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

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

Heathside is a two storey care home that provides accommodation and personal care for up to 40 older people, some of who 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 35 people.

There was a registered manager at 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.

During our inspection of Heathside, we observed people living in the home to be appropriately supported by staff who were responsive to their individual needs. People spoken with confirmed they were satisfied with the standard of care provided and appeared relaxed in the presence of other residents and staff.

The service had established a person centred approach to care planning. Holistic assessments of need had been completed for each individual and care plans developed which were tailored to people’s individual needs and 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.

Staff demonstrated a good understanding of people's life histories; needs and their individual requirements and preferred routines. We saw good levels of interaction between staff and people using the service during our inspection. Some interactions we observed and conversations we overheard demonstrated that staff knew people well and that people were on friendly and familiar terms with each other. Staff were seen to be attentive and responsive and took time to respond to people’s requests for help and support during the time we spent in the home.

People had access to health care professionals and medication was ordered, stored, administered and disposed of safely by staff that had received training and completed an assessment of their competency periodically. People also had access to a choice of menu which offered a varied, balanced and wholesome diet.

The manager and staff spoken with demonstrated knowledge and awareness of the principles of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards (DoLs). The provider had ensured all staff had access to training in this protective legislation so they understood the rights of people living in the home and their duty of care in respect of this important legislation.

Staff recruitment systems were in place which offered protection to vulnerable people. Information about prospective employees had been obtained prior to new staff commencing employment.

A comprehensive induction was provided to new staff and a mentorship programme, staff supervision and an annual appraisal system were in place to provide additional support and guidance. Established staff also had access to continuing training and development opportunities to develop their knowledge and competency.

The provider had a quality assurance system in place which was based on seeking the views of people using the service, their relatives and staff. There was a systematic cycle of business planning, action and review and a range of audits had been established to monitor key operational areas. Systems were also in place to safeguard people from abuse and to respond to complaints.

People had access to a range of one to one and group activities that were facilitated by activity coordinators. This is an area that is subject to on-going development to further enhanc

We undertook an inspection of Heathside on 15th April 2014. During the inspection we spoke with the registered manager, four staff, three relatives, a health care professional and seventeen 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).

We were informed that none of the people using the service had been referred for a mental capacity assessment and no applications had therefore been submitted to deprive a person of their liberty.

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 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 which had been stored electronically. Examination of records and / or discussion with staff confirmed staff had undergone a comprehensive recruitment process prior to commencing work with the provider.

A full application could not be located for one employee. We have received assurances from the provider that action was being taken to recover missing records and to audit all personnel files to identify any other gaps.

We noted a number of gaps in one person’s fluid intake / output chart. Likewise, there was an inconsistent approach used by staff to monitor and review care plan records on a monthly basis. Examples were discussed with the manager who confirmed that action would be taken to improve record keeping.

Is the service effective?

We spoke to seventeen people who lived at Heathside during our inspection. Comments received from people using the service included; “The staff are very good and look after you”; “I’m very happy. I can’t fault the way I am cared for” and “It’s a pleasant place to live. I would recommend the home.”

Records highlighted that there had been eight complaints in the last twelve months and that complaints had been listened to and acted upon. No complaints or allegations were received from people using the service or their representatives during our inspection. We have highlighted to the provider the need to ensure the procedure is visible and accessible to people using the service and / or their representatives.

No concerns were raised by the people using the service or their representatives about the meal options, standard of catering or quantity of food provided during our visit. People spoken with informed us they were offered a choice of menu and records of individual choices were available for reference.

Comments received included: “The food is very good. We can choose what we want” and “There are drinks throughout the day and plenty to eat.”

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: “This place is brilliant”; “My mother is very well cared for. I have no concerns”; “The staff are brilliant. They are welcoming and friendly. I can’t fault anything” and “I’m very happy with my observations and the feedback I receive from my relative.”

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.

Is the service well- led?

The provider has worked well with the Care Quality Commission and was 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 had developed systems to involve and obtain feedback from people using the service and / or their representatives.

People using the service at Heathside confirmed that they were treated with respect and their dignity was maintained. People also told us that they were satisfied with the standard of care provided and were of the opinion that staff understood their needs.

For example, comments received from people using the service included; “The girls [staff] work hard and do their very best to look after us”; “The staff are very good”; “I like living here and overall the standard of care is good in my opinion” and “I have only been here a short time but I have always been treated well and have no concerns.”

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 during our visit to Heathside.

Feedback received from the people using the service regarding activities was positive overall however two people expressed concerns as follows. ”I would like to get out more” and “I would like to see more activities. I get tired of watching the televison”. We have asked the provider to take this feedback into consideration in developing the service to ensure best practice.

People using the service at Heathside confirmed that they were treated with respect and their dignity was maintained. People also told us that they were satisfied with the standard of care provided and were of the opinion that staff understood their needs.

For example, comments received included: “I say what I think and I’d recommend this place”; “I enjoy it here. I’m being looked after okay”; “I’d prefer to live in my own bungalow but I realise I can’t anymore. This is therefore the best place I could be”; “I can assure you I’ve no concerns and that I’m being looked after well” and “The care staff are very patient and understand the things I need help with.”

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 during our visit to Heathside.

People spoken with confirmed they had confidence in the staff that provided care. Comments received included: “The girls [staff] are wonderful”; “Staff respond quickly when needed”; “The carers are fabulous” and “The staff treat me like a daughter”.

People living at Heathside who we spoke to during our visit reported that they were treated well by staff. Comments received included; “I like it here. The staff listen and are kind”; “Overall I am very satisfied. I am generally very well looked after and the girls [staff] are great” and “I miss my own home but I can’t grumble about the care I receive.”

People also told us that they were generally satisfied with the standard of care provided and were of the opinion that staff understood their needs. For example, one person told us that; “The staff are pleasant people and do their best to look after us.” Likewise, another stated; “I have no issues. I have everything I want here and the staff help me whenever I need.”