This inspection took place on the 26 and 31 July 2018 and was unannounced.

We carried out an inspection at Healey House on 30 June and 1 July 2016 when we found the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had not met the regulations in relation to safe medicine practices and had not ensured that new staff completed induction training and had been assessed as competent in their role. The overall rating was requires improvement with one area identified as Inadequate.

At the last inspection on 23 and 27 June 2017 we found there had been significant improvements and the provider had met the regulations in relation to the safe management of medicines and induction training for new staff training. However, there were still areas to improve and embed the improvements into everyday practice. The overall rating continued to be requires improvement although three key questions had been identified as Good.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and confirm it had improved. We found improvements had not been made and there were breaches of regulation. The overall rating continues to be Requires Improvement and only one area has been identified as Good.

Healey House is a 'care home'. 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.

Healey House is part of the Hastings and Rother Voluntary Association for the Blind, a charity set up to support people with visual impairment. The home is registered to provide accommodation and personal care for up to 28 older people and at the time of the inspection 18 people were living there. Some people were independent and required minimal assistance whilst others required assistance moving around the home safely due to visual impairment, frailty, physical disability or medical conditions, such as diabetes and heart failure.

The registered manager was present during the inspection. 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.

Although the quality assurance system had been reviewed and a number of audits developed to monitor the services provided and identify areas for improvement it was not effective. The audits had not identified the areas of concern we found during the inspection; including the care planning process, record keeping and meeting people’s dietary needs.

Staff were supported to develop their knowledge and practice through regular supervision and yearly appraisals had been planned. Training had been provided, including fire safety, infection control and moving and handling and staff were required to attend. However, there were no records to show that new staff were supported to develop the knowledge to understand people’s needs; or that their competency had been assessed and they had the skills to provide appropriate care.

We recommended that the provider sources appropriate training for staff responsible for giving out medicines to ensure their practice is observed; they have been assessed as competent and follow the guidelines for managing medicines in care homes issued by National Institute for Health and Care Excellence (NICE).

From 1 August 2016, all providers of NHS care and publicly-funded adult social care must follow the Accessible Information Standard (AIS) in full, in line with section 250 of the Health and Social Care Act 2012. Services must identify, record, flag, share and meet people’s information and communication needs. Staff said most people could communicate well

We inspected Healey House on the 23 and 26 June 2017. This was an unannounced inspection.

Healey House provides accommodation and personal care for up to 28 older people. Healey House is owned by the Hastings and Rother Voluntary Association for the Blind. A number of people living at the home have a visual impairment, and some required support for a range of other health care needs.

There were 19 people living at the home at the time of our inspection which included four people staying for a period of respite care. Respite care is when people stay for a short break either as a holiday or providing support whilst their main carer is unavailable.

Healey House was last inspected on 30 June and 01 July 2016. Two breaches were of regulation were identified and it was rated as requires improvement overall, with one area identified as inadequate. We asked the provider to make improvements to ensure that care and treatment was provided in a safe way and that quality assurance systems improved. The provider sent us an action plan stating they would have addressed all of these concerns by June 2017.

This unannounced comprehensive inspection on the 23 and 26 June 2017 found that whilst there were areas still to improve and embed in to everyday practice, there had been significant progress made and that they had now met the breaches of regulation. However there were areas still to improve and embed in to everyday practice,

At the time of the inspection there was an acting manager at Healey House. The acting manager had commenced the registration process with CQC and it was confirmed by the registration team that this was in progress. An interview date had been agreed.

The provider had progressed quality assurance systems to review the support and care provided. A number of audits had been developed including those for accidents and incidents, care plans, medicines and health and safety. It demonstrated that further embedding of the audits were required now to ensure continued improvement. Some areas of documentation had not been completed or maintained to ensure accurate contemporaneous records were in place to underpin safe care and support for people at all times. This had not compromised people’s safety at this time but was an area that needs to improve.

Care plans reflected people’s assessed level of care needs and were based on people's preferences. Risk assessments included falls, skin damage, nutritional risks including swallowing problems and risk of choking and moving and handling. For example, cushions were in place for people who were susceptible to skin damage and pressure ulcers. The care plans also highlighted health risks such as diabetes. Visits from healthcare professionals were recorded in the care plans, with information about any changes and guidance for staff to ensure people's health needs were met. There were systems in place for the management of medicines and people received their medicines in a safe way.

All staff were involved in writing the care plans and all staff were expected to record the care and support provided and any changes in people's needs. The manager said care staff were being supported to do this and additional training was on-going.

Staff had a good understanding of people's needs and treated them with respect and protected their dignity when supporting them. People we spoke with were complimentary about the caring nature of the staff. People told us care staff were kind and compassionate. Staff interactions demonstrated staff had built rapport with people and they responded to staff with smiles. People previously isolated in their room were seen in communal lounges for activities, meetings and meal times and were seen to enjoy the atmosphere and stimulation.

A range of activities were available for people to participate in if they wished and people enjoyed spending time with staff. Activities were provided throughout the whole day in the adjoining day centre, five days a week an

Healey House provides accommodation and personal care for up to 28 older people. Healey House is owned by the Hastings and Rother Voluntary Association for the Blind. A number of people living at the home have a visual impairment, and some required support for a range of other health care needs.

There were 22 people living at the home at the time of our inspection. Including four people staying for a period of respite care, one of whom was in hospital at the time of the inspection

Healey House was inspected in February 2015. A number of breaches were identified and it was rated as requires improvement overall, with one area identified as inadequate. We asked the provider to make improvements to ensure that care and treatment was provided in a safe way. The provider sent us an action plan stating they would have addressed all of these concerns by July 2015. At this inspection we found that although some improvements had been made, further work was needed to embed and ensure safe and good practice in all areas. Records needed to be improved to ensure people received safe and appropriate care at all times. Good governance systems were not in place to support the day to day running of the service and ensure safe standards were met and maintained at all times. In the absence of a registered manager the provider had not maintained an oversight of the service by continuing good governance to identify areas of improvement. This is a repeated breech of regulation. Some further breeches of regulation were also found during this inspection.

At the time of the inspection there was an acting manager at Healey House. The acting manager had commenced their application to registered with CQC and this was in progress.

Medicines systems needed to be monitored to ensure safe standards were met and maintained. New staff were not receiving a formal induction to ensure they were supported and appropriately confident and competent to work unsupervised. Effective systems and processes were not in place to show how the provider assessed and monitored the quality of service provided.

Some areas of documentation had not been completed or maintained to ensure accurate contemporaneous records were in place to underpin safe care and support for people at all times.

Training records were not clear and some online training had fallen behind. Staff demonstrated knowledge and understanding of people’s needs however this needed to be backed up with regular training and updates to ensure knowledge up to date and in accordance with current guidelines.

A complaints procedure was in place. However the complaints policy needed to be reviewed to ensure all information and contact details were correct.

Staff knew people well and were able to tell us about their needs and preferences however, this was not supported by up to date relevant documentation. Not all areas of risk had been appropriately assessed to ensure people were safe when they left the home or self-medicated their medicines.

Staff told us they thought there were enough staff to provide care, people and visitors agreed that staff were always available to help them and they felt staffing levels were appropriate.

Mental capacity assessments took place and changes to people’s mental health were responded to. Staff demonstrated an understanding around MCA and DoLS.

A clear system for the maintenance of equipment and services was in place. With a monthly programme to show what needed to take place each month. Fire safety had been improved, with each person having an up to date personal emergency evacuation plan (PEEPS) in place in the event of an emergency evacuation.

People were complimentary about the meals provided and told us the food was of a high standard.

Kitchen staff were aware of people’s dietary needs for example diabetic or fortified meals. Choices were offered and alternatives available if people changed their minds.

Activities were provided and people told us they enjoyed so

There were twenty two people living in the home at the time of our visit. We spoke with people in their private bedrooms, in communal areas and during a meal time. People that spoke with us said they felt well cared for. Comments included. “It is lovely and I feel very lucky to be here. The staff are all so different but every one of them is very kind.

There were processes in place that ensured that people, wherever possible, were supported to give informed consent about the care they received.

People had their individual needs and wishes recorded in a detailed plan of care that was kept under regular review.

People were protected from risk of abuse or harm by their being safeguarding policies and procedures in place and by staff knowing how and when to use them.

Evidence we saw showed us that people were supported by a caring, experienced staff team. The staff team were well trained and well supported by the manager.

There were processes in place to audit and monitor the quality of service being provided and people told us that their views were respected.

A family member told us. “We have no concerns at all, the manager and staff are wonderful and Mum is well and truly looked after.”

We carried out this inspection to follow up on compliance actions made in April 2012.

We looked at care plans and saw that they reflected the assessed needs of the people who lived at Healey House. People we spoke with told us they were happy living at the home. One person told us, “it’s good here.” This person then told us how they were going to spend their day.

Another person told us about the meal they had just eaten. They told us, “the food is really nice.”

A visiting professional we spoke with told us they found the care at the home to be of a good standard.

Staff we spoke with were able to tell us about the care that people who lived at the home required.

Staff spoke to us about training. One staff member said that training was, “well organised, and staff knew what training they had to do.”

We saw there were systems in place to monitor the quality of the care provided.

People who use the service told us they were very happy with the care and treatment they received at the home. They told us that staff were kind and would always offer assistance.

One person we spoke with told us that they were looking forward to going out. It was something they enjoyed doing and went out quite often.

People who use the service told us they were very happy with the care and treatment they received at the home. They told us that staff were kind and would always offer assistance.

One person we spoke with told us that they were looking forward to going out. It was something they enjoyed doing and went out quite often.

People in the home have varying levels of visual impairment. Not all of the people using the service were able to tell us about their experiences in the home. However those who could told us “staff always treat everyone with dignity especially those who need more help” and that the food was “really nice, with good choices” Visitors told us they were happy with the home and the care provided.

We inspected Healey House on 17 and 18 February 2015. This was an unannounced inspection. The home was last inspected in December 2013, no concerns were identified at that time.

Healey House is registered to provide accommodation, support and rehabilitation services for people who are visually Impaired. The service is provided by Hastings and Rother Voluntary Association for the Blind. There is a day centre attached to the service that provides transport, social and rehabilitation services for people living at the home and the wider community.

The home can provide care and support for up to 28 people. There were 21 people living at the home during our inspection. Accommodation is provided over three floors with communal lounge and dining areas.

A registered manager was 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 and associated Regulations about how the service is run.

People and their visitors spoke positively about the service and commented they were made to feel welcome and felt safe at the home. We saw that there enough staff to spend time with people and support them in ways that encouraged their independence and made them feel safe.

However, our own observations and the records we looked at did not always reflect the positive comments people had made. Risk assessments did not always provide sufficient information for staff to support people safely or respond appropriately to risks. Incident and accident information was not used proactively or always taken into account when reviewing risk assessments. Information, required in the event of an emergency, was not in place.

Essential training, and other training identified as appropriate, had not been delivered to some staff and training records were incomplete. Some staff were unclear how to recognise and respond to safeguarding matters should they encounter them. Although a quality assurance framework was in place, it was not wholly effective. This was because it did not provide adequate oversight of the operation of the home.

Positive comments were made about many aspects of the care and support provided, but particularly about the inclusiveness of the home and the caring nature of the staff. Many staff interactions demonstrated they had built good rapports with people and people responded to this positively. People and visitors told us staff were kind and compassionate and respectful. However, we found improvement could be made in the way that some staff interacted with people.

Medicines were stored and administered safely. Staff were trained in the administration of medicines and relevant records were kept that were accurate and fit for purpose.

People were supported to have a balanced and nutritious diet by staff who were sensitive to people’s individual needs.

People were able to see their friends and families as they wanted. The home encouraged visitors and welcomed their views about the care and support provided and how the home was run.

Visitors told us they were made welcome by the staff and had no concerns about the standard of care provided. Established communication systems were in place and feedback was regularly sought from people, relatives and staff.

There were breaches of regulations. You can see what action we told the provider to take at the back of the full version of the report.