This inspection took place on 21February 2017 and was unannounced.

Heatherdene Residential Care Home is registered to provide accommodation with personal care for up to a maximum of 20 people. There were 20 people living at the home on the day of our inspection. Some people were living with dementia.

At the last inspection on 19 April 2016 we identified that improvements were needed regarding all five of the key questions. We identified breaches of Regulations 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider sent us an action plan telling us what they would do to make improvements and meet legal requirements in relation to the law. We found at this inspection the provider had taken most of the necessary measures to ensure the quality of care people experienced had improved.

A registered manager was in post and present throughout this inspection. 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 received support with their medicines from staff who were trained to safely administer them. Medicines were locked away safely and in accordance with their individual risk assessments.

People were safe as staff had been trained and understood how to support people in a way that protected them from harm and abuse. People’s records had individual assessments of risk associated with their care. Staff knew what to do in order to minimise the potential for harm.

People were supported by enough staff to safely meet their needs. The provider now followed safe recruitment practices and completed checks on staff before they were allowed to start work. The provider had systems in place to address any unsafe staff practice including retraining and disciplinary processes if needed.

People received care from staff that had the skills and knowledge to meet their needs. New staff received an introduction to their role and were equipped with the skills they needed to work with people. Staff attended training that was relevant to the people they supported and any additional training needed to meet people’s requirements was provided.

People’s rights were protected by staff who were aware of current guidance and legislation directing their work. People were involved in decisions about their care and had information they needed in a way they understood.

Staff received support and guidance from a registered manager who they found approachable. People and staff felt able to express their views and felt their opinions mattered. People had good relationships with the staff who supported them. People’s likes and dislikes were known by staff who assisted them in a way which was personal to them.

People had their privacy and dignity respected by those supporting them. People had access to healthcare when needed and staff responded to any changes in needs promptly. People were supported to eat and drink sufficient amounts to maintain optimum health.

The registered manager had started to do more regular quality checks of the service. The provider engaged more with people and their families at their visits to the service. The provider encouraged feedback from people in order to improve the service. People felt confident they were listened to and their views were valued. The registered manager acknowledged the need to sustain improvement of the record keeping and imbed management practice consistently.

The inspection was carried out on 19 April 2016 and was unannounced.

Heatherdene residential care home is registered to provide accommodation with personal care for up to a maximum of 20 people. There were 18 people living at the home on the day of our inspection. Some people were living with dementia.

There was a registered manager in post who was present during the inspection. 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 home was last inspected on 15 June 2015 where we gave it an overall rating of requires improvement. We had identified that the provider was in breach of Regulation 11, 12, 17 and 18 of the Health and Social Care Act 2008(Regulated Activities) Regulations 2014. The breaches related to a failure by the provider to ensure people’s ability to make decisions had been properly assessed. The premises were unsafe for their intended purpose and were not used in a safe way. The quality assurance monitoring systems in place were not robust enough to ensure people received a safe and effective service. The provider had failed to ensure that all staff were competent and skilled or that staff received suitable training, supervision and induction. We asked the provider to make improvements to the environment and staff practice. The provider sent us an action plan detailing what action they had and proposed to take to address the concerns raised.

At this inspection we found that some improvements had been made. The restrictors on the windows had been repaired and electrical improvement work had been completed. Staff had received training on the Mental Capacity Act and the provider was no longer in breach of Regulation 11 of the Health and Social Care Act 2008(Regulated Activities) Regulation 2014. However we found further improvement were still needed.

The leadership was not effective, while people and staff felt that they could approach the registered manager for support, areas of concerns were not always acted upon in a prompt or appropriate manner. People were not always protected from harm because not all staff had received training to help people move around the home safely. While there was secure storage for cleaning products, staff did not always lock hazardous products away after use. People were placed at risk because safe recruitment procedures were not followed. Checks of the environment were not regularly completed and concerns were not always reported or rectified.

People were not always kept warm and comfortable. People were not always involved in decisions about their care or support and their preferences were not known or respected. People told us they were not always given choice about what they wanted to eat. They did not know they could ask for alternatives if they did not like what was being served.

People told us there was a lack of stimulation. People were not always consulted about their interests and hobbies or about changes that were made in the home.

People received their medicine when they needed it. Staff made sure medicine was given to people safely and maintained accurate records. People were able to see health care professionals as and when needed.

People told us that staff asked their consent before supporting them and respected their wishes when they declined support. Where people were unable to make decisions for themselves we saw that decisions had been made in their best interest. People were supported by staff who were respectful and kind. People were supported by staff who knew them well and who had access to up to date information about their needs.

There was a complaints process in place and people and their relatives felt comfortable to raise complaints with staff or the registered

This inspection took place on 15 June 2015 and was unannounced.

Heatherdene Residential Care Home provides accommodation and personal care for older people and people living with dementia for a maximum of 20. On the day of our inspection 18 people were living in the home.

The home had a registered manager in post who was present for our inspection. 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 previous inspection in May 2014 people’s health was compromised by poor hygiene standards within the home. The provider had taken action to address this and an infection prevention and control lead was in place to promote hygiene standards. Cleaning schedules had been put in place to drive improvements but these were not always completed to show that the tasks had been carried out. The provider was also required to take action to improve the environment. They sent us an action plan in June 2014. At this inspection we found that not all the required improvements to the environment had been made.

The provider’s recruitment procedure was not always followed and this meant that staff may not be suitable to work in the home. The management of medicines was not robust to ensure people received their medicines properly.

People told us that they felt safe living in the home and staff knew how to keep them safe. Staff had access to various risk assessments that told them how to care and support people safely. People told us that they did not have to wait a long time for support and we saw that staff were always nearby to assist them when required.

The manager had limited understanding of the Mental Capacity Act 2005. Where people lacked mental capacity to give consent to their care and treatment, arrangements were not in place to ensure decisions made on their behalf were in their best interests.

People told us that the meals were good but they were not provided with a choice. People told us that they were able to see their GP when needed and they had access to other healthcare professionals when required.

People were not involved in discussions about their care and treatment but they were satisfied with the care and support they received. People told us that staff respected their right to privacy and dignity.

People had limited access to social activities and the provider had not explored people’s hobbies and interests or provided support to enable them to pursue this. People told us that they were unaware of the provider’s complaint procedures but were confident to share their concerns with staff or the manager.

The provider took no action to address the breach of regulation from our last inspection. The leadership within the home was not effective and staff lacked support and supervision to carry out their roles. People who used the service were not involved in the quality monitoring of it and had no say in how the service was run.

You can see what action we told the provider to take at the back of the full version of the report.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

We spoke with two people who used the service who told us that they felt comfortable and safe within their home. However, we found that the environment was unsafe and could place people at risk of harm. For example, we saw that a bedroom that was occupied, the door handle was missing which could lead to entrapment. The registered manager told us that the handle had been removed three days ago because it had broken. We saw that cords from sash windows were missing and the registered manager was aware of this. We saw fire doors wedged open throughout the home. Cleaning chemicals were not securely stored and for people who lacked capacity due to their mental health, this could place them at risk of harm.

At our previous inspection on 13 June 2013, the provider was found to be non-compliant with the regulation relating to cleanliness and infection control. At this inspection we found that the cleanliness of the home remained unsatisfactory. The registered manager said that they were the nominated infection prevention and control (IPC) lead. An (IPC) lead is responsible for processes in place to reduce the risk of cross infection and the cleanliness of the home. The registered manager confirmed that there were insufficient staff hours to maintain the cleanliness of the home. This meant that people were placed at risk of cross infection.

Is the service effective?

The registered manager said that a needs assessment was carried out before people were admitted to the home and this was confirmed by a visiting relative. This meant that people could be confident that their assessed care needs would be met when they moved into the home.

We spoke with two people who used the service who confirmed that they were satisfied with the care provided to them. We found that staff had access to detailed care plans that told them about people's needs and how to meet them.

We found that people were provided with support to take their prescribed medicines. However, medication systems and practices needed to be reviewed to ensure that they were entirely robust. For example, one medication administration record (MAR) showed that medicines had been administered but we found that they had not. This meant that the person did not receive their prescribed treatment.

We observed a number of shortfalls during this inspection that could have a negative impact on people's safety. The registered manager was aware of these shortfalls. For example, we saw that a number of single pane windows were cracked and these were accessible to people who used the service. However, no action had been taken to reduce the risk to people.

Is the service caring?

We spoke with two people who used the service who told us that they were happy living at the home. One person said, “It’s alright living here, it’s nice here.” We found that staff had access to detailed care plans that told them about people’s assessed needs and how to meet them. The registered manager told us that where possible, people or their family were involved in their care planning and this was confirmed by a visiting relative. This meant that people would receive care and treatment the way they preferred.

We observed that staff were attentive to people’s needs. For example, we saw that one person was distressed and saw a care staff reassure them. We saw that risk assessments were in place to promote people’s health and wellbeing. For example, one risk assessment provided staff with information about how to prevent pressure sores and the appropriate equipment needed. We observed that this equipment was in use. This meant that people could be confident that efforts would be made to ensure their skin integrity.

Discussions with the registered manager and the care records we looked at confirmed that people had access to relevant health care services when needed. Access to these services ensured that people’s mental and physical healthcare needs would be met.

Is the service responsive?

We saw that one person used a household device to assist with their mobility. Discussions with the registered manager and the care records we looked at confirmed that this person had not been referred to an occupational therapist. Access to an occupational therapist would ensure that the person was equipped with an appropriate walking aid to safely promote their independence.

We found that the registered manager was aware of shortfalls identified at this inspection but had not taken action to address these and ensure people’s safety.

Is the service well led?

We spoke with two people who used the service and two visiting relatives who confirmed their satisfaction with the care and treatment they had received. We found that the registered manager had a good understanding of people’s assessed needs and had an auditing system in place to ensure people received appropriate care and treatment.

The registered manager told us that staff meetings were carried out and this was confirmed by one care staff. Access to these meetings ensured that staff were aware of changes to policies and procedures that could affect the service provided to people.

The registered manager informed us that quality assurance questionnaires were given to people who used the service to obtain their views and comments about their experience of using the service. One person who used the service confirmed that they had completed this questionnaire. This meant that people were encouraged to be involved in the running of the home.

There had been significant improvements to the décor of the building since our last visit. All of the communal areas of the home had been redecorated. There was also new furniture, curtains and lighting. One person living in the home told us, “It’s really posh now”.

People we spoke with were happy with the service they received. Their comments included, “It’s very good”, “I like it here” and, “I’m happy here”.

The staff we spoke with were happy in their work and told us that they were well supported by the management.

We found that the staff gained consent from people in relation to the care and support provided to them.

We found that care plans were comprehensive and up to date. Staff told us that they gave them all the information they needed to provide consistently good care. We saw care being delivered with kindness and sensitivity.

However, we saw several instances of poor practice in relation to cleanliness and infection control that needed to be addressed to ensure people were protected from the risk of infection.

We reviewed all the information we hold about this provider, carried out a visit on 17 May 2012, observed how people were being cared for, looked at records of people who use services and other records relating to the running of the home. We talked to five people who live at the home, one relative, four staff and the manager.

All the people spoken with were satisfied with the care they received from staff. One person told us that staff were ‘”very kind” and they felt well looked after at the home. Another person told us that they had received considerable support from staff and described them as “marvellous”.

A relative spoken with was satisfied with the care their relative receives and described the manager and staff as welcoming and approachable.

Everyone living at the home had a care plan tailored to their individual needs which gave guidance and advice to staff on how to support people.

The home dealt with any safeguarding issues promptly but did not have copies of the relevant documents which provide advice and guidance for staff.

Improvements need to be made in relation to infection control practice to make the risk of cross infection is reduced. Some of the issues indentified were to do with the lack of ongoing investment and maintenance of the home.

The home was clean, but untidy in some areas. Some areas had an unpleasant odour. Some areas of the home were adequately maintained but some areas needed redecorating and refurbishment. Equipment necessary for the running of the home was not maintained or replaced when broken.

A staff training programme was in place and staff were supervised to make sure that they worked in line with the homes expectations and values.

There were some systems in place to monitor the quality of the service, including seeking the views of people who live there.

Records were not all kept in a way that maintained people’s confidentiality. Some records were not completed and others not reviewed when people’s circumstances changed. Improvements were needed particularly in relation to completing risk assessments and making sure that they are up to date.