The inspection of Heath Lodge took place on 28 March 2017 and was unannounced. This inspection was to follow up on actions we had asked the provider to take to improve the service people received.

Heath Lodge is registered to provide accommodation with nursing care for up to 24 people. At the time of our visit, there were 21 older people living at the home. The majority of the people who lived at the home were living with dementia, some have complex needs. The home also provides end of life care. The accommodation is provided over two floors that are accessible by stairs and a stair lift. The service is a detached house with communal lounges, dining room, kitchen and bathroom facilities.

The service had a registered manager in place. 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.

At our previous inspection on 12 April 2016 we found a breach of one of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to take action in relation to the systems in place to assess and monitor the quality of the service provided. The provider sent us an action plan and provided timescales by which time the regulations would be met. They stated that the actions would be completed by 30 August 2016. We also made three recommendations to the provider in regard to infection control, risk management and deployment of staff.

During this inspection we found that improvements had been made and breaches of the regulation were now met.

There had been some improvements to the environment with new carpets and flooring fitted and further improvements were planned. The were arrangements for managing good hygiene and infection control in place. This reduced the risk of cross infections and maintained a clean environment.

Risks to people's safety had been assessed and staff knew what actions to take to minimise these risks.

People received their medicines as prescribed and on time and the storage of topical creams had improved.

Recruitment systems had improved and new staff would all have the necessary checks in place prior to them starting work, which minimises the risk of unsuitable staff being employed.

There were enough staff effectively deployed to meet people’s needs which meant people were assisted with their care in a reasonable time.

People made positive comments about their care, how good the staff were and how much they liked living in the home.

Staff had clear understanding of their responsibilities regarding the Mental Capacity Act or Deprivation of Liberty Safeguards. Where people lacked capacity they were assessed and best interest meetings had taken place when specific decisions needed to be made.

Staff were trained and supervised. A new supervision system was in place to ensure all staff received regular support and supervision, which included clinical supervision for the nurses.

Care plans had improved and although there were further on-going improvements to make the staff could see from these plans what care they needed to give to each person. Staff understood peoples needs and they could describe how people preferred to be helped with their personal and healthcare needs.

People told us that the activities that were provided could be improved. Although activities took place we have recommended that more emphasis is placed in personalising activity and occupation, especially for people living with dementia.

There were quality assurance systems in place, to review and monitor the quality of the service provided. Audits had been carried out and this had led to an action plan to continue to improve the service.

People had enough to eat and drink throughout the day and they w

The inspection of Heath Lodge Home took place on 12 April 2016 and was unannounced.

Heath Lodge Care Home is a care home which provides accommodation and personal care for up to 26 people. At the time of our visit there were 18 people living at the home all of whom were living with dementia. The home is a large detached house with accommodation arranged over two floors. There was no lift and access to the first floor was via a stair lift.

At the time of our visit there was 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.

Quality assurance systems were not robust or effective enough to identify all the shortfalls in the service. These included poor infection control practices, lack of some risk assessments and not all records being up to date and accurate.

Although risk assessments were in place, there were some inconsistencies in the recording of information which could put people at risk of harm. Arrangements in place to identify and support people who were at risk of diabetes or smoking were not up to date or monitored. We found that staff were knowledgeable about people’s needs and risks and what action to take to protect them from these risks. However new staff would not have this knowledge or access to up to date information to provide appropriate and safe care to people. We made a recommendation that the provider reviews risk management and assessments in line with people’s current needs.

There were sufficient staff to provide people’s care needs but the deployment of staff had an impact on the personalised support provided. Although staff were provided in the numbers that had been assessed as needed by the registered manager, staff were very busy, responding and providing care tasks such as personal care to people. We made a recommendation that the provider reassess the way staff are deployed to ensure that people have all of their needs, not just the need for personal care, met.

Although the home was clean, people were not always safe because the processes in place to prevent and control infection were not always followed by staff. We made a recommendation that the provider ensures that staff follow the current guidelines and policies in regard to infection control

People were at risk as information for people with special dietary requirements were not always up to date. Although people had enough to eat and drink throughout the day and night they were not involved and consulted in the development of the menus. We made a recommendation that the provider ensures that specialist healthcare professionals are involved with people who have special dietary requirements.

Staff had an understanding of Deprivation of Liberty Safeguards (DoLS), the Mental Capacity Act (MCA) and their responsibilities in respect of this. Mental capacity assessments were fully completed and DoLS applications had been submitted in accordance with current legislation.

People were cared for by caring staff. People’s privacy was respected and promoted. We saw examples of caring practice from staff. People’s preferences, likes and dislikes had always been taken into consideration and support was provided in accordance with people’s wishes.

People were supported to have access to healthcare services and were involved in the regular monitoring of their health. The home worked effectively with healthcare professionals and was proactive in referring people for treatment.

People told us they felt safe at the home. One person told us, “I feel safe here and the girls look after me and I do not have to worry about anything.” Staff had a good understanding about the signs of abuse and were aware of what to do if they suspected a

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

The unannounced inspection took place on 4 August 2014.

Heath Lodge Care Home is a residential home which provides accommodation and personal care for up to 26 people. At the time of our visit there were 20 people living there. The home provides support to elderly people, some of who are living with dementia. The premises consisted of two buildings, a large detached house with accommodation arranged over 2 floors. People’s rooms were personalised with photographs, pictures and personal items.

Heath Lodge Care Home had a registered manager in post that was a responsible for the day to day running of the home. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

An inspection carried out by an external contractor identified that some of the smoke detectors were not working. These were still not working at the time of our inspection. Further checks raised concerns about a fire exit door and that a fire risk assessment had not been updated since October 2013. People were at risk of harm in the event of a fire as the smoke detection systems did not work.

The provider’s quality assurance checks had not been effective at identifying the problems with the fire safety system. For example the health and safety check had not identified the ongoing issues with the fire safety systems that we found during our visit.

People told us that they felt safe at Heath Lodge Care Home. A person said, “The carers are very good.” Staff had a good understanding about the signs of abuse and were aware of what to do if they suspected abuse was taking place.

People were supported by staff that had the necessary skills and knowledge to meet their assessed needs. Recruitment practices were safe and relevant checks had been completed before staff started work. Staff worked within good practice guidelines to ensure people’s care, treatment and support promoted good quality of life.

People had enough to eat and drink throughout the day and night and there were arrangements in place to identify and support people who needed to be monitored. People were supported to have access to healthcare services and were involved in the regular monitoring of their health. The service worked effectively with healthcare professionals and was pro-active in referring people for treatment.

Staff involved and treated people with compassion, kindness, dignity and respect. People told us, “The care is very good indeed. They are very caring. The staff react as soon as someone needs something.” Staff were happy, cheerful and caring towards people. People’s preferences, likes and dislikes had been taken into consideration and support was provided in accordance with people’s wishes. People’s relatives and friends were able to visit. People’s privacy and dignity were respected and promoted.

The service was organised to meet people’s changing needs. People’s needs were assessed when they entered the service and on a continuous basis.

People told us they would feel comfortable talking to the staff or the registered manager if they were unhappy about anything. People were very positive about the service, one person said “I would give them first place.”

People were encouraged to voice their concerns or complaints about the service and there were different ways for their voice to be heard. Suggestions, concerns and complaints were used as an opportunity to learn and improve the service.

People had access to activities that were important and relevant to them. People were protected from social isolation with the activities, interests and hobbies they were involved with. Staff supported people with their interests and religious beliefs in their local community.

The provider actively sought, encouraged and supported people’s involvement in the improvement of the service. People’s care and welfare was monitored regularly to make sure their needs were met within a safe environment. The provider had systems in place to regularly assess and monitor the quality of the service provided. Management obtained guidance and best practice techniques from external agencies and professional bodies.

People told us the staff were friendly and management were always visible and approachable. Staff were encouraged to contribute to the improvement of the service. Staff told us they would report any concerns to their manager. Staff told us the manager of the service very good and very supportive.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

On the day of our inspection there were 18 people who lived in the home. We spoke to four people, spoke with relatives, staff and healthcare professionals who visited the service. We also observed care throughout the visit.

The people we spoke with were happy living in the home. One said “I am happy here” and another told us “there is nothing I’d change.”

All of the relatives and healthcare professionals we spoke with spoke highly of the home and felt that the people who used the service were well cared for. They told us that their relatives were given choices and encouraged to be independent.

We saw that the home had appropriate processes in place that ensured that the premises were suitable and safe for the people who lived there.

We looked at six staff files and found that the service had good recruitment processes in place that ensured that they employed suitable staff.

The service had systems in place that monitored the quality of the care the service gave. They also identified when things needed to be changed.

People told us what it was like to live in Heath Lodge care home. They described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people in care services were treated with dignity and respect and whether their nutritional needs were met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by an Expert by Experience, who has personal experience of using or caring for someone who uses this type of service.

People using the service said that staff were polite and treated them with respect. They told us that staff knew their needs and how they liked things to be done. One person said, “We [staff and people using the service] all get on very well together” and another told us, “Nothing’s too much trouble for them [the staff].”

People told us that staff were available when they needed them and that they provided good care. One person said, “There’s always someone about if I need them” and another told us, “The staff are all very good.”

People told us that they usually enjoyed the food provided by the home and that they had choice in what they ate and flexibility in when they took their meals. One person said, “The food’s very good here and there’s plenty of it” and another told us, “The food is very good – I’ve got no complaints there.”

People said that they had been asked for their opinions about the food and that they were able to have alternatives if they did not like what was on the menu. Two people who had specific dietary requirements told us that the home were aware of their needs and provided appropriate meals.