This inspection visit took place on 16 October 2018 and was unannounced. It was completed by two inspectors, a nurse specialist and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Heather Vale is a care home registered to support 39 people. 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 accommodation is provided over two floors. On each floor there are two separate units. Each have their own dining facilities and assisted bathrooms. On the ground floor there is a large communal lounge and an accessible secure garden. At the time of our inspection 36 people were living at the home.

There was a registered manager at this location. 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 last inspection we rated the service as ‘Good.’ At this inspection we found some areas required improvement

There were not always enough staff to support the needs of people. Risk assessments had not always been updated or reflected the persons current situation. When people received their medicine support this was completed safely. However, some areas of medicine needed improvement and plans were in place for the training to be completed.

When people were nearing the end of their lives, care plans and assessments did not reflect the support needs the person may wish. Some other care plans were not up to date in reflecting changes in people’s care needs.

People were protected from the risk of infection and staff were observed to use gloves and aprons when supporting people with personal needs or support with their meal. Lessons had been learnt from events which had been used to make changes to drive improvements.

People were supported with activities to pass the day and regular entertainment or days out were planned. The staff worked in partnership with a range of professionals and local contacts. Meals provided people with a choice and supported their nutritional needs.

Complaints had been addressed and the registered manager understood their role in relation to their registration with us. Information was displayed for people and relatives to access, including the displaying of the rating of the most recent inspection.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. Health care had a focus to ensure people’s ongoing wellbeing.

Staff had received training to support their role. In addition, ongoing support was available to staff which they felt was responsive to their needs. Staff had received training in safeguarding and knew how to raise any concerns. When concerns had been raised they were investigated and addressed. The registered manager informed us of events and any actions they had taken.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

This inspection took place 23 March 2016 and was unannounced. The last inspection took place in November 2013 when we found it met all the regulations we reviewed.

The service is registered to provide accommodation with personal care for up to 39 older people. There were 37 people living in the service on the day of our inspection. The service provides care and support for older people, with a range of medical and age related conditions, including mobility issues, diabetes and dementia.

At the time of our inspection there was 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.

People living at the service were safe. The management team and the staff understood their responsibilities in safeguarding people. Staffing levels were assessed to support people’s needs. Pre-employment checks were made before staff started working at the service, to ensure staff were suitable to work with people.

People received care and support from kind, caring and compassionate staff. Staff were responsive to people’s individual need, choice and preferences. Staff were friendly towards people and treated them with respect. We saw and heard a lot of chatting and laughter between the staff and the people who lived at Heather Vale.

Food provided was of a good quality and catered for people’s individual preferences. This included catering for people’s specific health and cultural requirements. Food and drinks were available to people throughout the day and night. The support provided to people with additional needs enabled them to maintain their independence, links to the community and as a result this had a positive impact on their well-being and health.

Staff attended training and used it to effectively support people. The registered manager and staff understood and complied with the requirements of the Mental Capacity Act 2005 (MCA). When decisions had been made about a person’s care where they lacked capacity, these had been made in the persons best interests. The registered manager understood their role in relation to the Deprivation of Liberty Safeguards (DoLS).

The registered manager and the staff clearly understood the needs of people who were living with dementia. We saw the service was undergoing an extensive re-decoration. The re-decoration was designed around providing people with a dementia friendly environment.

The service was well-led. People knew the registered manager and saw them as approachable. The management culture of the service was open and inclusive. People had opportunity to say how they felt about the service and the care being provided. People’s views were listened to and actions were taken in response. The provider and registered manager had systems in place to check on the quality of the service and put measures in place to reduce risks.

On the day of inspection there were 37 people living at the home. We spoke with four of the people who there. One person said, "I'm very happy here; the staff are very nice." Another person said, "The staff are very good". Some people were not able to speak with us due to their needs. We observed the care and attention that they received from staff. All of the interactions we saw were appropriate, respectful, helpful and friendly.

The accommodation was designed and adapted to meet the needs of the people living there and risks within the home had been assessed. The home was clean and was personalised to the people who lived there.

We observed that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Where people did not have the capacity to consent, we found the provider acted in accordance with legal requirements.

We saw that support plans and risk assessments were informative and up to date. Staff we spoke with were aware of their contents, which supported them to deliver appropriate and safe care. The provider had systems in place that ensured the safe receipt, storage, administration and recording of medicines. Accurate and appropriate care records were maintained and stored securely. Staff recruitment systems were robust.

At our visit we spoke with six people using the service, one relative and six staff. People told us about their care and experiences in the home, how they were involved in making choices about their care and how staff treated them.

People said they experienced overall care and treatment that met their needs and rights and they felt their dignity, choice and independence were promoted. All said staff, were respectful towards them. People commented favourably on the standard of their personal laundry service, their environment and cleanliness there and meals provided.

One person said, “Staff know my needs, they are very good.” Another said, “There is always choice of food to suit my dietary needs and if I don’t fancy anything from the menu, they will always make me something else.”

We saw that staff carried out assessments to determine whether there were any risks to people and took action to reduce risks. The assessments included their health related conditions. For example, where there was a risk of falls. We found the provider took account of people’s views and experiences to inform them about improvements in the quality and safety of their service. We also found that staff received appropriate professional development, training and appraisal.

Consent was not consistently obtained to some aspects of people’s care and the correct procedures were not always used to obtain consent to care where they could not make decisions for themselves.

At our visit, three people said they were satisfied with their environment and the cleanliness and tidiness of their own rooms. They said that staff, were usually available when they needed them. One person said,

‘I get the care and support I need,’ ‘Staff all treat me with respect,’ ‘They know what they are doing.’

Two people told us their care plans were discussed with them. Including by way of their care reviews and that they had signed their agreement to these.

One person said group meetings were regularly held with people accommodated, to discuss meals and activities. They also said they were sometimes given questionnaires for their views about the care and services they received. Telling us that the results of these were usually displayed on notice boards around the home.

Another person said the home’s complaints procedure was also displayed.

At our visit people gave us positive examples telling us where their rights to privacy, choice, dignity and respect were promoted. They said they were mostly well supported and consulted with about their individual care and treatment and daily living arrangements. Positive examples given, included for their medicines arrangements, meals and access to recreational and social activities. People said the latter were particularly varied and well organised in consultation with them.

People said they were often asked for their views about the service, by way of individual consultation, surveys and activities meetings and knew how to raise concerns and make complaints. They also said that for the most part they received the care and support needed and were always able to access relevant outside health and social care professionals.

People told us that they often had to wait too long for assistance when requested, advising that this occurred sometimes during the afternoons, but particularly so at night.

We received many positive comments from people, which included,

“Staff are very good and always do their best for me.”

“I have a key worker, who makes sure my care is organised the way I like.”

Most people said they usually enjoyed the food provided, were given the time they needed to eat their meals and were offered regular drinks and snacks between meals. They also said that the home was usually kept fresh and clean, comfortable and well maintained and that they were provided with the equipment they needed to assist in their independence.