The provider, Care UK Community Partnerships Ltd, is registered to provide accommodation, personal care and/or nursing care for up to 60 older people at Heavers Court. This service specialises in supporting people living with dementia. However, the provider is only contractually obliged by the commissioning local authority to provide personal and nursing care to people. Another organisation maintains the premises and equipment and provides the cleaning, laundry and catering services. Notwithstanding this arrangement, as the registered provider, Care UK Community Partnerships Ltd retains overall responsibility for ensuring all the legal requirements are met in relation to the accommodation, care and support provided to people. At the time of this inspection there were 54 people using the service.

This inspection took place on 17 October 2018. At our last comprehensive inspection of the service in September 2017 we gave the service an overall rating of ‘requires improvement’. This was because the mealtime service was not always tailored to meeting people’s needs. Some aspects of the environment were not tailored to support people living with dementia. At times, there was also not enough for people to do to meet their social and physical needs. We saw the range and quality of activities on offer was variable. Because of the issues we identified, we found the provider and the other organisation did not always work as well as they could to ensure people experienced good quality personalised care that met their needs

At this inspection we found the provider had taken on board our findings from the previous inspection and used this to drive improvement at the service. The provider was now working more proactively with the other organisation to meet the needs of people using the service. Communication between the two organisations about the timings of the meal service was better and meals were served promptly. The registered manager had driven improvements to the presentation and quality of meals so that these were attractive, well balanced and nutritious. Staff supported people to eat and drink enough to meet their needs.

Changes to the environment had been made to make this more suitable for people living with dementia. New flooring was put in to make it easier for people to move freely around. Memory boxes were used to help orientate people to their rooms. New signage was due to go up by the end of the year which would make it easier for people to find their way around the premises.

Activities provision at the service had improved. People had been involved in designing an activities programme that reflected the preferences, choices and needs of people using the service. There was a range of activities and events for people to participate in to meet their social and physical needs. People’s families and friends were encouraged to take part in events and activities at the service to help them feel included in the lives of their loves ones.

Staff continued to be well supported to safeguard people from the risk of abuse and knew when and how to report any safeguarding concerns about people to the appropriate person and agencies. Staff were provided with up to date information about the risks posed to people and knew how these should be managed to keep people safe from injury or harm. The provider used learning from accidents and incidents to take appropriate action when things had gone wrong. At this inspection we saw improvements had been made following an incident involving a person to help reduce the risk of a similar incident reoccurring.

The provider maintained arrangements to monitor the safety of the premises and the equipment. They sought assurances from the other organisation, responsible for the premises and equipment and the cleaning, laundry and catering services, that they had appropriate measures in place to check these aspects of the service did not pose unnecessary risks to people’s safety. The provider’s s

Care UK Community Partnerships Ltd are registered to provide accommodation, personal care and/or nursing care for up to 60 older people at Heavers Court. The service specialises in supporting people living with dementia. However they are only contractually obliged by the commissioning local authority to provide personal and nursing care to people. Another organisation maintained the premises and equipment, provided the cleaning and laundry service and the catering provision. Notwithstanding this arrangement, as the registered provider, Care UK Community Partnerships Ltd retains overall responsibility for ensuring all the legal requirements are met in relation to the accommodation, care and support provided to people. At the time of this inspection there were 58 people using the service.

At the last Care Quality Commission (CQC) inspection in December 2014 the service was rated ‘good’ overall. However in the key question ‘Is it well led? we rated the service ‘requires improvement’. This was because the service did not have a registered manager in post and we identified some concerns about the lack of continuity in leadership at the service and the quality of management communication with staff.

At this inspection we rated the service ‘requires improvement’ overall. The service demonstrated they met the regulations and fundamental standards. But under the key question ‘Is it effective?’ we rated the service ‘requires improvement’. This is because we found the current provision of the mealtime service did not enable staff to tailor this aspect of the service to meet people’s individual needs. We also found some aspects of the environment were not tailored to support people living with dementia.

Under the key question ‘Is it responsive?’ we rated the service ‘requires improvement’. This is because we found, at times, there was not enough for people to do to meet their social and physical needs. We saw the range and quality of activities on offer was variable. Senior managers were already aware that improvement was needed to this aspect of the service and were taking steps to address this at the time of our inspection.

We also rated the service ‘requires improvement’ under the key question ‘Is it well led?’ This is because we found the provider and the other organisation did not always work as well as they could to ensure people experienced good quality personalised care that met their needs. Some aspects of the service provided were not being driven by the needs of people using the service.

We did identify that improvements had been made since our last inspection. A registered manager and deputy manager had been appointed at the service. People, relatives and staff were positive about the managers and said they were open, transparent, accessible and supportive. Staff told us communication with managers had improved and staff were now kept up to date.

Although people said the provision of activities at the service needed to improve, they were generally satisfied with other aspects of the service. The provider maintained appropriate arrangements to deal with people’s complaints and concerns if they were dissatisfied with any aspect of the service.

People continued to be safe at Heavers Court. Staff knew how to protect people from the risk of abuse and followed appropriate guidance to minimise identified risks to people's health, safety and welfare. There were enough staff deployed to keep people safe. The provider had arrangements in place to check the suitability and fitness of all staff to support people.

The provider had arrangements in place to monitor the premises and equipment to check these did not pose unnecessary risks to people’s safety. The environment was clean and clear of slip and trip hazards.

People had a current care plan which reflected their choices and preferences for how their care and support needs should be met by staff. These were reviewed regularly by senior staff. Staff received relevant tra

Heavers Court was divided into six clusters of 10 people with each cluster having its own lounge and kitchen/dining area. One of the clusters was designated for people with dementia who also have nursing needs. We were able to spend varying amounts of time on all of the six clusters.

Heavers Court had a warm, friendly atmosphere with a number of relatives and professionals visiting the home. There were also a large number of support staff who in undertaking their work freed up care staff to undertake work directly with people. In addition, the support staff were generally aware of the needs of people who used the service and were therefore able to engage with them in an understanding and meaningful way.

In total we were able to talk to five relatives who were visiting on the day of our inspection and six people who used the service. On the whole we received some very positive comments, these included, “my mum is very happy here and she never asked to go home”, “this home is fabulous and so are the carers” and “I am happy here, this is a very nice home”.

The people that we could speak to were positive about the care and support they were getting particularly from staff. Comments we received included, “all the girls are good” and the “staff look after you well”.

Using our SOFI we observed staff interaction and saw that people had high levels of well being. Staff knew people well and could anticipate needs, whilst giving options where they could.

Two inspectors visited Heavers Court because of the size and complexity of the needs of some of the people who use the service. The home is divided into six clusters of 10 people with each cluster having its own lounge and kitchen/dining area. One of the clusters is designated for people with nursing needs. We were able to spend varying amounts of time on five out of the six clusters.

Comments from individuals included ‘people here seem to like each other’, ‘I’m quite happy’, ‘they are good here – polite and respectful’, ‘we all get on together’ and ‘I like it’. One individual commented that ‘I do anything I like and go anywhere I like’.

People told us that ‘they look after you’, ‘it’s very good all round’, ‘they make me happy’ and ‘I can’t find no complaints’. Visitors spoken to commented that ‘you won’t find many like this’ and ‘generally speaking, this is one of the best homes’.

All of the people we spoke to said they were treated with dignity and respect by the staff who work at the home. One person told us that ‘they let you do things your way’ and another said that they were ‘well respected’. Comments about staff included ‘there are enough around’, ‘I like the staff’, ‘they seem quite nice’, ‘they are very nice’ and ‘a lot of them work hard’.

Comments about the food included ‘very good’, ‘mostly nice’, ‘it’s alright’, ‘quite good’ and not bad’. One person told us that it was ‘fairly good but not like mum makes’.

We visited Heavers Court on 11 and 12 December 2014. The inspection was unannounced.

The service provides residential and nursing care for up to 60 people with dementia.

The service had a registered manager until 1 December 2014. ‘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 service was in the process of recruiting a new manager.

People at the service felt safe and secure. Staff knew how to recognise and respond to abuse and had completed safeguarding of vulnerable adults training. They knew how to report safeguarding incidents and escalate concerns if necessary. The service provided a safe environment for people, visitors and staff. People’s needs were assessed and corresponding risk assessments were developed. There were sufficient numbers of staff to meet people’s needs. Medicines management was safe. We saw that people were receiving their medicines safely and as prescribed. Improvements were needed to the records of application for topical medicines, such as creams.

Staff had the skills, knowledge and experience to deliver effective care and treatment. Mental capacity assessments had been completed to establish each person’s capacity to make decisions and consent to care and treatment. Where it was necessary to deprive people of their liberty the service had obtained appropriate authorisations under the Deprivation of Liberty Safeguards. People were supported to have a healthy diet and to maintain good health. There were some concerns about choices of meals for people.

People commented positively about their relationships with staff and we observed numerous examples of positive interactions. People and their representatives were supported to express their views and were involved in making decisions about their care and treatment. Keyworkers provided additional support for people. There were meetings for people and relatives where they could express their views and opinions about the day to day running of the home. Staff respected people’s privacy and dignity.

People received personalised care. Care plans were person centred and addressed a wide range of social and healthcare needs. People were involved in the development of their care and treatment. Care plans and associated risk assessments reflected their needs and preferences. People were encouraged to take part in activities which reduced the risks of them becoming isolated, frustrated, bored and unhappy. People were confident that they could raise concerns with staff and those concerns would be addressed.

There were concerns about the number of changes in the management team and the lack of consistency and communication. We were informed that the service was in the process of recruiting a permanent manager. (Since the inspection a manager has been appointed and was in the process of registering with the Care Quality Commission). There was a system of internal and external audits to monitor and assess service provision.