We carried out this inspection on 08 and 09 October 2018. The inspection was unannounced.

This service was last inspected in March 2016 and was rated Good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Heathercliffe Residential Care Home is a ‘care home’. 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.

There were 21 people living in the home at the time we carried out our inspection.

There was an experienced registered manager responsible for the day-to-day management of the service. 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 registered manager had been working at the service for over 18 years.

We looked at how the service managed its recruitment of new staff and saw that this was done well and all of the required checks were carried out before staff commenced working at the home.

We spoke with seven people who lived in the home and one relative who all gave positive feedback about the home and the staff who worked in it. They told us that the staff supported people well. We saw that warm, positive relationships with people were apparent and many people described the staff as “like family.”

Staff spoken with and records seen confirmed training had been provided to enable them to support the people with their specific needs. We found staff were knowledgeable about the support needs of people in their care. We observed staff providing support to people throughout our inspection visit. We saw they knew people well and how they liked to be cared for.

We found medication procedures at the home were safe. Staff responsible for the administration of medicines had received training to ensure they had the competency and skills required. Medicines were kept safely with appropriate arrangements for storage in place.

The registered manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they were working within the law to support people who may lack capacity to make their own decisions. We saw that people were supported to make their own decisions and their choices were respected. We asked the home to improve its audit trails of how it supported people with consent and capacity issues.

Care plans were person centred and driven by the people who lived who lived in the home. They detailed how people wished and needed to be cared for. They were regularly reviewed and updated as required. We saw that relatives were very involved in supporting staff to understand how people wished to be cared for.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included regular audits of the service and staff meetings to seek the views of staff about the service. They also regularly spoke with the people who lived in the home. The provider also provided close scrutiny of the service and was a regular presence in the home visiting almost daily.

The inspection was unannounced and took place on the 17 March 2016. The previous inspection was carried out in June 2014, and the service was found to be meeting all the regulations that were assessed.

Heathercliffe Residential Care Home provides care and support for up to 22 people living with dementia, and is located in Helsby, three miles from the town of Frodsham. At the time of the inspection, there were 21 people living within the service.

The manager had been registered with the CQC since October 2010. 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.

Checks were carried out to ensure that the environment was safe. At the time of the inspection, a legionella check had not be completed to ensure that the water supply was safe from contamination, however following the inspection the registered provider provided documentation to confirm that this had since been carried out. Equipment such as hoists and the lift were serviced on a routine basis to ensure they were safe for use.

There were sufficient numbers of staff in place to maintain people’s safety, and recruitment processes ensured that staff were suitable to work with vulnerable people. Staff were subject to a check by the disclosure and barring service [DBS]. The DBS enabled the registered provider to make decisions about whether potential staff were suitable for the role.

People were protected from the risk of abuse. Staff had received training in safeguarding and knew how to report any concerns that they may have. There was an up-to-date safeguarding policy in place, along with a copy of the local authority safeguarding procedure, both of which were accessible to staff.

Some staff had received training in administering medication, and people received their medication as prescribed. People’s medication was stored within a locked trolley which was secured to the wall when not in use. Controlled medications and those that needed to be kept in the fridge were securely stored in a locked office.

Staff had received mandatory training in areas such as the Mental Capacity Act 2005, manual handling and infection control. New staff were supported through an induction process which included a period of shadowing more experienced staff and the completion of mandatory training.

Staff received supervision and appraisals, and team meetings were held periodically. This allowed staff to discuss areas of development, and to voice any concerns with management. It also enabled managers to give updates and share information with staff.

People’s privacy and dignity was maintained. People told us that staff were respectful whilst attending to their needs, and staff were able to give appropriate examples around how they worked to maintain people’s dignity. For example staff told us that they would ensure doors were closed during personal care interventions. Staff spoke kindly to people, and there was a lot of laughter and banter throughout the service.

People’s personal information was stored securely on an electronic system, which was password protected. There was an up-to-date policy in place for staff on keeping passwords secure, and computers were kept in offices which were locked when not in use.

People told us that they knew how to make a complaint and that they felt the registered manager was approachable. The registered provider had not received any complaints, however there was an up-to-date copy of the complaints policy which was available for people and their relatives. The registered provider had received a number of 'thankyou' cards which were on display at the entrance to the building.

People, their relatives and staff all knew who the registered manager was and spoke positively a

We gathered evidence to help us answer our five questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

Below is a summary of what we found.

Is it safe?

We looked at four personal staff files, all of which contained the correct documentation for recruitment. We saw staff files contained evidence that satisfactory Disclosure and Barring Service (DBS) checks were carried out before the staff member commenced employment.

All staff were able to tell us what they would do in an event of witnessing abuse. This included gathering basic information, ensuring people’s safety and informing their line manager, local authority and the Care Quality Commission. All staff were aware of the need to document the incident.

Is it effective?

From discussions with staff and examination of training records we saw that staff were supported by the provider to gain National Vocational Qualifications (NVQ) levels 2 and 3 in social care. Comments from staff included: "I have not worked anywhere else as good as here"; “The manager has such high standards here” and “We are well supported here”. Staff told us that the induction process was sufficient and thorough.

We saw there were sufficient levels of staff to meet people’s needs. Staff were observed being kind and promoting people's independence. The relatives we spoke with commented that staff were always “Polite” and “Friendly”. All five staff that we spoke with said they were happy at the home and felt that the people who lived there all had quality of life.

Is it caring?

We saw people’s needs were taken into account when care plans were developed. We saw several activities were planned such as: days out, games and entertainment. Relatives told us they reflected what the person enjoyed doing. We saw staff were sat with people in the lounge assisting them to knit. Staff told us they always have time to engage with people and do activities. Staff were observed being kind and promoting people's independence.

Is it responsive?

The chef told us that he talked to the people who used the service regularly to discuss what food they would like. We saw clear records of this which were updated regularly. He also explained he was flexible to prepare meals at short notice if a person who used the service wanted something that wasn't on the menu. This meant they were able to be flexible and responsive to people’s needs.

We saw the provider conducted regularly monthly audits or ‘monthly manager reports’ in order to review the service. This included scrutiny of falls, complaints, quality of meals and activities. We were told by the manager she would then act accordingly dependant on what she found. We saw one month a person who used the service suffered several falls and the manager acted by contacting the GP who referred the person to physiotherapy. This meant the service was responsive.

Is it well-led?

The two relatives we spoke to told us the manager was “Very professional” and “Easy to talk to”. Staff said the provider was always obliging with further training and they felt that they had plenty of training to fulfil the duties and responsibilities of the job. All staff told us that she was “Approachable” and they were able to openly discuss issues with her. They also felt she was a “Good leader” and would deal with any concerns promptly.

You can see our judgements on the front page of this report.

We spoke to three people who lived at Heathercliffe and two family members. Comments included:

"There is a lovely atmosphere, the home is well decorated and it is bright"

"There is always a cup of tea waiting" I have no complaints but I know they would sort anything out"

"I can see care plans and I get up to date information"

"It is incredible"

"I feel I have got my relation back"

"We are always consulted"

"My relation is safe here, I can walk away knowing they are looked after"

"I feel safe here"

"They look after us"

"I would not want to be anywhere else"

We found that the care and welfare of people using the service was promoted and this was verified through looking at records, talking to people and observing general routines at the time. We found that people were protected from harm by the policies and procedures in place within the service as well as staff knowledge. We found that the management of medication promoted the wellbeing of people.

Both individuals and relatives were aware of the complaints procedure although no complaints had been received by the service. Records were found to be accurate, up to date and securely stored.

We found that people’s privacy, dignity and independence were respected. People’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care. One person who used the service said, "This is a great place. The food is good. The beds are comfy. We have sing along's."

People experienced care, treatment and support that met their needs and protected their rights. Everyone we spoke with liked living there. One person who used the service said, "We are very well looked after."

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. One person who used the service said, "All the staff are very good. I never knew people were so kind."

There were enough qualified, skilled and experienced staff to meet people’s needs. One person who used the service said, "The staff are lovely", another said, "They are very good. We have no complaints. The food is good. We get plenty of attention."

We found that the provider had an effective system to regularly assess and monitor the quality of service that people receive. The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others. One family member said, "They have been so good to him here. The care is excellent. We are so happy."

When we visited Heathercliffe residential care home we had the opportunity to observe the care that was being given to residents living at the home. This was called a “short observational study”. We saw many examples of good communication and patience by care staff, who interacted with the residents in a positive manner. Staff were warm, friendly and respectful to the people they were supporting.

We spoke with three people who were living in Heathercliffe residential care home and met other residents throughout the day.

One relative was able to tell us that they were very happy with the care and that the standard of care was always very good whenever they visited. They felt that the home was beautifully furnished and always clean and tidy and never had any unpleasant smells.

When we visited we noted that everyone was well dressed and well groomed and most people were engaged in the afternoon activities in the lounge singing, while some people were sat in the conservatory or choosing to walk around the home and the garden.

The manager told us they had recently carried out a survey with residents and their relatives and we looked at a sample that had already been returned.

They contained a lot of positive comments such as:

“can’t be faulted for friendliness of staff,” “hard to say how it could be improved,” “a homely atmosphere.”

We had also contacted the local authority contracts and monitoring team for Cheshire West and Chester before we visited the service. They had no issues of concern to report.