About the service.

Heather View is a residential care home that provides personal and nursing care for up to 74 people. At the time of inspection, 62 people were living at the service. People were aged 65 and over and lived with a range of health and physical health needs including degenerative conditions and dementia.

The building is purpose built over four floors. The reception was on the ground floor and there was a floor for each of the three specialist support units. These are older persons, nursing care and people living with dementia.

People’s experience of using this service:

¿People and their relatives spoke positively about staff and the care they received. People were treated with dignity and compassion by a kind, caring staff and management team who understood people's individual needs, choices and preferences well. One relative said, “Everything is spot on, I couldn’t wish for the care to be better, (name) is happy here and we are delighted with the consistent and high quality of care (name) has received over the years”.

¿The service was homely and welcoming, and people told us that they felt safe. They said that there were enough staff to look after them and they were listened to and treated with kindness. Staff were trained and understood how to report safeguarding or other concern’s they may have.

¿People were involved in decisions about their care and staff sought appropriate consent and asked people what help they needed. People received care that respected their privacy and dignity as well as promoting their independence whenever possible.

¿Training, supervision and observations of staff practice by managers, ensured that staff were competent in their roles.

¿People received their medicines safely including; medicines that were prescribed on an ‘as and when required’ basis.

¿The provider had systems of quality assurance to measure and monitor the standard of the service and drive improvement. These systems also supported people to stay safe by assessing and mitigating risk and ensuring that people’s care was personalised and met their needs.

¿People told us that the meals were very good and there was plenty to eat and drink. The service employed a chef and meals were freshly prepared and cooked. People who had dietary needs such as allergies or required specialist diets were catered for. One relative said, “we bring in a fish and chip supper once a week and eat in the café downstairs which is really nice”.

¿The service was led by a dedicated management team who demonstrated compassion and commitment to the needs of the people who used the service, and the staff who worked for them. The management team worked professionally with other agencies outside of the service and ensured a transparent, honest and open approach to their work.

¿People had access to meaning full occupation and stimulation and there was a varied programme of activities. People told us there was plenty to do, their comments included “sometimes someone comes in with a guitar, the pop violinist gets everybody dancing and I like it when the pets come in”, and “On a Wednesday the toddler group runs in the café, I really enjoy joining the mums and children”. A relative told us “(Name) joins in all the activities; animals come in including chickens, a Shetland pony, a goat, sheep and dogs. There is a choir, exercise class and a church comes in regularly”.

Rating at last inspection:

Good. (Published 21 September 2016)

Why we inspected:

We inspected the service as part of our inspection methodology for ‘Good’ rated services.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The inspection took place on 26 and 28 July 2016 and was unannounced. Heather View is a large purpose built house that provides accommodation and nursing care up to 74 older people, some of whom live with dementia. There were 68 people living in Heather View at the time of our inspection, two thirds of whom lived with dementia.

People were accommodated in three different units. Ashdown unit provided residential dementia care on the ground floor; Broadstone unit provided nursing care and Chelswood unit provided residential care, on the first floor and second floor. These units were connected via stairs and three passenger lifts.

There was a manager in post who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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.

Staff knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or make sure people were protected from harm. Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced.

There was a sufficient number of staff deployed to meet people’s needs. Thorough recruitment procedures in place which included the checking of references.

Medicines were stored, administered, recorded and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records that were accurate.

At our last inspection in July 2015, we had identified shortfalls relevant to laundry processes. At this inspection we found that all necessary improvements had been implemented.

Staff knew each person well and understood how to meet their support and communication needs. Staff communicated effectively with people and treated them with utmost kindness and respect. People were able to spend private time in quiet areas when they chose to.

Staff received essential training, additional training relevant to people’s individual needs, and regular one to one supervision sessions.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people’s freedom had been submitted and the least restrictive options had been considered. Staff sought and obtained people’s consent before they helped them. People’s mental capacity was assessed when necessary about particular decisions. When applicable, meetings were held to make decisions in people’s best interest, as per the requirements of the Mental Capacity Act 2005.

The staff provided meals that were in sufficient quantity and met people’s needs and choices. People told us they enjoyed the food and their meal times. Staff knew about and provided for people’s dietary preferences and restrictions.

At our last inspection in July 2015 we had identified shortfalls in regard to people’s care planning. At this inspection, we found that improvements had been implemented. People’s individual assessments and care plans were person-centred, reviewed monthly or when their needs changed. Clear information about the service, the facilities, and how to complain was provided to people and visitors. Relatives told us that staff and management were “excellent at communication.”

Staff developed a positive rapport with people and placed their wellbeing at the heart of their practice. Great attention was paid by staff to details about how to enhance their comfort and make people’s experience in the home pleasurable. A relative described staff general attitude towards people as “exceptionally caring”.

People were prompt

Because the people using the service had complex needs they were not all able to tell us their experiences. We used a number of different methods to help us understand the experiences of people using the service. These included looking at records, talking to staff and observing care. We also used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We found that the quality of care and support had improved since the new manager started. People were encouraged to be involved in the service and had their assessed needs met. One person commented that they were happy living there.

People liked the food they were offered and were given sufficient amounts to eat and drink. Those people that needed special diets were catered for.

Staff told us that they were supported in their role and had seen improvements in the home over the last two months.

This inspection took place on 9 and 12 June 2015. It was unannounced. There were 57 people living at Heather View when we inspected. People cared for were all older people. They were living with a range of complex needs, including diabetes, stroke and heart conditions. Some people were also living with dementia. Some of the people living with dementia could show behaviour which may challenge others. Many people needed support with their personal care, eating and drinking and mobility needs. The registered manager reported they provided end of life care when required. No one was receiving end of life care at the time of our inspection.

Heather View was purpose-built as a care home. It provided accommodation, treatment and care for up to 74 people, over four floors. Accommodation for people was provided on three floors. The top floor provided accommodation to people who had residential care needs. The second floor provided nursing and care to people who had nursing care needs. The first floor provided care to people who were living with dementia, who had residential care needs. Each floor had its own sitting and dining areas. The ground floor provided further communal areas for people, the offices and support facilities like the laundry. A passenger lift was provided between floors. There was an enclosed garden area, which was wheelchair accessible. Heather View was situated close to the centre of Crowborough. The provider was Care UK Community Partnerships Ltd, a national provider of care.

Heather View had a registered manager. 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 told us they felt there were not enough activities provided. We observed some activities taking place but most of the people, particularly people who did not go out of their rooms, had little to occupy them. People’s care plans relating to activities did not focus on activities which benefited them. Management had identified that action was needed and a new activities worker was in the process of being appointed.

People’s care and treatment plans were mixed. We saw occasions where people’s care needs were not documented and where people’s care plans did not clearly document what their needs were. This meant staff who were unfamiliar with the person would not know about all of people’s needs. Such matters had not all been identified during audit. Other care plans were clear and documented care that staff told us about and we observed being provided.

Many people’s clothes were unmarked so were not returned to them. Domestic workers did not have evidence of regular supervision, so areas for action had not been identified and addressed. Other staff felt supported in their roles by their line manager but said they did not always receive supervision. Each head of department had their own ways of recording supervision so there was not a consistent system, to ensure all staff were received supervision.

All of the staff we spoke with showed a clear understanding of their responsibilities for safeguarding people from risk of harm. Staff also showed a clear understanding of their responsibilities under the Mental Capacity Act 2015 and the Deprivation of Liberties Safeguards.

People said there were enough staff on duty to meet their needs and staff responded quickly when they needed them. The provider had standard systems to ensure prospective staff were fully assessed for their suitability to work with people, prior to employment. Recently employed staff described their induction as “Very effective.” Staff were positive about the training. Staff supported people in an effective, safe way, including people who were living with dementia.

People said Heather View was a caring place. Staff supported people in a caring way, seeking their permission before they supported them and involving them in decisions about how they wanted to be cared for. Staff were always polite to people and clearly knew them as individuals. People’s relatives said they were involved in supporting staff to care for their loved ones and people’s independence was encouraged. Staff practice ensured people’s privacy and dignity.

Heather View had relevant environmental risk assessments. All people also had individual risk assessments to ensure their safety. There were regularly reviewed. Heather View complied with national guidelines when ensuring people’s safety. The registered manager had clear systems for auditing accidents and incidents. They took action where matters were identified.

Heather View had safe systems for administration of medicines. These systems were regularly reviewed and audited, to ensure staff followed the provider’s policies. People said their medical needs were met. A GP said staff worked effectively with them to ensure people’s medical needs were promptly reported to relevant external professionals.

All of the people we spoke with made positive comments about the meals. Meals were attractively presented. People were able to make choices about what they wanted to eat and drink. Staff were readily available to support people with eating and drinking if needed.

The registered manager followed the provider’s complaints policy. Records of complaints were clearly documented, together with actions taken. People and their relatives were regularly consulted about quality of care provision.

People told us they thought Heather View was well managed. The registered manager and provider had established systems for auditing the quality of the service. Where matters were identified, action was taken. For example action had been taken to replace old furniture.

Staff said they were consulted and informed. Regular meetings took place. These were minuted so staff could review matters raised. Staff were aware of Heather View’s managerial structure and aims and values. One member of staff summed Heather View’s values up by saying their role was to “Make sure the care to everyone is person-centred.”