range of health care professionals. Risk assessments were in place to ensure that people could be safely supported at all times.

People were provided with a varied menu and had a range of meals and healthy options to choose from. There was a sufficient quantity of food and drinks and snacks made available to people.

People’s care was provided by staff in a respectful, caring, kind and compassionate way. Staff supported people to take part in their chosen activities to prevent them from becoming socially isolated.

The service had a complaints procedure available for people and their relatives to use and staff were aware of the procedure. Prompt action was taken to address people’s concerns and prevent any potential for recurrence.

There was an open culture within the service and people were freely able to talk and raise any issues with the registered manager and staff team. People, staff and relatives were provided with several ways that they could comment on the quality of their care.

We looked at the answers to five questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Is the service safe?

We viewed all areas of the premises and saw that they were well maintained and visibly clean in all areas. We talked with housekeeping staff and found there were daily cleaning programmes in place and deep cleaning programmes to ensure that good infection control practices were maintained. A relative told us that they were 'Always struck by the cleanliness of the home.'

We talked with people on each floor and spent time carrying out an observational inspection on the first floor. The Short Observational Framework Inspection (SOFI) is a method for observing people's care when they are unable to give clear verbal feedback. We saw that staff were kind and attentive, and treated people with respect and dignity.

We found that the home had comprehensive procedures in place to check that people had consented to the care and treatment provided for them. People who lacked the mental capacity to make decisions about where they lived or the care that they needed had been appropriately supported by their family members or advocates, and by health and social care professionals, to make decisions on their behalf and in their best interests. The manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). This meant that people who lacked full mental capacity were appropriately represented by people who knew their previous wishes and decisions.

We saw confirmation that all of the staff had been trained in safeguarding vulnerable adults. We spoke to staff who gave clear explanations of the different types of abuse to be aware of, and who knew the action to take in the event of any suspicion of abuse. The manager and senior staff were informed about their responsibilities to report any safeguarding concerns, and liaised with the local authority safeguarding team for any support or advice.

Is it effective?

We viewed care plans on each floor and saw that people or their representatives had been involved in all aspects of their care planning. The care plans covered all aspects of people's care and treatment, and had associated risk assessments. We saw that people's preferences were recorded and were adhered to in regards to their individual care.

The home included a floor for people receiving rehabilitation and short term care after being in hospital. This floor had NHS staff as well as nursing and care staff employed by the home. The NHS staff were health professionals who carried out physiotherapy and occupational therapy; and Social Services care managers who arranged for people's placements or return home after their period of rehabilitation. We saw that the staff liaised with each other throughout the day so that there was good communication between them about people's care. The staff appropriately arranged for referrals to other health and social care professionals for people who were receiving long term care.

We viewed training records and saw that staff kept up to date with required training courses, and carried out other training which was relevant to their individual job roles. This meant that they were able to provide effective care and support.

Is the service caring?

All of the people that we spoke with, and relatives, spoke highly of the staff and the care they received in the home. People's comments included, 'The nurses and care staff are outstanding. They have to deal with all sorts of things. It is very good here'; 'It's very, very good, the staff are lovely'; and 'The care has been brilliant. The staff are excellent. I am so pleased with the progress I have made.'

We saw that care plans identified people's own preferences, such as the name they preferred to be called by. We observed that staff offered people a variety of choices in regards to food and drinks; and in where they wanted to go, and what they wanted to do.

We saw that staff took time to listen to people and did not rush them for answers. They included people who appeared withdrawn in the activities going on around them, and drew them gently into conversations so that they did not feel isolated.

Is the service responsive?

The home employed an activities co-ordinator who arranged for a variety of different activities to be available. We saw that care staff also took part in assisting people with activities during the day of our visit. This included people joining in with games and quizzes; and taking some people outside to sit in the garden.

We saw that there were on-going assessments and care plan reviews to ensure that people's changing needs were identified and addressed. This was especially important on the second floor, as people having rehabilitation often made daily progress, which changed their care planning. We saw that the health professionals gave clear directions, so that nursing and care staff knew how to assist people with their mobility and daily living tasks.

People said that if they had any concerns they were able to raise them with the manager and the staff. The manager and deputy were available throughout the week, and people said that they were confident that if they had any concerns or complaints that these would be dealt with appropriately. A relative said that the staff always informed them of any changes in the person's care plan, and would contact them if they had concerns about their health needs.

People's views were obtained through using questionnaires and through residents and relatives' meetings. We saw that the responses were collated, and action was taken to address any issues raised. The results were given to people at the next meeting.

Is the service well-led?

Staff said that they worked well together as a team and were supported by the management structure. We saw that they interacted well with each other as well as with the people living in the home. Each floor had a nurse on duty who provided an overall lead for the floor. The manager and deputy manager provided daily support working alongside the nursing and care staff.

Staff had individual supervision with their heads of department, which enabled them to discuss any training needs or raise any issues. They were also supported through yearly appraisals and monthly team meetings.

We saw that the manager provided a clear lead for the other staff in the home. There were systems in place to monitor the home's progress, which included weekly and monthly audits for areas such as medication and care plans; and other audits for infection control; health and safety; staff training; housekeeping; laundry services and kitchen management. We saw that there was a yearly audit for how well people living in the home were involved in the running of the home, and this had scored 100 per cent at the last review.

People were provided with sufficient nutritious food and drink to meet their needs and were able to make choices about their meals. People were given the support they needed to take their prescribed medication.

There were sufficient numbers of skilled and qualified staff working in the service to meet people's needs.

People said that they were very happy with the care they had received. Comments included, 'I had a bad time in hospital but now I feel I am walking on air, I am very lucky to be here' and 'they don't just do a job it is a vocation'.

People felt safe at the service. Relatives also felt the service was safe. One person commented, 'There is an under current of kindness and sensitivity ... (staff) identify with the patient and the visitor'. We spoke to officers from the local social services who felt the service was safe one.

Staff felt well supported and trained to carry out their tasks.

There were systems in place to monitor the quality of the service.