This unannounced inspection took place on 20 February 2018 .

At our last inspection in January 2017 we found that the provider was in breach of Regulation 18 of Care Quality Commission (Registration) Regulations 2009 because the registered manager had not notified CQC in a timely manner where Deprivation of Liberty Safeguards (DoLS) were in place. At this inspection we found that the registered manager had promptly forwarded notifications to CQC when DoLS were authorised by the Local Authority to keep people safe.

Addington Heights is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service accommodates up to 50 people in one adapted building which is separated into

five units that can accommodate up to a maximum of ten people. These units are self-contained and each have their own lounge and dining areas. 46 people were living at the service at the time of our inspection.

The service had a registered manager in post. 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 were safe living in Addington Heights. Staff assessed and reduced risks to people and were trained to protect people from abuse. The provider used robust recruiting practices to ensure people were supported by safe and suitable staff. People received their medicines safely and the care home was clean and hygienic. Staff regularly rehearsed their planned response to an emergency at the service which included fully evacuating the building. The registered manager deployed staff in sufficient numbers to ensure people received their care safely and as planned.

Trained and supervised staff assessed people’s needs. People were served nutritious food and received the support they required to eat safely. Staff supported people to access healthcare services whenever they needed to and ensured people received care in line with the Mental Capacity Act 2005. The environment of the service supported people’s mobility needs.

People received their care and support from kind and caring staff. Relatives were made to feel welcome and they observed warm relationships between people receiving care and the staff who provided it. People’s spiritual and cultural needs were met and they were supported to make decisions. Staff maintained people’s privacy and promoted their dignity.

People’s care was personalised and staff maintained up to date and accurate electronic care records. People’s changing needs were identified and met. People were supported to participate in a range of activities and quiet areas offered privacy and calming views. People were supported with compassion during their end of life care.

The registered manager oversaw detailed quality assurance checks and used the findings from these to address shortfalls. The service had an open atmosphere and the views of people, their relatives and staff were sought to shape care delivery. The service developed links in the community and worked closely with other organisations in people’s best interests.

This was an unannounced inspection that took place on 4 and 5 January 2017.

Addington Heights is a residential care home that provides nursing and personal support for up to fifty older people who have a range of nursing, and other care needs associated with old age. The service is separated into five clusters that can accommodate a maximum of ten people. Each unit specialises in providing care to people with either nursing, residential or respite needs. The units are self-contained and each have their own lounge and open plan kitchen/dining areas.

The home 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 and associated Regulations about how the service is run.

In January 2016, our inspection found that the home did not meet all the regulations we inspected against. At this inspection the home had followed their action plan and made improvements. They had met all the regulations from that inspection. However there was a new breach of Care Quality Commission (Registration) Regulations 2009: Regulation 18. The manager had not sent in a timely manner the notifications required by regulation where Deprivation of Liberty Safeguards (DoLS) were in place. We identified other areas that required further improvement. See what actions we have taken at the rear of the report.

People and their relatives told us the home provided a relatively good service that continued to strive for improvements, the environment was comfortable and people liked living there. They found that staff were caring, attentive and provided the care and support they needed in a friendly and kind way.

Although the staff team continued to experience a turnover of staff there were fewer changes in personnel. Management addressed staff absenteeism and practice issues and these were managed more effectively. Staff received appropriate training and support to be able to effectively offer safe care and treatment. Staff understood people’s needs and preferences for the way they wished their care to be delivered.

People enjoyed their meals and were protected from risks associated with nutrition and hydration they had balanced diets that also met their likes, dislikes and preferences. People and their relatives were positive about the improvements to the choice and quality of food available.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. The registered manager was aware of DoLS and had made referrals when required, a number of people were subject to restriction under the DoLS guidelines. Staff understood how to support people to make choices.

Staff had a good understanding of how to identify if people were at risk of abuse and knew what to do in these circumstances. The provider had a safe and effective recruitment process in place to help ensure that staff they recruited were suitable to work with the people they supported. Risks to people's health and welfare were assessed, and appropriate provision was made for staff to manage these effectively thus reducing or eliminating the risk.

People and their relatives when appropriate, were involved in planning the care and support their family member received. Care was delivered in a personalised way and people were supported to make choices. People and their relatives described staff as “kind” and “caring”. We observed positive interactions between people and staff. Most staff knew people well and spoke about them respectfully. They engaged in meaningful conversations and encouraged people to remain as independent as possible.

Staff continued to ensure people were well

This was an unannounced inspection that took place on 12 and 13 January 2016.

Addington Heights is a residential care home and respite unit that provides accommodation and personal support for up to fifty older people who have a range of nursing, and other care needs associated with old age. The service is separated into five clusters that can accommodate a maximum of ten people. Each unit specialises in providing care to people with either nursing, residential or respite needs. The units are self-contained and each have their own lounge and open plan kitchen/dining areas.

The home 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 and associated Regulations about how the service is run.

In September 2014, our inspection found that the home met the regulations we inspected against. At this inspection the home did not meet all the regulations.

People and their relatives told us the home provided a relatively good service, the environment was comfortable and they liked living there. They found that staff were caring, attentive and provided the care and support they needed in a friendly and kind way.

The staff team experienced a turnover of staff which meant people experienced further changes in personnel. Staff supervision and training arrangements did not provide staff with appropriate support, training and development. The service needed improvements in this area and was in breach of regulation.

The records were comprehensive; the electronic (Caresay) and paper records were used. They contained clearly recorded, fully completed, and regularly reviewed information which enabled staff to perform their duties well. However, on one unit we found that some important information was misfiled which meant this information was not shared in a timely manner with relevant professionals which may have had a negative impact on people.

People and their relatives were encouraged to discuss health needs with staff and had access to community based health professionals, as GPs as required. There were improvement to how people had their healthcare needs promoted, for example the introduction of a weekly surgery by the GP and improved communication with healthcare professionals.

People were protected from risks associated with nutrition and hydration and had balanced diets that also met their likes, dislikes and preferences. People and their relatives were positive about the choice and quality of food available.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. The registered manager was aware and had made referrals when required, but told us no one at the home was subject to any restriction under the DoLS guidelines. Staff understood how to support people to make choices.

The home was well maintained, furnished, and clean and provided a safe environment for people to live in.

People’s social needs were not fully met. The service failed to give people enough opportunities to participate in meaningful social activities, and many spoke of being bored and a need to improve provision in this area. The service needed to improve in this area and was in breach of regulation.

The majority of staff were knowledgeable about the people they worked with and about the care field they worked in, there was a lack of consistency on four of the units because care staff were continually rotated, this prevented staff developing beneficial relationships with people.

Relatives said the management team at the home were approachable, and mostly responsive. However two of the relatives commented that they h

This inspection visit was undertaken by two inspectors and an expert by experience. At the time of our inspection there were 42 people living at the service. We spoke with fourteen people using the service, six relatives, nine members of staff and the manager. We looked at seven people’s care plans as well as quality assurance records kept by the provider.

We considered all the evidence gathered under the outcomes inspected. We used the information to answer the five questions we always ask: - Is the service safe, effective, caring, responsive and well led?

This is a summary of what we found-

Is the service safe?

The home environment was safe, clean and well maintained. Individual assessments identified risks presented by people and management plans were in place to enable staff minimise the risks presented.

People told us that the care staff treated them well and they felt safe. Comments included “It’s nice here”, “Lovely here” and “Very nice.” Staffing levels were appropriate to keep people safe and meet their needs.

New staff had a complete induction, completed training on how to safeguard vulnerable adults, and shadowed experienced staff before they worked unsupervised. The service had a training and development programme in place, and staff had access to mandatory training such as moving and handling, safeguarding and fire safety. Records were kept by the service to ensure that this important mandatory training was kept up to date.

Is the service effective?

People’s identified needs were being met by suitably skilled staff who had the necessary qualities for their roles. Staff received the support and supervision that helped them do their jobs.

Staff liaised with health professionals and followed their advice in looking after people in a way that promoted their health and welfare. Staff were observant and summoned help promptly from health professionals if people had a change in their conditions or became unwell.

People enjoyed the meals they were served as they took into account their preferences and dietary needs.

Care plans were up to date reflecting individual care needs across important areas such as mobility, personal hygiene, communication and sleep.

Further work could take place to make the environment more homely, personalised and ‘dementia friendly’ for the people living on each of the five clusters. It was sometimes difficult to differentiate one area from another with corridors and lounges quite uniform in appearance and lacking ‘identity’.

Is the service caring?

People using the service told us that staff treated them with respect and they were happy living at the home. Feedback included “The staff are alright to me”, “The nurses are nice to me” and “Some of them are nice.” One person told us “They come quick” when talking about using the call bell and said that staff had supported them that morning with a shower.

Staff understood the importance of treating people with dignity and respect and said they were made aware of the standards expected of them in this important area. The service demonstrated it monitored staff practice and took appropriate action as necessary to address any shortfalls.

Staff were familiar with people they looked after and knew what was expected to enhance their quality of life.

Is the service responsive?

Care was planned and delivered in line with people’s individual care needs. People’s care plans had essential information recorded for staff to see about their needs around ability, age, disability, gender, race, religion and belief and sexuality. Relatives were involved when appropriate in discussions about how people liked to be supported. Regular reviews of individual needs made sure any changes were identified and addressed.

We had mixed feedback from people using the service about the activities provided within the service or in the community. Some people said they would welcome more things to do as they were sometimes bored. Comments included “Not much to do “ and “I would like to go out to pubs more." However a person told us "My elderly parent likes to spend time in their own bedroom, having the radio on and reading the paper, they invite others in on occasions for a chat, staff respect their decision".

Is the service well-led?

The service had a registered manager in post for the past eighteen months. This has provided stability to the staff team. Staff told us they got support and training needed which helped them to meet people’s needs.

The quality of the service was assessed by the service provider so they could identify any improvements that were necessary. The systems in place for regularly assessing and monitoring quality and risk matters at the service included monitoring the environment, care plan records, medication procedures, and maintenance of the building, and handling of complaints.

Quality assurance processes however could be developed to be more outcome led and focussed on peoples experiences living in the home using observation tools and peer review audits.

This visit was a follow up from a previous inspection undertaken on the 27th November 2013.

During that inspection we did not consider the home was meeting minimum standards as laid out by legislation and therefore made a compliance action. The action which related to the complaints procedure, required the provider to tell us in a report how they would meet the minimum standards. This inspection was undertaken to check they had complied with what we had required of them. We also raised a number of issues which were recommendations of good practise.

We considered the home had met the minimum standards which related to the complaints procedure. However, we made another compliance action which related to staffing levels within the home. We have required the provider to review the staffing level and tell us how they would meet the minimum standards. A further inspection will be undertaken to check they have complied with what we have required of them.

To get a full picture of the home and how it functioned, the reader is advised to read this report in conjunction with the report written following our visit on the 27th November 2013.

During our inspection we talked with the new acting manager and eight other members of staff who were on duty at the time. We also spoke with six people who used the service and four of their visiting relatives. They told us staff who worked there were kind and caring, and most felt happy with the overall quality of the care provided at Addington Heights. One person said “I am very happy with this place. The staff are very nice” Another person told us “The staff are alright, most are friendly”.

Overall, we found that people who lived or stayed for respite at the home received safe and appropriate care from sufficient numbers of suitably trained and supported staff. We saw staff treated people who used the service and their guests with respect and always involved them in discussions about their care. The provider also had effective systems in place to continually monitor the quality of the care and support people received.

However, although people receiving services told us they were happy with the care provided; we found that failures to ensure the providers complaints procedure was accessible to all meant people might not know how to make a complaint if they were dissatisfied with the service they received. We also found peoples social needs may not be fully met because they did not have enough opportunities to participate in meaningful social activities. The interior design of the home lacked colour contrast and pictures of interest, which meant the communal areas were not particularly stimulating places to be. Finally, the provider may wish to note that mealtimes were not a particularly social or positive experience for people because staff did not sit with them.

In this report the names of registered managers appear who are no longer in post and therefore not managing the regulatory activities at Addington Heights at the time of our inspection. Their name appears because they were still the services registered manager on our register at the time. The acting manager is in the process of applying to become the services registered manager.

Two inspectors visited Addington Heights because of the size and complexity of the needs of some of the people who use the service. The home is divided into five clusters of 10 people with each cluster having its own lounge and kitchen/dining area. One cluster was specifically for people receiving respite care or re-enablement services after being discharged from hospital. Another cluster is primarily for people who receive services from the Community Intermediate Care Services (CICS) who provide intensive physiotherapy for a two week period after a hospital admission.

We focused much of the inspection on the two clusters mentioned, but also spent varying degrees of time on the other clusters.

Everyone that we spoke with told us that they were happy living at Addington Heights. One person told us, “it works very well here….I’ve got no complaints”. Another person told us, “I’ve been treated very nicely” and someone else said, “its better than being in hospital”

There were a number of minor issues which appear within the body of the report, and which we have discussed with the provider, as issues that they need to review.

We spoke to fifteen people who use the service, two visitors and three staff members during our unannounced visit.

Comments about the service included ‘I’m quite happy’, ‘It’s quite nice’, ‘I can’t fault it – I’m a satisfied customer’, ‘everything is satisfactory’ and ‘everything is beautiful’.

We asked individuals if they were treated with dignity and respect. Feedback included ‘they are alright - they treat me with respect’, ‘always polite’, ‘very polite’, ‘they are always respectful, it goes both ways’ and ‘very respectful’.

Comments about staff included ‘quite nice, we have a laugh and a joke’, ‘the people who do the work are nice’, ‘the staff are good’ and ‘they are all nice’. One person said ‘I get on well with the staff’. The majority of people we spoke to said that there were enough staff around when they needed them

We received mixed comments however when we asked people what they did each day. Feedback included ‘I just sit and watch TV – there are one or two activities’, ‘bingo is not my scene’, ‘we sometimes have activities’, ‘I do get tired of doing nothing’ and ‘we have games sometimes’. People using the service would clearly benefit from the further development of the activities programme.