The inspection was carried out on 27 April 2017 and was unannounced. We returned on 3 May 2017 to complete the inspection.

The home provided accommodation, personal and nursing care for older people. The accommodation spanned two floors and a lift was available for people to travel between floors. There were 38 people living in the home when we inspected. Nursing staff and care staff assisted people to manage chronic and longer term health issues associated with aging or after an accident or illness.

There was a registered manager employed at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

At our last inspection 25 May 2016, we gave the home an overall rating of, ‘Good’, but found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This breach was in relation to Regulation 12, Safe Care and Treatment. Medicine’s records were not always accurate. We asked the provider to take action to meet Regulation 12. The registered manager sent us an action plan telling us the actions they had taken to meet the regulation.

At this inspection, there had been some improvements, but we found recording errors were still occurring. We made a recommendation about this.

Staff received training that related to the needs of the people they were caring for and nurses were supported to develop their professional skills maintaining their registration with the Nursing and Midwifery Council (NMC).

There were policies in place for the safe administration of medicines. Nursing staff were aware of these policies and had been trained to administer medicines safely.

Nursing staff assessed people’s needs and planned people’s care. They worked closely with other staff to ensure the assessed care was delivered. General and individual risks were assessed, recorded and reviewed. Infection risks were assessed and control protocols were in place and understood by staff to ensure that infections were contained if they occurred.

The provider and registered manager ensured that they had planned for foreseeable emergencies, so that should emergencies happen, people’s care needs would continue to be met. Equipment in the home had been tested and well maintained.

Decisions people made about their care or medical treatment were dealt with lawfully and fully recorded. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Restrictions imposed on people were only considered after their ability to make individual decisions had been assessed as required under the Mental Capacity Act (2005) Code of Practice. The registered manager understood when an application should be made.

The registered manager had ensured that they employed enough nursing and care staff to meet people’s assessed needs. A robust agency back up system was in place. The provider had a system in place to assess people’s needs and to work out the required staffing levels. Nursing staff had the skills and experience to lead care staff and to meet people’s needs effectively and the registered manager provided nurses with clinical training and development.

People were supported to eat and drink enough to maintain their health and wellbeing. They had access to good quality foods and staff ensured people had access to food, snacks and drinks during the day and at night.

We observed safe care. Staff had received training about protecting people from abuse and showed a good understanding of what their roles and responsibilities were in preventing abuse. Nursing staff understood their professional responsibility to safeguard people. The registered manager responded quickly to safeguarding conce

This inspection took place on 15 and 16 March 2016 and was unannounced.

Heatherdale Nursing Home provides accommodation for up to 40 people who need nursing and personal care. Communal areas, such as the lounge and dining room are on the ground floor. Bedrooms are over three floors accessed by stairs and a passenger lift. There is a garden to the rear of the building. At the time of our visit, there were 39 people who lived in the home. People had a variety of complex needs including dementia, physical health needs and mobility difficulties.

There was a registered manager at the home. 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.

Medicines were not being administered safely to all people living at the home. Clear and accurate medicines records were not maintained in all instances.

The registered manager had systems in place to manage safeguarding matters and make sure that safeguarding alerts were raised with other agencies. All of the people who were able to converse with us said that they felt safe in the home; and said that if they had any concerns they were confident these would be quickly addressed by the registered manager.

The home had risk assessments in place to identify risks that may be involved when meeting people’s needs. The risk assessments showed ways that these risks could be reduced. Staff were aware of people’s individual risks and were able to tell us about the arrangements in place to

manage these safely.

There were sufficient numbers of qualified, skilled and experienced staff to meet people’s needs. Staff were not hurried or rushed and when people requested care or support, this was delivered quickly. The provider operated safe recruitment procedures.

Staff knew each person well and had a good knowledge of the needs of people who lived at the home. Training records showed that all staff had completed training in a range of areas that reflected their job role. Nurses were given training suitable for them to validate their ongoing registration as a nurse. Staff told us that they had received supervision and appraisals were on-going.

Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 to ensure any decisions were made in the person’s best interests. We found the home to be meeting the requirements of Deprivation of Liberty Safeguards.

The food menus offered variety and choice. They provided people with nutritious and a well-balanced diet. The cook prepared meals to meet people’s specialist dietary needs.

People were involved in their care planning, and that staff supported people with health care appointments and visits from health care professionals. Care plans were amended immediately to show any changes, and care plans were routinely reviewed every month to check they were up to date.

People were treated with kindness. Staff were patient and encouraged people to do what they could for themselves, whilst allowing people time for the support they needed. Staff encouraged people to make their own choices and promoted their independence.

People knew who to talk to if they had a complaint. Complaints were managed in accordance with the provider’s complaints policy.

People’s needs were fully assessed with them before they moved to the home to make sure that the home could meet their needs. Assessments were reviewed with the person and their relatives. People were encouraged to take part in activities and leisure pursuits of their choice, and to go out into the community as they wished.

People spoke positively about the way the home was run. The management team and staff understood their respective roles and responsibilities. Staff to

The inspection was carried out by one inspector over a time period of two hours. This was a follow-up inspection. At our inspection in April 2014 we found the service was not meeting all of the regulations in the Health and Social Care Act (2008). The manager sent us an action plan telling us what actions they would take to become fully compliant with the regulations.

Is the service safe?

The service was kept clean and free from infection because the manager ensured that the home was cleaned in a planned way. Staff were trained in infection control and they understood their role in minimising infection risks. People told us that the home was kept clean. People confirmed that staff followed guidance about wearing gloves and other protective equipment when providing personal care.

We received information that one or more of the essential standards of quality and safety were not being met. We visited on 28 March 2014 to ensure that the service was safe and effective.

We spoke with three people who lived at the home, one relative and a visiting professional. They told us they were happy with the care provided by the home. The visiting professional said they had been coming to the home for a number of years and felt the physical health of people living in the home was promoted. The relative we spoke with told us that the care was "Very good really" and they did not have any concerns. One person said "The staff are good to me".

We looked at how the home was meeting the nutritional needs of the people living at the home. We saw people had access to plenty to eat and drink. They were able to make requests if they wished to have an alternative meal. Referrals were made to appropriate professionals if people had difficulty with their swallowing.

We looked at cleanliness and infection control at the home. We found there were some measures in place to ensure infection control was maintained, such as a system for managing laundry appropriately. However some of the bins used for disposing gloves were not suitable, this meant that used gloves were left in open bins. Some staff had recently attended infection control training but other staff had no record of attending this training. Others had not completed the training for several years.

At the inspection conducted on 3 June 2013 we had concerns regarding the storage of confidential records. The manager wrote to us following our inspection to tell us how records were going to be stored securely. We visited the service and found that the manager had completed the action plan and that confidential records relating to individuals living at the service were stored securely.

People told us that they were involved in making decisions in their daily lives and that they were treated with dignity and respect. One person told us that the manager often came to see them and asked them if they were alright and if they needed anything.

People told us that staff understood their individual needs and said they felt well cared for. People said they liked the staff. One person said “I am very well cared for here”.

People spoke highly of the quality of the meals at Heatherdale. Comments made included “The food is good, there is always a choice”.

Medicines were handled appropriately and people were protected against the risk of unsafe management through effective procedures and practices.

We found that the service carried out the appropriate checks on new staff and had effective recruitment procedures in place to protect people living at the service.

We found evidence that when people made a complaint, their complaint was taken seriously and investigated thoroughly. People said they were confident that if they raised a concern it would be dealt with.

We found that whilst records were accurate and kept up to date, they were not stored securely.

We spoke with five people living at the home and the relatives of one person living at the home.

Three people said the food was okay, one said it was “not good” and the other person said they liked the food. None of the people had been asked their opinions about the menus for some time.

The people we spoke with said they liked their rooms and these and the home were kept clean and tidy.

People said that the activities were generally good, and they could take part in the activities that interested them.

One person said “The staff are very nice”. Relatives of a person said that the staff were “pleasant and friendly, and kept them informed of any changes or worries”.

Another person commented that the staff had helped her to settle in, and that they were “helpful and very nice”.

We spoke with seven people who live at the home, five people in some depth. All the people spoken with said they liked living at the home and that they felt their needs were met by the staff.

People had slightly varying opinions about the food, though the majority liked the food, and one person said that improvements had been made recently with food arriving to bedrooms hot and food being better seasoned. Some people said they would like more fresh fruit and vegetables.

One person said they felt safe and in good hands at the home, and everyone spoke positively about the staff. Comments included “they are very helpful”, “we don’t wait long for help, and they seem well staffed”. Two people said that thought the home does not have enough staff on at night, and that on some occasions they had to wait some time before having their call bells answered.

All the people we spoke with said they liked the activities and entertainment provided at the home as it suited their interests. Others who preferred not to take part had their wishes respected.

People said they would talk to the matron if they were not happy with anything and that their recent comments about the food were being acted on.

People said their rooms were kept clean and tidy and that the laundry service at the home was good. People we spoke with liked their rooms and were happy overall with the home.