This inspection took place on 17 and 18 July 2018 and the first day was unannounced. Heathside Retirement Home (known as Heathside) is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Heathside is registered to provide accommodation with personal care for up to 30 people. At the time of our inspection there were 27 people living at the home. All rooms are single occupancy with the majority having an en-suite toilet. Since our last inspection in May 2017 the dining room had been moved to the first floor, which reduced the need for people to queue for the lift at meal times and had consequently reduced the number of falls occurring. There are two lounges and an accessible garden to the rear of the property.

At our last inspection in May 2017 the home was rated as requires improvement; there were no breaches of the regulations found. At this inspection we found improvements had been made and the home was now rated as good.

Heathside had a registered manager, who was registered with the CQC in February 2018. 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 quality assurance system used to monitor the service had been strengthened since our last inspection. This helped to improve the performance of the service. Additional monitoring had been introduced including weight monitoring, equipment checks and call bell responses. Weekly and monthly audits were completed. Accidents and incidents were reviewed to assess if there were any patterns across the home. Actions and recommendations, for example from the fire risk assessment or local authority audit, had been implemented.

Infection control measures had been improved and included the management team carrying out daily walk rounds to check the cleanliness of the home.

We observed staff engaging with people throughout the inspection. Staff sought people’s permission before providing support and explained to people the support they were about to provide. People told us the staff treated them with dignity and respect.

We observed safe moving and handling techniques being used; however, on one occasion the available equipment was not used in a timely manner when one person was struggling to stand up.

People’s medicines were administered as prescribed. Care staff added thickeners to people’s drinks to reduce the risk of choking. The registered and assistant managers told us they would introduce a recording chart for this.

Care plans and risk assessments were in place which provided guidance and information about people’s support needs, their likes, dislikes and preferences and how to mitigate the identified risks. Staff we spoke with knew people and their needs well. Care files were reviewed every six months or when people’s needs changed.

Heathside used a care planning system called CareDocs. This added standard prompts to the assessments which were not person centred. The registered manager said they would add the action taken for each individual to the assessments so it was clear what had been done to mitigate the assessed risk. The care plans already included this information.

A pre-admission assessment was completed before people moved to Heathside and initial care plans written. Staff said they received sufficient information about new people’s support needs before they moved in.

Relatives told us they were involved in providing the information for the care plans and the home kept them very well informed of any changes in their relatives’ health or wellbeing.

People were supported with their health

This inspection took place on the 24 and 25 May 2017 and was unannounced. The service was last inspected in May 2016 and was rated as requires improvement.

Heathside is a care home registered to provide personal care with accommodation for a maximum of 30 people. The home has 28 single rooms and one double room. Most rooms have an en-suite toilet. At the time of our inspection 30 people were living at Heathside. The home has three lounges and a dining room. There is a large accessible garden area to the rear of the property.

One of the owners / providers is also the registered manager for Heathside. 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 registered manager was supported by a manager who managed the service on a day to day basis. They had been promoted from deputy manager one month before our inspection. There had been two other managers at the service since our last inspection, but both had left. A training consultant was also employed for four days per week whose role was to arrange staff training and complete staff supervisions and audits of the service.

At the last inspection we found two breaches of the Health and Social Care Act 2008 as not all risks had been assessed and guidance to staff had not always been updated when people’s needs changed. At this inspection we found some improvements had been made.

The new computer system, Care Docs, had been implemented since our last inspection. We saw risks were identified and guidance given to staff to mitigate these risks. Care plans were written in a person centred way and identified the support required to meet people’s health and social are needs. The manager was in the process of reviewing all care plans and risk assessments at the time of our inspection. They then planned to review them every six months or when people’s needs changed.

However we found that action had not been taken when one person was weighed and had lost weight. When the person’s weight was re-checked during our inspection it was found the last reading had been incorrect. A senior carer had now been given the responsibility for ensuring people were weighed, entering the weights into Care Docs and ensuring appropriate referrals are made if people lose weight and their care plans are updated. This should help ensure that action is taken if people lose weight in future.

We also saw that a plan of care for one person who had a skin tear had not been updated when the district nurse and GP had visited. These visits had been noted in the daily record, which meant staff reading the plan of care may not be aware of the visits and any advice provided to the home.

Staff received a handover at the start of each shift. This provided information about any changes in people’s health and wellbeing.

People told us they felt safe living at Heathside and their relatives agreed. People and their relatives said there were enough staff on duty to meet their needs; our observations confirmed this. People said the staff treated them with kindness and respect and knew their needs well. We heard and saw positive interactions between people and staff members throughout the inspection.

A safe system of recruitment was in place. We saw one person had commenced work before the second reference had been received. The registered manager said they had been completing their training and induction by shadowing experienced staff until the second reference had been obtained.

Staff received a range of training, included distance learning through a national college, to meet people’s needs. Staff who were new to care were enrolled on two distance learning courses which met the requirements of the care certificate as part of their inducti

This inspection took place on the 18 and 19 May 2016 and was unannounced.

Heathside Retirement Home was last inspected in February 2015 when it was found to be meeting all the regulations we reviewed.

Heathside is a care home registered to provide personal care with accommodation for a maximum of 30 people. The home has 28 single rooms and one double room. Most rooms have an en-suite toilet. At the time of our inspection 29 people were living at Heathside. The home has two lounges and a dining room. There is a large accessible garden area to the rear of the property.

One of the owners / providers is also the registered manager for Heathside. 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.

A manager was also employed to manage the service on a day to day basis. We were told the manager was in the process of applying to become the registered manager; however at the time of our inspection CQC had not received an application for this.

During this inspection we found breaches of Regulations 9 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because not all risks had been assessed. Guidance for staff to follow had not always been updated when people’s needs had changed. You can see what action we told the provider to take at the back of the full version of the report.

A process was in place to recruit suitable staff; however records of staff recruitment did not fully evidence that the people who used the service were protected from the risks of unsuitable staff being recruited. We found the reasons for gaps in three people’s employment history had not been recorded. The manager told us they would record this information in future.

People told us they felt safe in the service and had no concerns about the care and support they received. Staff had received training in safeguarding adults and knew the correct action to take if they witnessed or suspected abuse. Staff were confident that the provider and manager would act on any concerns raised.

Care staff received the induction, training and supervision they required to be able to deliver effective care. We saw that a training consultant had recently been employed to support the staff with their training requirements. We saw, and were told, the staffing levels were sufficient to meet people’s needs.

We saw that medicines were managed safely. People told us that they received their medicines as prescribed. Protocols were in place to guide staff as to when ‘as required’ medicines were to be administered. We found there were discrepancies in the stock of two PRN medicines. Weekly audits were completed and any issues found were acted upon.

All areas of the home were clean. Procedures were in place to prevent and control the spread of infection. Systems were in place to deal with any emergency that could affect the provision of care, such as a failure of the electricity and gas supply. Regular checks were in place of fire systems and equipment.

People told us they received the care they needed. Care records we reviewed showed that people’s needs had been identified. However, it was not always clear what changes had been made when people’s needs had changed. Records had not been dated to show the most current information for staff to follow. We noted a new computerised care record system was being introduced.

Systems were in place to help ensure people’s health and nutritional needs were met. Records we reviewed showed that staff contacted relevant health professionals to ensure people received the care and treatment they required.

People we spoke with told us that the staff at Heathside were kind and caring. During the inspection we observed kind a

An adult social care inspector carried out this inspection. This was a follow up inspection as the provider had been non -compliant in two outcomes at the previous inspection.

As part of this inspection we observed people who use the service, the registered manager, and three care staff. We also reviewed four care records, daily care records and medication administration records.

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

Is the service safe?

There was a staffing rota in place and staff told us they felt there was enough staff on duty at any time. All staff felt they received plenty of training and felt competent to do their job. A member of staff told us “Yes there are enough staff here.” Medication was managed and administered in a safe and effective manner.

Is the service effective?

People's needs were being met at the home. We found that people's needs were assessed in a timely manner and care files included information about people's diagnosed health conditions and also their preferences.

Is the service caring?

We observed that staff providing people's care were kind and encouraging and spoke to people in a friendly manner.

People appeared to be treated with dignity and the staff could tell us what they were able to do to maintain a person’s dignity. One member of staff told us "I always knock on people's door." One person who lives at the home told us "The staff here are lovely, very friendly."

Is the service responsive?

People’s needs had been assessed before they moved to the home. People’s records identified personal preferences and choices and the support that needed to be provided.

.

Is the service well-led?

Staff felt listened to and supported by their manager. One member of staff told us "The manager is very supportive, you can go to her about anything."

We carried out an early morning visit to Heathside Retirement Home in response to concerns shared with us by Trafford local authority.

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?

This is a summary of what we found-

Is the service safe?

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Suitable policies and procedures were in place and staff had been trained to understand their responsibilities under the DoLS Codes of Practice. Care plans and our observation of staff provided evidence of good practice in applying the least restrictive options to promote each person's autonomy.

Risks relating to care, treatment and support had been appropriately assessed and were being managed well to keep people safe from accidental harm.

Care plans provided evidence of good risk management. For example, information in records provided evidence of staff taking prompt action to prevent people living in the home from accidental injury due to falls.

The home's equipment had been subject to servicing and maintenance at regular intervals.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines. We will revisit Heathside to check that suitable improvements have been made.

Is the service effective?

Staff understood and respected the people they cared for as individuals and provided their care and support in line with each person's choices and preferences.

Systems for dealing with complaints, suggestions and compliments made sure that the views of people using the service and their representatives were responded to by making improvements where appropriate. We saw evidence of this in the action taken to prevent people's clothes going missing in the laundry.

Is the service caring?

People living in the home were provided with stimulating and interesting activities, and care and support was in line with good practice guidelines. We saw staff treating people with respect and compassion. A relative told us, "I have seen them (staff) stop what they are doing to help people who are distressed or upset about something."

The two relatives we spoke with expressed positive feedback about the care provided to people living in the home. One of the relatives told us staff communicated well and were always pleasant and helpful.

Is the service responsive?

People living in the home had their needs assessed and their care plans showed us how staff would provide care and support to meet their needs. Care plans also contained some information about individuals' choices and preferences. One person's health and welfare was placed at risk, because no care plan had been written to tell staff how to provide care and support according to the person's preferences.

People living in the home said that staff were good at responding to their requests for help. Two relatives told us, “There is always a member of staff around if we need to speak to them. We have got no problems with the staff here. They’re very pleasant and extremely helpful.”

Is the service well-led?

The provider told us systems were in place to monitor, audit and review the quality of the service provided by Heathside, although written evidence was not available during our visit.

The management took a positive approach in responding to feedback from people who used the service and their representatives. We saw evidence of the action being taken to learn from incidents and identify where improvements should be made in the best interests of people using the service.

The staff we spoke with said they received good support from the manager. One member of night staff said, "The registered manager always responded in an emergency or if we need assistance or guidance during the night."

We saw care plans contained a signed consent form agreeing to care and treatment. One person who lived at the home told us: “I signed my care plan to show I agreed to it.”

We spoke with six people who lived at the home who were complimentary about the care and the support they received from staff. Comments included: “They asked me what my preferences were.” “I was asked about my likes and dislikes.” “They are lovely, very kind.” “I am really happy here they are marvellous.”

We saw staff using appropriate personal protective equipment (PPE) such as; aprons and gloves. We spoke with staff who told us they always had access to PPE.

We looked at a sample of staff supervision records and saw topics such as policies and procedures, personal development and training, attitude, appearance, safeguarding and dignity were discussed.

We saw the provider used a variety of methods to obtain feedback about the service they offered. These included regular resident meetings and a questionnaire sent to relatives. We spoke with two relatives who told us: “I have completed a questionnaire about what we think of the home.”

During our visit to Heathside we spoke with six people living in the home, two visitors, a social worker, the manager and two members of the care staff.

People who used the service told us that they were treated in a dignified and private manner and that their rights to choice and decision making was maintained. One of the people we spoke with said, "I decide when I go to bed and get up, what I have to eat and what I do during the day" "I can choose where I see my visitors."

People living in the home said that they received the right amount of care and support to meet their needs. They confirmed that they were provided with activities to interest and stimulate them and that their medication was given to them in accordance with their doctor's instructions.

We found that sufficient staff had been provided to ensure that people received the care and support they needed. The people accommodated described staff as kind, caring and considerate and they told us that they got on well with the providers and care staff. One person commented "The staff are very good. They know us well and they work very hard to make sure we get the support we need. They always find time to have a laugh and a joke with us."

The provider had a robust system in place for managing risks in the home and for continually improving the quality of the service provided. A visitor told us "I don't have to worry about my X any more. I know they are in good hands."

People told us they were happy living at the home. We had annonymous concerns rasied about staffing levels and locked emergency exits.