The inspection took place on 23 and 28th February 2017 and was unannounced. The inspection was undertaken by one inspector.

Heath House provides accommodation for up to 62 people with residential and dementia needs. It does not provide nursing care. At the time of the inspection 53 people were living at Heath House.

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.

When we last inspected the service on 30/06/2016. We found the provider was not meeting the regulations and the overall rating was requires improvement, with a breach of regulation 17. At this inspection we found that the provider had made the required improvements and was now meeting the regulations.

People told us they felt safe living at Heath House and we saw staff worked as a team to help keep people safe. Staff demonstrated they understood how to keep people safe and risks to people's safety and well-being were assessed and kept under regular review to help to keep them safe. People's medicines were managed safely, by staff who had received training.

In most cases people had their needs met in a timely way and we observed there were sufficient numbers of staff who had the right skills and experience to support people safely. However we found on one unit in the communal lounge people looked ‘unkempt’, and we brought this to the registered manager’s attention, who took immediate action to address the issue.

There was a robust recruitment process in place, and we saw from records that all the appropriate pre-employment checks had been completed. Staff were well supported by the management team and received regular one to one supervision and attended bi-monthly team meetings. Staff told us they felt well supported by the registered manager and deputy.

People received the assistance they needed to eat and drink sufficient amounts to help keep them healthy. People were supported to maintain their physical and mental health and staff made referrals to healthcare professionals when required.

We observed staff to be kind and caring overall. And staff knew people’s individual requirements in relation to their care and support needs and preferences. People and or their relatives had been involved in the planning of their care where they were able to and where this was appropriate.

Visitors were welcomed to the home at all times and were involved in events at the home. There was a cheerful atmosphere in particular in the main activities lounge where people were engaged in a range of activities. People who were unable to participate due to reduced mobility were engaged in conversation and reminiscence.

There were arrangements in place to receive feedback from people and their relatives. People felt they were able to raise any issues or concerns they had and told us that they were confident they would be listened to and any concerns raised would be addressed.

People and their relatives were positive about the staff and management at the service. There were systems and processes in place to regularly monitor the quality of the care and support provided for people who used the service. Where shortfalls were identified an action plan was developed to make the required improvements.

The inspection took place on 30 June, and the 1 and 4 July 2016 and was unannounced. When the service was last inspected on 9 November 2015 we found the service was not meeting all the required standards.

Heath House provides accommodation for up to 62 people who have varying level of residential care needs and also for people living with dementia. It does not provide nursing care. At the time of this inspection there were 57 people living at Heath House.

There was a registered manager in post who had registered with the Care Quality Commission (CQC). 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.

We saw that most of the time there were adequate numbers of staff on duty to keep people safe. However at times of peak demand people had to wait to be assisted. Dependency assessments had not always been accurately or fully completed with current information to enable senior staff to identify the level of support people needed. This was discussed with senior managers and was being reviewed as a matter of priority.

People were supported to make choices around food and drink. However the mealtime experience was not person centred and people were not always supported in a timely or appropriate manner. We observed that staff did not always have the skills to assist people appropriately to ensure people received effective care and support. This was referred to the senior management team who took immediate remedial action to address the concerns and a specialist support team was assembled and deployed to the service immediately to provide coaching and mentoring support to staff and managers.

We observed food and fluid records were not completed in a timely way and were not effectively monitored or recorded to enable appropriate interaction if concerns were identified. Again immediate remedial action and resources were deployed to address this shortfall and immediate monitoring was implemented to reduce any risks to people.

People were supported to participate in a range of activities. However these were mainly suited to people who were mobile and could attend the activities areas. Staff told us and our observations confirmed that where people were less mobile or able very little ‘engagement or stimulation’ was available to help ensure they did not become socially isolated. This was being reviewed at the time of our inspection.

We observed that staff did not always interact with people in a meaningful way and on occasions we observed staff to be talking together without including the people in their care. Senior staff addressed this matter on the day of our inspection and staff were being coached and supported to a better level of understanding about how this impacted on people who lived at the home.

People were generally complimentary about the care they received from staff. Staff were mostly knowledgeable about individual’s needs and preferences and where possible people were involved in the planning of their care. However in the case of some people there was little information about them as an individual or their likes and dislikes, so staff did not have the detailed information available to enable them to provide individualised care and support. We observed that people’s dignity was not always respected and promoted in the way staff addressed or included them. We observed some staff to be kind and caring.

Staff were able to attend meetings from time to time to discuss aspects of the home. People and their relatives also had opportunities to attend meetings to discuss the running of the service and to share ideas, however actions were not recorded as being completed so although the records indicated a discussion had taken place the p

The inspection took place on 09 November 2015 and was unannounced. When we last inspected the service on 27 September 2013 we found the service was meeting the required standards at that time.

Heath House provides accommodation for up to 62 people with residential and dementia needs. It does not provide nursing care. At the time of this inspection there were 58 people accommodated at Heath House.

There was a manager in post who had submitted an application to register with the Care Quality Commission (CQC). 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.

At the time of the inspection we found that applications had been made to the local authority where people’s freedom was restricted and they were pending an outcome.

People and their relatives told us that they felt people were safe living at Heath House. Staff and management were knowledgeable about safeguarding matters. Risks to people`s mobility and general safety were identified and risk assessments had been developed to mitigate these risks. Our observations during the inspection confirmed that staffing levels in the home were appropriate to meet people’s needs. Staff members did not start to work at the home until satisfactory employment checks had been completed. There were suitable arrangements for the safe storage and disposal of people’s medicines.

People were supported to make meaningful meal choices and people were assisted to eat in a calm and unhurried manner. People received care and support from a staff team who were well supervised and had the knowledge and skills necessary to provide safe and effective care. Staff asked people for their consent before they delivered all aspects of care. People’s health needs were well catered for.

People were complimentary about the care and kindness demonstrated by the staff team. Staff were knowledgeable about individual’s needs and preferences and people were involved in the planning of their care where they were able. Visitors were encouraged at any time of the day and people’s privacy was promoted. We observed sensitive and kind interactions between staff and people who used the service.

Care was centred on the needs of individuals. There were arrangements for activities and stimulation in the home that were under development at this time to increase the opportunities for people to become further engaged. Meetings were arranged with people who used the service, and their relatives to facilitate feedback about the quality of the service provision. People were confident to raise anything that concerned them with staff or management and satisfied that they would be listened to.

People who used the service, their relatives and staff members found the home manager to be approachable and supportive. Systems in place to monitor various aspects of the care delivery in the home were not always effective in identifying areas of poor practice.

Assessments had not always been accurately completed with correct information in order to identify the level of support people needed and to provide staff with the relevant guidance. The provider’s audits had not identified these shortfalls in record keeping.

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

Following our previous inspection carried out on the 15 and 16 July 2013, the provider was found to be non-compliant with Regulations 9, 14 and 22 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2010.

On the 13 August 2013, the provider submitted an action plan as to how and when they would become compliant with the regulation. On our follow-up inspection we found the provider to be compliant with those regulations.

We saw that care plans had a summary sheet that staff used daily to ensure that they were providing appropriate and safe care to people who used the service. Yearly reviews had been undertaken however, these did not always provide sufficient information and/or demonstrate that people were given the opportunity to be involved with the decision making process. Fluid and food charts were completed regularly and concerns were escalated to appropriate medical professional for advice.

People were given a choice of foods and the soup of the day was served at a safe temperature. Where people required assistance this was done in an appropriate manner and at a pace suitable for the person. Fluid and food charts were completed regularly and concerns were escalated to appropriate medical professionals.

Staff we spoke with felt that there was enough staff available to ensure that people’s needs were met. The rotas reviewed showed that an additional member of staff was available to assist on two units during the morning shift.

People that we spoke with told us that they had been treated with respect and that they received the personal care they needed. They were satisfied with the social activities available to them. Comments from people included “We went on a beautiful boat trip the other day and we had a fish and chips lunch” and “I love friends and family coffee mornings we talk about so many different things”.

People told us that staff were friendly, attentive and caring and that staff always had time to listen to them. People said that they felt very involved in their care and were always given a say in connection to the activities and food choices available.

People we spoke with felt that their privacy and dignity was respected by staff and that there were enough activities provided by the home.

Care plans were not always fit for purpose as they required updating and did not always provide staff with information on how to care for people. Not all people were given call bells to alert the staff if they needed help or assistance.

Action was not always taken where people were at risk of dehydration. People were not always given the opportunity to have their preferred meals and were not involved in the planning of the menu. People were served food that was too hot placing them at risk of burns.

There was not enough staff on duty to meet the needs of some people who used the service.

The home had a complaints policy and procedure in place.