Heathlands Care Home is registered to provide accommodation for up to 63 older people who need support with personal care. On the day of our inspection there were 58 people living at the home.

The inspection took place on the 9 and 10 June 2016 and was unannounced.

There was a registered manager at this home. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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 and their relatives said there was sufficient staff available to support people living at the home safely. They told us staff were caring and promoted people’s independence as much as possible. People told us they were able to maintain important relationships with family and friends. We saw people had food and drink they enjoyed and had choices available to them, to maintain a healthy diet. They were supported to eat and drink well in a discreet and dignified way. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage them. People and their relatives told us they had access to health professionals as soon as they were needed.

Relatives said they felt included in planning for the care their relative received and were always kept up to date with any concerns. Relatives told us an assessment of people’s needs before and when they arrived at the service supported staff to know their family member well and provide the care they needed. People living at the home were able to see their friends and relatives as they wanted. They knew how to raise complaints and felt confident that they would be listened to and action taken to resolve any concerns. We saw the registered manager acknowledged when things had not gone well and put actions in place for improvements.

Staff we spoke with knew how to recognise signs of abuse, and systems were in place to guide them in reporting these. They were knowledgeable about how to manage people’s individual risks, and were able to respond to people’s needs. Staff had up to date knowledge and training to support people. We saw staff treated people with dignity and respect whilst supporting their needs. They knew people well, and took people’s preferences into account and respected them.

The management team had assessed people’s ability to make specific decisions about their daily life when they needed to. They had put in place support for people to ensure decisions were made in a person’s best interest within the legal framework. Staff we spoke with understood how to work with people to ensure they made their own decisions where possible.

People who lived at the home and staff were encouraged to be involved in regular meetings to share their views and concerns about the quality of the service. People and their relatives thought the service was well managed. The provider and registered manager had systems in place to monitor how the service was provided, to continuously improve the quality of care.

We spent time at the home watching to see how staff supported people, and talked with people about life at Heathlands Care Home. We spoke with three people who lived at the home. We also looked at records, and spoke with five staff which included the care staff, maintenance person, the manager and the deputy manager.

We found people who lived at the home were safe because the staff were given clear instructions, support and guidance. People told us they were treated with care and compassion and the staff responded well to their needs. One person told us: “Life is very good here” and “Care is better than I expected.” Another person said that they had: “Absolute confidence in the staff to take care of me.”

We saw positive interactions between staff and people with lots of chatter and laughter during the day with staff helping people to make simple everyday decisions. There were arrangements in place where required, to help people with bigger decisions so that their best interests were upheld.

People who lived at the home told us that care and support was provided by skilled staff who knew them well. There were effective systems in place to ensure staff were suitably trained and supported.

We found that the service was well led. The provider had responsive systems in place to monitor and review people’s experiences and complaints. This meant that positive outcomes for people were continually developed, reviewed and improved upon when needed.

We spent time with the staff member who was responsible for the maintenance of the home environment. They showed us that there were effective arrangements in place that made sure that Heathlands Care Home was a suitable and safe place for people to live.

Sixty two people were living at the home when we visited. We talked with four of them about their experiences of living there. We also spoke with and the manager, assistant manger and two staff.

Some of the people who lived at the home were not able to talk directly with us because of their dementia so we used different methods to see whether they received the care and support they needed. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experiences of people who could not talk with us.

People we spoke with told us that staff treated them with respect and helped them to be as independent as possible. Throughout the day we observed staff supporting people with words of encouragement where needed while completing tasks. We saw that staff took time to speak with people who lived in the home. It was evident that staff had a good rapport with people and that the management team and staff knew people’s likes and dislikes.

The planning and allocation of staff ensured that there was enough staff, with the right skills and experience, to meet the needs of people who lived at the home. At different times during our visit, we observed staff fully engaged with providing care and support to people.

We were told that systems had started to improve and the staff team were working together to make sure people were being given their prescribed medicines.

We did not speak with people about their medicines.

People were protected against the risks associated with the unsafe use and management of medicines by means of making appropriate arrangements for the obtaining, recording, handling, using, safe keeping, dispensing, safe administration and disposal of medicines.

This visit was carried out by a specialist pharmacist inspector as we had received some concerns about an incident in the home that had happened seven months ago, involving medication that the home had not told us about. We were told that due to poor communication the error had not been reported to us at the time of the incident in January 2011. We were informed that many lessons had been learnt from the medicine error and further checks and audits were now in place to prevent it happening again.

We looked at the storage of medicines and a selection of people’s medicine records and care plans. We did not speak with people about their medicines. We found that although there were systems in place to check that people had been given their medicines they did not always identify and prevent medicine errors.