Heathbrook House provides accommodation with personal care for up to 45 older people. There were 36 people living at the home at the time of the inspection. At the last inspection, the service was rated Good. At this inspection the service remained Good.

People told us they were support by the staffing team to remain safe in the home. All staff understood the potential for risk of abuse and told us about how they kept people safe. During our inspection people were supported by enough staff that were available, offered guidance or care that reduced people’s risks. People told us they received their medicines and nursing staff looked after this for them. People were able to request additional medicines for pain relief or other medicines as needed. The nursing team were able to asses and know when a person may need these if they had not been able to communicate themselves.

People told us they received the care needed from care and nursing staff who looked after them well. All staff told us the training was useful in support of their role and understanding the needs of the people they looked after at the home. The nursing staff were supported by clinical supervision and practice discussions.

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 told us there was always a choice of meals and drinks which they enjoyed and kept them healthy. People had access to other healthcare professionals that provided treatment, advice and guidance to support their needs.

People were comfortable with the staff that supported them and chatted happily. All staff knew people’s individual care needs and respected people’s dignity and independence and were considerate when providing care and support in the communal lounges. People received support to have their choices and decisions respected with their day to day care.

People’s care needs were reviewed and assessed regularly and care planned and delivered to meet those needs. People and where requested families had been involved in the planning of their care. Relatives told us they were asked for their opinions and input. Dedicated members of staff offered encouragement and supported for people to be part of the home’s community and offered a variety of things to do.

People had the opportunity to raise comments or concerns and these were addressed. There were processes in place for handling and resolving complaints and guidance was available to people in the home.

The management team were approachable and visible within the home which people and relatives liked. The registered manager and provider had completed regular checks to monitor the quality of the care that people received. Any improvements or changes had been included in the homes improvement plan for action.

Further information is in the detailed findings below.

This inspection took place on 29 July 2015 and was unannounced.

The provider of Heathbrook House is registered to provide accommodation for personal and nursing care for a maximum of 45 people. There were 38 people living at the home on the day of our visit. At the time of our inspection there was no 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. The provider had appointed a ‘relief manager’ to oversee the management of the home until the newly appointed manager started.

When people required assistance they looked to staff to help them. Staff were available when people needed them. However, staff felt they did not always have time to support people when required. The provider and manager were aware that further monitoring was required to ensure that people’s needs were met in a timely way. People received safe care and felt supported by staff who knew how to keep them safe. Staff knew the steps they would take to protect a person from the risk of harm and how to report any concerns. Staff provided people with their medicines and recorded when they had received them.

Staff were confident about how to care for people and that their training and support provided them with the skills needed. Staff listened and respected people’s decisions about their care and treatment. Staff showed they listened and responded to people’s choice to choose or refuse care.

The registered manager had consistently applied the Mental Capacity Act 2005 (MCA). The assessments of people’s capacity to consent and records of decisions had been completed. Where needed staff had followed the legal process when considering a decision where a person had not had the capacity.

People enjoyed the food and had choices regarding their meals. Where people required a specialist diet or wanted a particular choice this had been arranged. People had access to other health and social care professionals to support their health conditions. They had regular visits from their GP when needed and were supported by staff to attend appointments in hospital.

Staff knew people’s care needs and people felt involved in their care and treatment. Staff were able to tell us about people’s individual care needs. People’s dignity had been respected and were supported to maintain relationships with their families who also contributed in planning their care.

The manager was available, approachable and known by people and relatives. Staff also felt confident to raise any concerns of behalf of people. The management team had kept their knowledge current and they led by example. The management team were approachable and visible within the home and people knew them well. The provider ensured regular checks were completed to monitor the quality of the care delivered.

There were 37 people living at Heathbrook House Nursing Home when we carried out our inspection. We looked at how care was provided to people with dementia. We asked staff how many people had a diagnosed dementia. The registered manager told us that 21 people had dementia the majority of whom lived on the first floor known as Willows.

People told us that they were happy at Heathbrook House. One relative told us: “I am very satisfied that the staff here understand my mum’s needs. When she is upset they communicate with patience and in a respectful manner.”

We saw positive interactions between staff and people with lots of chatter and laughter during the day. We saw that staff offered people assistance with their personal care discreetly and people chose what they wanted to do on the day.

We found that before people came to live at the home their needs were assessed by a range professionals alongside a member of the nursing team from Heathbrook House. This ensured that people with dementia had care tailored to meet their individual needs when they came to live at the home.

We found that staff knew the likes and dislikes of people with dementia, and that people's wishes were respected. We saw that staff spent individual time with people and provided care and support in a gentle way when people’s behaviour needed to be supported. This showed that staff had developed positive practices when they supported people with dementia with their emotional and psychological needs.

The provider had responsive systems in place to monitor and review people’s experiences and complaints to ensure improvements were made where necessary.

We observed that there were good relationships between the staff and the people that lived at the home. Staff were friendly and respectful when speaking with people. We saw that staff offered people assistance with their personal care discreetly. Staff offered people choices during the day and these included how they wanted to spend their time.

The people living at the home and relatives that we spoke with told us that they were happy with the standards of care and support from staff to meet their needs.

We observed that there were enough staff to meet people’s care and support needs. The manager explained how they ensured staffing levels met the individual needs of people who lived at the home and told us how they kept these under review.

The quality monitoring processes that were employed in the home ensured people received a good standard of care. We found that improvements had been made following our inspection in January 2012. This included care delivery ensuring people's needs were met in a timely way by sufficient numbers of staff. This showed that where improvements were needed these were listened to with actions taken.

We reviewed all the information we hold about this provider, carried out a visit on 31 January and 1 February 2012, observed how people were being cared for, looked at records of people who use services, talked to staff, people who use services and visiting relatives.

We carried out this review to check on the care and welfare of people using this service. We looked at information we have received about this provider since our last visit in November 2011.

We checked the systems for the planning and delivery of care and we identified improvements. However there are still gaps in some of the records and some people still experience delays in having their needs met. This means that people may be at risk of not getting the care they need when they need it.

We spoke with a range of people whilst at the service. Staff told us that there had been improvements in the staffing levels since the last visit. People who lived at the service told us staff supported them when they needed it. Relatives told us they had noted a range of improvements but were still concerned about consistency and the level of activity available.

Staff told us that although the staffing levels had improved they could do with more staff. The manager assured us that a full review of people’s dependency levels would be undertaken to try and determine staffing levels. We found that whilst there had been a number of improvements further assurances are needed that staffing levels and staff skills are fully addressed to meet the needs of people with dementia, before the service can be judged compliant.

We reviewed all the information we hold about this provider, carried out a visit on 18 November 2011, checked the provider's records, observed how people were being cared for, looked at records of people who use services, talked to staff, and reviewed information from stakeholders.

Some people who use the service were not able to express their views to us, so we observed the care being provided throughout the visit. We found that some people received care which was unsafe and put them at risk of harm. For example, staff did not use safe techniques when supporting people to move from one area to another. Medication was not managed safely, and this meant that some people had not received their medication as prescribed.

A relative told us there was not enough staff who understood the needs of people with dementia and that people on the upstairs unit were being ‘overlooked’. One relative told us that their family member had unexplained bruising and was concerned about the safety of medication.