This inspection took place on 9 and 16 November 2018 and was unannounced.

Heathfield Lodge is a residential ‘care home’ which provides accommodation and personal care for up to 26 older people, including people living with dementia. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Heathfield Lodge is large Victorian property with accommodation located over three floors. The upper floors are accessible via a passenger lift. There are two dining areas on the ground floor and a large lounge. A garden area is located at the rear of the building and parking at the front. At the time of the inspection 21 people were living at the service.

There was a registered manager in post. A registered manager is a person who has registered with 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. During the inspection we found the registered manager to be open, transparent and receptive to the feedback provided.

At the last inspection which took place in October 2017 we identified breaches of Regulations 12, 17 and 20A of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Heathfield Lodge was awarded an overall rating of ‘Requires Improvement’. Following the inspection, we asked the registered provider to complete an action plan to tell us what changes they would make and by when. During this inspection, we looked to see if the registered provider had made the necessary improvements.

At the last inspection, we found the registered provider was in breach of regulation in relation to ‘Safe Care and Treatment’. Medication management processes were not safely in place and the health and safety of people living at Heathfield Lodge was being compromised. During this inspection we found that the registered provider was no longer in breach of this regulation in relation to ‘Safe Care and treatment’. However, this area of care could be further developed.

We have recommended that the registered provider reviews the medication processes to maintain the level of safe care people receive.

At the last inspection, we found the registered provider was in breach of regulation in relation to ‘Good Governance’. The systems which were in place did not effectively monitor and assess the quality and safety of care people received. During this inspection we looked at the governance systems, audits and checks which were in place and found that improvements had been made. Although the registered provider was no longer in breach of regulation in relation to ‘Good governance’ further developments could be made in relation to this area of care.

We have recommended that the registered provider reviews some of the quality assurance systems to further improve the quality and safety of care being provided.

At the last inspection, we found that the registered provider was in breach of regulation in relation to the ‘display of performance assessments’. The registered provider was not clearly displaying the previous inspection ratings which must be displayed for people, visitors and staff to see. During this inspection we found that the registered provider was clearly displaying the ratings from the last inspection and therefore was no longer in breach of this regulation.

Risk assessments were in place for people who lived at Heathfield Lodge. People’s level of risk was identified from the outset and measures were put in place to keep people safe. Staff were familiar with people’s risks, they told us they received regular updates in relation to people’s health and well-being.

People told us they felt safe living at Heathfield Lodge.

At the last inspection we found breaches of regulation and made recommendations to improve practice. The service was rated as Requires Improvement and submitted an action plan which detailed how the necessary improvements would be made.

This unannounced inspection was conducted on 23 October 2017.

Heathfield Lodge care home provides accommodation and personal care for up to 26 older people. It is a large Victorian property with accommodation located over three floors. The upper floors are accessible via a passenger lift. There are two dining areas on the ground floor and a large lounge. A garden area is located at the rear of the building and parking at the front. At the time of the inspection 23 people were living at the service.

A registered manager was in post. 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.

During the last inspection we found that people’s medication was not always stored and administered in accordance with good practice. As part of this inspection we checked to see if the necessary improvements had been made and sustained. We saw that stock levels were not always accurate, some signatures were missing from administration records, PRN (as required medicines) protocols were missing and the temperatures of the room and refrigerator where medicines were stored were not monitored and recorded.

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

During the last inspection we saw that some fire doors were propped open with chairs while others did not fully close. As part of this inspection we checked to see if the necessary improvements had been made and sustained. We found that some bedroom doors did not have an automatic closure device fitted while other did not close fully. We also saw one bedroom door that was kept open by a footstool. This meant that they would not provide sufficient protection in the event of a fire. Evacuation equipment was insufficient to safely evacuate the building. Some personal emergency evacuation plans (PEEP’s) did not contain sufficient information to inform staff or emergency services of people’s requirements during an evacuation.

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

The ratings from the previous inspection were not displayed as required.

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

We saw evidence that the registered manager and provider conducted regular audits. However, the processes had failed to identify issues picked-up during the inspection. The majority of these issues were identified at the previous inspection and satisfactory improvements had not been made or sustained to keep people safe.

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

Essential safety checks, for example, gas safety and electrical safety were completed in accordance with the relevant schedule by suitably qualified external contractors. There was no evidence that water systems had been flushed or recently tested to reduce risk.

We made a recommendation regarding this.

The provider had not always submitted notifications to the Commission as required.

We made a recommendation regarding this.

At the last inspection we highlighted that evidence of people’s involvement in reviews of care plans was weak. As part of this inspection we looked at care records to see if practice had improved. We saw that some care records did not contain personalised information. For example, about people’s life histories and their likes and dislikes.

We made a recommendation regarding this.

There was a risk th

This unannounced inspection was conducted on 27 September 2016.

Heathfield Lodge care home provides accommodation and personal care for up to 26 older people. It is a large Victorian property with accommodation located over three floors. The upper floors are accessible via a passenger lift. There are two dining areas to the ground floor and a large lounge. A garden area is located at the rear of the building and parking at the front. At the time of the inspection 23 people were living at the service.

A registered manager was in post. However, the registered manager was not available on the day of 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.

As part of the inspection process we were escorted around the building by a senior carer. We saw that some fire doors were propped open with wedges or chairs while others did not fully close.

People were placed at risk of serious injury because staff had not followed a management instruction to keep a door leading to the basement locked.

Water temperatures were not effectively monitored giving vulnerable people access to hot water at excessive temperatures.

Some people expressed concern about the safety of staffing levels at night-time.

We have made a recommendation regarding this.

Staff were safely recruited however, checks on the suitability to work with vulnerable adults had not been updated over a prolonged period. This meant that the provider could not be certain that staff were not barred from working with vulnerable adults.

We have made a recommendation regarding this.

People’s medication was not always stored and administered in accordance with good practice. We spot-checked Medicine Administration Record (MAR) sheets and stock levels. In most cases stock levels were accurate and the MAR sheet completed correctly. However, one MAR sheet indicated a stock balance which was not accurate. We also saw that staff were not counter-signing when controlled drugs were administered. The service did not have protocols in place to instruct staff under which circumstances PRN (as required) medicines should be administered.

People told us that they felt safe living at Heathfield Lodge. Staff were able to explain how they helped keep people safe and made appropriate reference to training, monitoring and safeguarding procedures.

We saw evidence in care records that risk was assessed and regularly reviewed for each person living at the home. Risk was assessed in relation to; nutrition, falls, fire and pressure care.

Staff were trained in a range of subjects which were relevant to the needs of people living at the service including; infection control, administration of medicines and safeguarding adults. We saw evidence of training in staff records which indicated that all training was up to date or had been arranged.

Staff told us that they received regular supervision and appraisal from senior staff or the registered manager. We saw evidence that these meetings had taken place and that important information had been shared.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

The records that we saw demonstrated that the home was operating in accordance with the principles of the MCA. We saw evidence that people’s capacity to consent to care had been assessed as part of the care-planning process. Some peo

As part of our inspection we spoke with five people who lived at the home and a relative who was visiting at the time of our inspection. We invited them to share with us their experience of the care and support provided at Heathfield Lodge.

People were positive about the staff team and the care they received. They told us they could make choices about how they spent their day. One person said, “I can get up and go to bed when I want.” We heard from other people that they could choose where to eat their meals but most people opted to have meals in the dining room. A family member told us, “The family are happy with the treatment [relative] is receiving.”

The staffing levels throughout the day and night had been increased and people were pleased with this change. One person said to us, “There are more staff than there was 12 months ago and they are all very kind.”

Throughout the day we observed staff engaging with people in a kindly manner and involving them in decisions about activity related to their care needs. One person said, “The staff are most kind and will spend time talking with me.”

Effective processes were in place for on-going assessment and monitoring of the quality and safety of the services provided at Heathfield Lodge.

Complaints were managed appropriately to the satisfaction of the complainants.

During our inspection we invited people living at the home to share with us their views and experience of living at Heathfield Lodge.

People told us they were satisfied with the care. They said staff were respectful of their wishes and choices. One person told us, “I am asked to join in activities but if I don’t want to, I don’t have to.” Another person said, “The staff are wonderful and very kind.” Throughout the day we observed staff speaking to, and supporting, people in a respectful and kind way.

People told us they liked the food and got plenty to eat. They said they could choose from a couple of menu options for each meal. People were offered plenty of drinks throughout the day.

Records of care provision were in place for each person. We found that risk assessments had not been completed and care plans had not been developed for people with known risks. An incident reporting system was in place but it was not up-to-date as recent incidents had not been recorded.

Although not fully clear from the record of staff training, staff confirmed they were up-to-date with required training. In addition, they told us they received regular supervision and an annual appraisal.

An effective system for managing complaints was not in place.

The people living at the home that we spoke with were content with the care and support they received. They said staff were available if they needed support. One person told us “The staff are good and you do not need to wait too long if you need something.” Another person said “The staff are kind and helpful”.

Detailed care records were in place. We could see that general assessments, risk assessments and care plans had been developed. They were regularly reviewed to reflect people’s changing needs.

Additional measures had been put in place to ensure the safety of the environment. Effective systems were in place to regularly monitor the quality and safety of care and support provided at the home.

During our inspection visit to the home seven people shared with us their views and experience of living at Heathfield Lodge. People told us that were happy living there and that the staff were pleasant and caring.

One of the people we spoke with said “I like the place, it is very clean.” Another person told us “I get looked after beautifully.” People said that they got support and help promptly and staff were quick to respond when they needed something.

We did not speak with people that use the service as part of the inspection.

People who used services at this home reported positive comments for the care, treatment and support they received. They told us staff were ‘kind’, ‘caring’ they said they felt ‘safe’ and they were ‘well cared for’.

Residents told us they felt ‘safe and well looked after’ at this home.