We carried out an unannounced inspection of Heathside Residential Home on 07 and 08 December 2016.

Heathside Residential Home is based in Leigh and is owned by Wigan Council. The home can accommodate up to 30 older people living with a diagnosis of dementia. All bedrooms are single accommodation with 15 providing en-suite facilities. Communal space within the home included two dining rooms, three lounges and a conservatory. A separate hairdressing room is also available. There are two secure central garden areas that are easily accessible from the main building. At the time of the inspection 28 people were living at Heathside Residential Home.

A comprehensive inspection was last carried out at the home on 20 November 2014, when we rated the service as ‘requires improvement’ overall with one breach of the previous regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, this was because the service did not have effective systems in place to assess and monitor the quality of service provision. A focussed inspection was carried out on 22 July 2015 which looked only at the well-led domain and the previous breach in regulation. At that inspection we found the service had made improvements and was meeting all the legal requirements in relation to the regulations.

At this inspection we found the service was still meeting all regulatory requirements and did not identify any concerns with the care provided to people living at the home. However, we have made two recommendations; these are in regards to ensuring the full completion of assessment documentation and the introduction of a supervisions matrix to assist in monitoring the completion of one to one meetings.

At the time of the inspection the home had a registered manager. 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.

We saw the home was clean and had appropriate infection control processes in place. Five domestics were employed, with four working on any one day to ensure the morning, afternoon and evening periods were covered. Cleaning products were signed in and out and checklists were in place to ensure all required cleaning tasks were carried out.

Each person we spoke with told us they felt safe. Relatives expressed no concerns about the safety of their family members and they were complementary about the level of care provided. The home had appropriate safeguarding policies and procedures in place, with detailed instructions on how to report any safeguarding concerns to the local authority. Staff were all trained in safeguarding vulnerable adults and had a good knowledge of how to identify and report any safeguarding or whistleblowing concerns.

We saw the home had systems in place for the safe storage, administration and recording of medicines. Each person kept their medication in a locked cabinet in their bedroom and only staff authorised to administer medicines were allowed access. All people taking medicines had a medication administration record (MAR) in place, which included a photograph to ensure medicines were given to the correct person. During the inspection all records we observed had been filled out correctly and all medicine amounts tallied.

All staff demonstrated a good knowledge and understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), which is used when someone needs to be deprived of their liberty in their best interest. We checked whether the service was working within the principles of the MCA. We found that the provider had followed the requirements in DoLS authorisations and related assessments and decisions had been appropriately taken.

Staff spoke positively about the training ava

We carried out an unannounced comprehensive inspection of this service on 20 November 2014. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Heathside Residential Home on our website at www.cqc.org.uk

This inspection took place on 22 July 2015 and was announced. We called the service one hour before our visit to inform them of our inspection. This was done to ensure the registered manager was working that day as we wanted to discuss the services action plan and the changes made with them. At our inspection on 20 November 2014 we found the service was in breach of regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. This was because the service did not have effective systems in place to monitor the quality of service delivery. We found improvements had been made and the service was meeting the legal requirements in relation to this regulation.

Heathside Residential Home is based in Leigh and is owned by Wigan Council. The home can accommodate up to 30 elderly people with dementia. At the time of our inspection there were 27 people living at the home. All the bedrooms are single with 15 providing en-suite facilities. Communal space within the home includes two dining rooms, three lounges and a conservatory, all of which are suitably decorated and furnished. A separate hairdressing room is also available. There are two secure central garden areas that are easily accessible from the main building.

There was a registered manager in post at the time of our visit. 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.

We found a number of improvements had been made to ensure feedback was received from people living at the home and their relatives in order to monitor the quality of the service provided. Whilst there had not been any residents or relatives’ meetings, the registered manager told us one was booked in for around two weeks after our visit. The service had sent out consultation surveys to people who used the service and their relatives. We were told the findings of the surveys would be discussed at the forthcoming residents and relatives meeting.

The service had sent out questionnaires in relation to meal-times and the food provided. The findings from this had been used to develop a new menu. The registered manager told us a number of other changes had been made as a result of feedback from people, a visit from Healthwatch and as a result of CQCs last inspection. This included new events and activities. A relative we spoke with told us a lot more was now going on at the home.

The audits we looked at had been completed consistently and had identified where actions were required. We saw the service had involved family members and other professionals in carrying out audits of the meal-time. This would help other alternative and new perspectives to help identify where improvements could be made.

The registered manager told us there were no active complaints about the service. We saw the service was now keeping a record of any complaints, compliments or concerns. This provided a summary of any actions taken and who was responsible for providing feedback to the person raising the complaint or concern.

Heathside Residential Home is based in Leigh and is owned by Wigan Council. The home can accommodate up to 30 older people living with a diagnosis of dementia. All the bedrooms are single accommodation with 15 providing en-suite facilities. Communal space within the home included two dining rooms, three lounges and a conservatory. A separate hairdressing room is also available. There are two secure central garden areas that are easily accessible from the main building.

There was no registered manager in place at Heathside Residential Home when we undertook our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. We were subsequently informed that the acting manager had been successful in their application to be manager at the home and that an application to register with CQC would be submitted.

On the 2 July 2014, we conducted an annual scheduled inspection at the home and found the service was not meeting the essential standards. We judged the service had not taken appropriate steps to ensure the care and welfare needs of people living in the home had been effectively met. We issued a compliance action and told the provider to take action to make improvements. We also served a warning notice on the provider as we found people were at risk, because the service did not have appropriate arrangements in place to manage the safe administration of medicines.

During this inspection we reviewed how medication was administered and found people were protected against the risks associated with medicines, because the home had appropriate arrangements in place to manage medicines. However, some improvements were required, as the minimum and maximum temperatures of the medicine refrigerator were not monitored so staff could not be certain that medicines in the fridge were safe to use. Additionally, some people who had been prescribed a painkiller to be taken ‘when required’ were given the medicine regularly. The inspector saw staff give two people a painkiller (prescribed ‘when required’) with their other medicines, without asking if they were currently experiencing pain. This meant people potentially received a medicine they didn’t need.

The service did not have effective management systems in place to monitor the quality of services provided. This was demonstrated by the failure of the auditing process used by the service to identify concerns we established during the inspection. These included the effectiveness of the medication and monthly meal time audits. The service was also unable to demonstrate how they responded effectively to any concerns raised by people who used the service or their representatives. We found no records were maintained of the interaction between management and people or their relatives in response to any concerns raised or of what if any improvements had been made to the service as a result.

This was a breach of Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, because the registered provider did not have effective systems in place to monitor the quality of service delivered.

During this inspection, people told us they felt safe and secure living at Heathside Residential Home. Throughout the inspection we observed staff treating people with respect and dignity. We saw staff supporting people in a sensitive and respectful manner, smiling and encouraging people when undertaking routine tasks such as supporting people with eating and drinking.

We found there were a range of risk assessments in place to keep people safe from harm. These included nutrition; falls; bathing; fire safety and moving and handling. Staff were aware of risks to people and what action was required to keep people safe from harm.

On the whole, we found there were sufficient numbers of trained staff on duty to provide appropriate levels of care and support for the current numbers of people staying at the home on the day of our inspection. Staff and team leaders told us that staffing levels were inconsistent varying from suitable numbers of staff to low levels of staffing. Improvements were required to ensure consistency with suitable staffing levels were maintained on a regular basis.

We found care plans reflected the current health needs of each person. Staff we spoke to were able to demonstrate a good understanding of each person’s needs and the care and support required.

We spoke with staff to ascertain their understanding of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards. We found all staff demonstrated a good understanding of the legislation and had received training which we verified from looking at training records.

We found people who used the service and their relatives were prevented from entering bedrooms at will as doors were permanently locked from the outside. This meant people and relatives had to be escorted to bedrooms and a staff key used to allow entry. One of the implications of continuing to adopt this practice was that people who used the service including their relatives were not able to enter their bedrooms without being unnecessarily restricted.

We discussed our concerns with the acting manager about the restrictive nature of this practice for people who lived at the home. The acting manager assured us that for people who had capacity they would review the policy by consulting with them and their relatives to ensure people fully approved and consented to the arrangement. In respect of people who lacked capacity, we were told that consultation would take place with the Local Authority Lead on the Deprivation of Liberty Safeguards (DoLS) to ensure the suitability of this practice was reviewed.

Improvements were required as both supervision and appraisal were undertaken inconsistently. While most staff confirmed that they had received recent formal supervision, one member of staff stated that had not received any formal supervision for at least eight months.

Improvements were required to ensure people’s needs were effectively met and managed during meal times and that a well organised, calm and relaxed experience was achieved for each person who used the service.

Most of the people who used the service suffered from varying degrees of dementia and were at times confused and disorientated. We found the home did not have the design and signage features that would help to orientate people with this type of need.

We observed staff supporting people in a kind and sensitive manner, laughing, joking and smiling with people who used the service. This included routine tasks such as when toileting and personal hygiene. We noted this was done in a sensitive and discreet manner which respected the person’s dignity and choice. This interaction was typical of the many positive interactions we saw during the inspection.

Care files provided clear instructions to staff on the level of care and support required for each person and included detailed instructions on hygiene and personal appearance, toileting and continence, communication and respect, and mobility and falls. Relatives were able to confirm to us that they were involved in determining and reviewing the care needs of loved ones.

We found no set activity programme in the home on the day of our inspection or very little in the way of mental or physical stimulation for people. We observed people sitting in one of the lounges where the TV was on but none of the residents seemed to be paying attention. We found improvements were required in the way people were stimulated both mentally and physically in order to meet their individual needs.

People told us they thought the home was well run and managed. They were able speak freely to staff and the acting manager about any concerns or issues they had and were confident these matters would be addressed. Improvements were required as it was not clear to us how the home responded to people’s concerns about the service and how improvements were made and recorded.

Heathside Residential Home is based in Leigh and is owned by Wigan Council. The home can accommodate up to 30 elderly people with dementia. At the time of our inspection there were 25 people who were resident at the home.

During our inspection we spoke to six people who used the service, two visiting relatives and one health care professional. We also spoke to 10 members of staff.

At the time of our visit there was a temporary manager in post, however we were informed that the current deputy manager would be applying for registration with CQC as the registered manager.

Our inspection team was made up of an inspector, a pharmacist inspector and an expert by experience. They helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? 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 who used 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?

We found people were treated with respect and dignity by the staff. People told us they felt safe. One visiting relative told us; “I feel X is safe and I have no concerns. The staff are wonderful, really caring and that's all of them.”

Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents. This reduced the risks to people and helped the service to continually improve.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. We found staff had received training in the Mental Capacity Act and were able to demonstrate a good understanding of the legislation. This meant that people would be safeguarded as required.

The service was safe, clean and hygienic.

Equipment was maintained and serviced regularly therefore not putting people at unnecessary risk.

The management set staff rotas and took account of people’s care needs when making decisions about the numbers, qualifications, skills and experience of staff required. This helped to ensure that people’s needs were always met.

Recruitment practice was safe and thorough.

Policies and procedures were in place to make sure that unsafe practice was identified and people were protected.

We found that medication was not managed safely.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the safe administration of medication.

Is the service effective?

We found people’s health and care needs were assessed with them, but they were not always involved in writing their care plans. Some people were not aware of what was in their care plans. Care plans had not been reviewed regularly and were incomplete and did not always reflect the current needs of people who used the service. We found care plans were therefore not able to support staff consistently to meet people’s needs.

People’s needs were taken into account with signage and the layout of the service enabling people to move around freely and safely.

Visitors confirmed that they were able to see people in private and that visiting times were flexible.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring the care and welfare needs of people living at the home had been effectively met.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented; “Staff are A1.” “Carers are very nice.” “Carers are brilliant, how they cope with others I don’t know.” “I can get up and go to bed when I like.” “It’s alright in here.”

Is the service responsive?

People knew how to make a complaint if they were unhappy.

People can be assured that complaints were investigated and action taken as necessary.

We found the service did not seek the views of people regarding the quality of services provided.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had some quality assurance systems, records viewed by us showed that identified shortfalls were addressed promptly.

Staff told us they were clear about their roles and responsibilities and had no concerns about staffing levels.

We visited Heathside Residential Home on 26th March 2014 to follow up on the progress since the provider was issued with a Compliance action about supporting workers at Heathside. Compliance actions are not enforcement action but a precursor to enforcement action and they inform a registered person that they are not compliant with the relevant legislation. This is where a registered person is not complying with a regulation, but people are not at immediate risk of harm, we will use our power under Regulation 10 (3) of the Regulated Activities Regulations to require a report showing how they will achieve compliance and the action they will take to do so.

When we inspected the home on 11th June 2013 we found that the service was not meeting the standards required relating to supporting workers in that several staff had not undertaken mandatory training since 2011. We found that this this could have an impact on the safety for people living at and working in Heathside Residential Home.

When we visited on 26th March 2014 we found that staff had undertaken mandatory training and we were subsequently provided with evidence of this.

During our inspection we met the manager and other staff, and talked to a person living in the home. This person told us that their medicine was always brought to them at the right time. When we watched people being given their medicines we saw that the carer administered medicines in a friendly and confident way. However, carers had insufficient information on how to administer some medicines. Medicines people needed were sometimes out of stock for more than a week. There were also shortfalls in the way medicines were recorded and stored.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We found that people's choices were recorded within the care plans and these were being followed by staff members. We saw the staff members on all units treating people with respect and spending time with people on an individual basis.

We spoke with relatives of people living at the home and they made comments such as "I have no issues with the home,"they look after my relative very well. One person said "The staff are wonderful they look after my relative but also take time to support me in what is a very difficult time."

We saw that staff were interacting well with people in order to ensure that they received the care and support they needed. The relationships we saw were warm, respectful, dignified and with plenty of smiles.

The training matrix demonstrated that several staff had not received mandatory training since 2011and some in 2012.The lack of training made available may mean that staff do not have the necessary skills to adequately care for the needs of people in the home .

We spoke with two visitors during our inspection. They were happy with the service their relatives were receiving and had no concerns. They told us that staff asked them for their consent before they carried out any care and involved them in some care decisions.

The visitors told us they were not aware of any concerns or issues around the administration of medication.

Both visitors were very complimentary of the staff and said they were caring, pleasant and lovely. One person said “The staff always help and maintain a good environment.”

Neither visitor had any concerns or complaints and told us they would speak with the manager if they had any concerns.

Due to the nature of the service, people we spoke with were unable to express themselves fully. We spent sometime talking with the residents who live there who appeared satisfied with the care and support received. Our evidence is therefore based on how people interact with the staff, general observations throughout the visit and discussion with visiting relatives and health care professionals.

Discussion with relatives, staff and visiting health care professional provided us with positive comments on the care and support provided.

We spoke with one relative who confirmed that she is involved in planning her mother’s care. She provided positive comments on the care provided. We were told that she came to have a look around the home prior to deciding to admit her mother and was’ Impressed by the very pleasant staff.’

We spoke with a visiting health care professional who provided positive comments on the home. ‘Staff are very approachable and responsive. The residents appear well cared for and clean.’ The visiting health care professional spoken with also confirmed the good working relationship she has with the staff and management.

We spoke with a relative who confirmed that she is fully aware of how to make a complaint and would approach the manager or staff should she need to.

A relative spoken with confirmed that access is available to health care professionals and the staff do not hesitate to contact them when the residents need it.

Staff spoken with provided positive comments regarding the support and supervision they receive and the management of the home. These comments include: ‘I love it here. I feel I have found my vocation. I have wasted years doing other jobs.’ ‘I enjoy the job. I love coming to work. Really lovely staff group. We provide continuity of care as some staff been here for years.’