About the service: Heathside Mews is a residential care home in the Penketh area of Warrington. They are registered to provide accommodation and personal care for up to 25 younger people, older people and people living with dementia. At the time of this inspection there were 24 people living there, all of whom were living with dementia.

People’s experience of using this service: People who lived at Heathside Mews told us they were happy and were cared for by staff who were kind and caring.

Without exception, relatives of people who lived there told us they were happy with the care their relatives received.

The service kept people safe with detailed risk assessments and management plans. The staff showed a good understanding of types of abuse, how to spot these and who to report them to.

The service had good infection prevention and control measures. The home was clean and free from malodours.

Staff received comprehensive training and competency assessments.

People were treated as individuals and their privacy, dignity and independence were promoted.

There were dedicated activities staff who devised a varied and imaginative schedule of activities both inside the home and trips out.

The service had close links with the local community and invited people in to engage and interact with people living there who had shared interests.

People living there, their relatives, staff and the local authority all spoke highly of the registered manager. Staff told us they felt supported by a fair and approachable management team.

The registered manager was supported by a deputy manager and team leaders. All worked together to ensure people's care was planned and reviewed with input people and their relatives.

The registered manager maintained complete oversight of the home with a comprehensive quality assurance system.

Rating at last inspection: At the last inspection the service was rated Good (Published May 2016).

Why we inspected: This was a planned comprehensive inspection.

This inspection was unannounced and took place on the 17 June 2016.

Heathside Mews was previously inspected in April 2014 when it was found to be meeting all the regulatory requirements which were inspected at that time.

Heathside Mews is a single-storey care home that provides accommodation and personal care for up to 25 older people that are living with dementia. The home is operated and managed by Warrington Community Living, a registered charity and non-profit making organisation. At the time of our inspection the service was accommodating 21 people.

Resident’s accommodation consists of twenty-five single rooms that have en-suite facilities. The home is equipped with two lounges and a dining area. There is a car park provided for visitors at the front of the home.

At the time of the inspection there was a registered manager at Heathside Mews. 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 our inspection of Heathside Mews we observed people living in the home to be relaxed, content and comfortable within their home environment.

Staff were observed to apply their knowledge and understanding of people’s personalities, preferences, needs and support requirements through positive and meaningful interactions. We also saw that people's choices and preferred routines were respected and that staff communicated and engaged with people in a compassionate and caring manner.

The service had established a person centred approach to care planning. We saw evidence that people had undergone an assessment of their needs and that plans had been developed which outlined what was most important to each person; what staff needed to know or do to be successful in supporting each individual and how to keep the person healthy and safe.

People had access to a range of one to one and group activities that were facilitated by activity coordinators or local church groups.

People had access to health care professionals and medication was ordered, stored, administered and disposed of safely by trained staff that had undergone an assessment of their competency periodically.

People had access to a choice of menu which offered a varied, balanced and wholesome diet.

Staff recruitment systems were in place and information about prospective employees had been obtained to make sure staff did not pose a risk to people using the service.

The provider had developed policies relating to the MCA (Mental Capacity Act (2005) and DoLS (Deprivation of Liberty Safeguards). The registered manager and staff understood their duty of care in relation to this protective legislation and rights of people living in the home.

Audits had been established to monitor the service and systems were in place to safeguard people from abuse and to respond to complaints.

Staff had access to induction, training and supervision to develop the necessary skills and competence for their roles.

We undertook an inspection of Heathside Mews on 23rd April 2014. During the inspection we spoke with the registered manager, four staff, four relatives, a health care professional and thirteen people who used the service. We encouraged the people using the service to participate in our visit using their preferred methods of communication.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• 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. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

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

Is the service safe?

Policies and procedures had been developed by the registered provider (Warrington Community Living) to provide guidance for staff on how to safeguard the care and welfare of the people using the service. This included guidance on the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS).

The registered manager informed us that a mental capacity assessment had been completed for eight of the people using the service for various reasons. Two applications for DoLs authorisations had also been made to ensure the rights of people deprived of their liberty were appropriately protected.

We noted that the provider had written to the local authority to seek advice on the use of a restricted egress system (coded door) which was fitted to the main entrance of the home. This is good practice as the use of this lock could prevent many of the people living at Heathside Mews from leaving the premises without assistance.

Training records highlighted that a number of staff had not completed Mental Capacity Act or Deprivation of Liberty Safeguards training. This has been brought to the attention of the provider so that action can be taken to increase staff knowledge and understanding.

The provider had developed guidance on recruitment and selection to provide information to staff on the procedures for recruiting new employees. We looked at a sample of recruitment records for three staff. Examination of records and / or discussion with staff confirmed staff had undergone a comprehensive recruitment process prior to commencing work with the provider.

Is the service effective?

We spoke to thirteen people who lived at Heathside Mews during our inspection.

Comments received from people using the service included; “I’m happy”; “It’s not a bad place. They [staff] do their best for us” and “It’s ok here but there is no place like home.”

Records highlighted that there had been one complaint in the last twelve months and that the complaint had been listened to and acted upon. This concerned the laundry service and lost items of clothing.

No complaints or allegations were received from people using the service during our visit however two visitors spoken with expressed concern regarding lost laundry. We discussed these concerns with the registered manager who confirmed she had become aware of the issues following recent feedback received from surveys and that further action was being taken in response to the matter.

We noted that people using the service were offered a choice of meals and support was available for people requiring support with eating and drinking. One person reported: “The meals are very nice.”

We noted that appropriate action had been taken to involve specialists such as speech and language therapists and dieticians when necessary, to ensure the changing needs of the people using the service were identified and planned for.

Is the service caring?

We also spoke with the relatives of three people who were supported by the service. All feedback received was positive and confirmed the service was responsive and caring to the needs of the people using the service.

We received comments such as: “Excellent care”; “On the whole the care has been excellent” and “Communication is good.”

Is the service responsive?

Records viewed highlighted that the provider is committed to the inclusion of people in the development and operation of the service. For example, since our last inspection the provider had involved a consultant to assess the service in accordance with ‘Progress for Providers’ (Care Homes). ‘Progress for Providers’ is a nationally well-regarded self-assessment to enable providers to check how they are doing in delivering personalised services to people living with dementia.

At the time of our inspection the service was continuing to introduce a person centred planning model known as ‘essential lifestyle planning’. This model helps to ensure services are responsive to the changing needs and wishes of people who use the service and that they remain central to the care planning process.

We noted that although the home remained in need of redecoration and refurbishment (especially in the main hallway), changes had been made to the information displayed on the walls in corridors to help people orientate around the home more easily.

Is the service well- led?

The provider has worked well with the Care Quality Commission and is aware of the need to keep us updated on any significant events via statutory notifications.

The service continued to utilise a comprehensive internal quality assurance system and has developed systems to involve and obtain feedback from people using the service and / or their representatives.

People using the service at Heathside Mews confirmed that they were treated with respect and their dignity was maintained.

Comments received from people using the service included; “I am keeping very well thanks to the way I am looked after”; “I think the home is a nice place to live and the food is first class” and “it’s okay. The staff are kind and I’ve nothing to worry about”.

Likewise, two relatives reported: “I am very happy with the way the home is run and the care provided to my mother”; “Overall, I am pleased with the care my mum receives but I think an extra member of staff in the afternoon would be beneficial” and “Whenever I call I have always been made to feel welcome and the interaction between staff and residents is good.”

Systems were in place to offer protection to the people who use the service from abuse and people spoken with confirmed that they felt safe and had no concerns regarding the care provided. No concerns, complaints or allegations were received from the people using the service or their representatives during our visit to Heathside Mews.

People using the service at Heathside Mews confirmed that they were treated with respect and their dignity was maintained.

For example, comments received from people using the service and their representatives included: “The staff have all been good to me”; “I’m treated okay. I can’t complain” and “It’s alright and the staff are nice.”

Likewise, comments received from the representatives of people using the service was generally positive and included: “The standard of care provided to my mother seems good”; “I’ve full respect for the staff here. They do a good job and I have no reason to doubt that my wife’s needs are not being met”; “The staff are fantastic” and “The carers are very good.”

One relative reported “I’ve not seen many activities. It would be nice if the people living here had more.” Likewise, another relative raised concerns about missing clothing. Two vistors also queried the staffing levels in the evening. We have raised these issues with the provider so they can review people's suggestions within the service.

Systems were in place to offer protection to the people who use the service from abuse and people spoken with confirmed that they felt safe and had no concerns regarding the care provided. No concerns, complaints or allegations were received from the people using the service or their representatives during our visit to Heathside Mews.

People living at Heathside Mews confirmed that they were treated well by staff. Comments received included; “The staff support me as and when I need help”; The girls [staff] are nice and they listen to me” and “I can’t complain. The staff are great.”

People spoken with reported that they were generally satisfied with the standard of care provided and were of the opinion that staff understood their needs. Comments received included: “I like it here”; It’s a nice place to be” and “The staff are quite pleasant.”

A number of people reported that they did not always have a choice of menu. We asked the manager to review this issue in consultation with the people using the service to reflect people’s needs, values and diversity. The representative of one person using the service also expressed concern about staffing levels and issues with the laundry service.

People spoken with confirmed that they felt safe living at Heathside Mews and were observed to be relaxed in their home environment and in the company of the staff team.