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Inspection carried out on 24 April 2019

During a routine inspection

About the service: Heathfield Care Home is a residential care home that provides personal and nursing care for up to 23 older people, some of whom are living with dementia. At the time of the inspection, 22 people were living at the home.

For more details, please see the full report which is on the CQC website at

People’s experience of using this service:

People and their relatives felt the home provided a safe environment. Staff knew how to keep people safe. Risks to people were identified, assessed and managed safely; staff supported people to be as independent as possible. Sufficient staff were on duty to support people to stay safe and meet their needs. Medicines were managed safely. The home was clean and smelled fresh. Learning had taken place when things went wrong. For example, barriers had been installed on the main staircase to prevent people from falling.

People’s needs and choices were met by staff who knew them well. A relative said, “I am totally reliant on staff and can’t thank them enough for what they do”. Staff had the skills, knowledge and experience to deliver effective care and support and had completed a range of training. Staff had regular supervisions and appraisals.

People were happy with the food on offer and told us they particularly liked roast dinners. A relative said, “At Easter and Christmas they do a good spread, which is very nice”. People had access to a range of healthcare professionals and services. The home was comfortable and people could bring in their own furniture and decorate their rooms if they wished. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were looked after by kind and caring staff. Staff were patient and warm and provided reassurance if people became anxious or distressed. People were encouraged to be involved in all aspects of their care. They were treated with dignity and respect.

Care plans were personalised and reflected people’s preferences. Activities were planned based on people’s interests and hobbies. There were outings into the community and external entertainers visited the home. People’s diverse needs were met. A relative referred to their family member and said, “Staff dance for her and sing for her and it makes her smile”.

People and their relatives were asked for their feedback through questionnaires; all results were positive. Residents’ meetings took place and suggestions were listened to and acted upon. Staff felt supported in their roles and were complimentary about the management of the home. A range of audits were effective in identifying any actions needed to drive improvement.

Rating at last inspection: At the last inspection, this service was rated as Requires Improvement (published in April 2018).

Why we inspected: We were required to inspect this service within 12 months of the last inspection because of the rating of Requires Improvement. The provider sent us an improvement plan after the last inspection which outlined the actions they proposed to take to address the issues of concern. This inspection took place to check on the improvements made and in line with CQC scheduling guidelines for adult social care services.

Follow up: We will review the service in line with our methodology for ‘Good’ services.

Inspection carried out on 7 February 2018

During a routine inspection

This unannounced comprehensive inspection took place on 7 February 2018. The last inspection took place on 13 Mary 2015 when the service was meeting the legal requirements. The service was rated as Good at that time. This inspection identified breaches of the regulations. The service has now been rated as Requires Improvement.

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. Heathfield is a care home which offers care and support for up to 23 predominantly older people. At the time of the inspection there were 20 people living at the service. Some of these people were living with dementia. The service occupies a detached house over two floors with a passenger lift and stair lift for people to access the upper floors. There was an on-going safeguarding investigation being carried out at the time of the inspection by the local authority. This incident is subject to a separate process and as a result this inspection did not examine the circumstances of that specific concern.

People's rights were not always protected because staff did not always act in accordance with the Mental Capacity Act 2005. The service did not have a policy in place to guide staff on the Mental Capacity Act 2005. Training had been attended by the registered manager and staff on this subject. However the registered manager and the staff were not entirely clear on this legislation. The information held in some people’s care plans about the Power of Attorney arrangements they had in place, was inaccurate and misleading. There was no evidence of any best interest process having been put in place before restrictions were applied, such as alarm mats and applications made for people to have a Deprivation of Liberty Safeguards authorisation. The service was not acting in accordance with the Mental Capacity Act 2005 Code of Practice.

We observed the lunchtime meal being provided to people. We saw that people were not always asked for their consent before care was provided. Staff placed clothing protectors over people’s heads, then removed them after the meal without first speaking to the person. People were told to go to the lounge after lunch, without a choice being offered. We heard staff telling people to wait when they asked for support from staff. Two staff were seen to go under the dining tables with dustpans and brushes to sweep up food debris from the floor. This was done while some people were still sitting at the dining table. People were seen to lift their feet up while food was swept up underneath them. This did not respect people’s dignity.

There were systems in place for the management and administration of medicines. It was clear that people had received their medicines as prescribed. Regular medicines audits were being carried out on specific areas of medicines administration and these were identifying if any errors occurred such as gaps in medicine administration records (MAR). However, handwritten entries on the MAR, which had not been signed and witnessed had not been identified by the audits.

The premises were well maintained and regularly checked by the provider. There was a programme of redecoration and refurbishment as rooms became vacant. New carpets had been laid in the dining room. There were no incontinence odours throughout the service. There was some pictorial signage at the service to support people who were living with dementia, who may require additional support with recognising their surroundings. Equipment and services used at Heathfield were regularly checked by competent people to ensure hey were safe to use. People’s bedrooms were personalised to reflect their individual tastes.

Risks in relation to people’s daily lives were identified, assessed and planned to minimise the risk of harm whilst helping people to be as independent as possible.

Inspection carried out on 13 May 2015

During a routine inspection

Heathfield Care Home is a service that is registered to provide accommodation and support for 23 older people living with dementia. The service also provided limited respite and day care facilities. The registered providers are AMJ Care Ltd. On the day of our visit 22 people lived at the home.

This was the first inspection of the service since new providers had taken over the home and

it was registered with the Care Quality Commission. This inspection took place on 13 May 2015 and was unannounced

The service had a registered manager in place. 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 and associated Regulations about how the service is run.

People told us that they felt safe in the home. Staff understood the need to protect people from harm and abuse and knew what action they should take if they had any concerns. Staffing levels ensured that people received the support they required at the times they needed. We observed that on the day of our inspection there were sufficient staff on duty. Thorough recruitment checks were carried out to check staff were suitable to work with people.

Care records contained risk assessments to protect people from identified risks and help to keep them safe. These gave information for staff on the identified risk and informed staff on the measures to take to minimise any risks. There were also contingency plans in place to help keep people safe in the event of an unforeseen emergency such as fire or flood.

People were supported to take their medicines as prescribed by their GP. Records showed that medicines were obtained, stored, administered and disposed of safely. People were supported to maintain good health and had access to healthcare services when needed.

Staff were supported to develop their skills by regular training. The provider supported staff to obtain recognised qualifications such as National Vocational Qualifications NVQ or Care Diplomas (These are work based awards that are achieved through assessment and training. To achieve these awards candidates must prove that they have the ability to carry out their job to the required standard.) All staff had completed training to a minimum of NVQ level two or equivalent. People said they were well supported

Staff said that they felt supported by management to undertake their roles. They received regular, formal, supervision to enable the registered manager to monitor staff practice and to support staff development. Staff also received an annual appraisal.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found the provider had suitable arrangements in place to establish, and act in accordance with people’s best interests if they did not have capacity to consent to their care and support. The registered manager understood his responsibility with regard to Deprivation of Liberty Safeguard (DoLS) and had completed mental capacity assessments and made DoLS applications when required. This meant that people’s rights were protected.

People were satisfied with the food provided and said there was always enough to eat. People were given a choice at meal times. Staff supported people to ensure their healthcare needs were met. People were registered with a GP of their choice and the registered manager and staff arranged regular health checks with GPs, specialist healthcare professionals, dentists and opticians. Appropriate records were kept of any appointments with healthcare professionals.

People told us the staff were kind and caring. Relatives had no concerns and said they were happy with the care and support their relatives received. Staff respected people’s privacy and dignity and used their preferred form of address when they spoke to them. Observations showed that staff had a kind and caring attitude.

There was a comprehensive programme of activities in place. An activities co-ordinator was employed who arranged and organised a range of activities in line with people’s interests. There were individual social get togethers such as a ‘chit chat club’ where the activities co-ordinator produced a paper which gave information on events that happened on the same date in history which produced lively discussion topics. There was also an ‘out and about club’ where people would go out in the mini bus once a week to local places of interest. The activities co-ordinator also organised monthly social get togethers. Currently they were organising a range of themed evenings. They had already held a 20’s & 30’s night, a 40’s night and the next event planned was a 60’s night. The registered manager had a purpose built bar made for the dining area because people had expressed a wish to have a pub atmosphere when socialising.

People told us the registered manager, deputy manager and staff were approachable. Relatives said they could speak with the manager or staff at any time. The registered manager operated an open door policy and welcomed feedback on any aspect of the service. Regular meetings took place with staff, people and relatives.

The provider had a policy and procedure for quality assurance. The registered manager carried out weekly and monthly checks to help to monitor the quality of the service provided. There were effective systems for staff to learn from incidents and staff were enabled to help develop the service.