This inspection took place on 19 April 2018 and was unannounced. This meant no-one at the service knew we were planning to visit. Heeley Bank was last inspected on 13 December 2016 and was rated as 'good' overall.

Heeley Bank 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. Heeley Bank is a purpose built care home that provides both residential and nursing care for up to 67 people. There are three separate units within the home divided into residential care, general nursing care and nursing care for people living with dementia. At the time of this inspection there were 49 people living at Heeley Bank.

The manager had been at Heeley Bank for approximately six months at the time of this inspection. They were in the process of registration with CQC. 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

Medicines were stored safely and securely, however the systems in place to ensure people received their medicines as prescribed were not always followed.

Not everyone we spoke with thought there were enough staff available to ensure people’s care and support needs were met in a timely way. Some people also told us there was a high use of agency staff which meant they did not always receive consistent care and support. We saw the manager had plans in place to recruit to the vacant posts. We recommend they consider the deployment of care staff during busy times, such as meal times and take into consideration what people have said regarding agency staff.

We saw the premises were clean and well maintained and the registered provider had systems in place to reduce the risk of the spread of infections. However, we saw these were not always observed by staff. The manager agreed to remind staff of the importance of wearing personal protective equipment (PPE).

Staff were provided with relevant training to make sure they had the right skills and knowledge for their role. However staff did receive appropriate supervision and regular appraisals to enable them to carry out their role effectively.

We saw staff delivering appropriate care to people even though this wasn’t always reflected in the person’s care record. People’s care records needed updating to reflect their current care and support needs. We saw plans were in place to do this.

People, their relatives and staff were not regularly asked for their views on the service or given opportunities to suggest any improvements.

The quality assurance and audits systems in place to monitor and improve service delivery were not always effective.

The service had up to date policies and procedures which reflected current legislation and good practice guidance. Some of these needed amending to include local contact details.

Staff understood what it meant to protect people from abuse. They told us they were confident any concerns they raised would be taken seriously by the manager.

The registered provider had effective recruitment procedures in place to make sure staff had the required skills and were of suitable character and background.

Staff understood the requirements of the Mental Capacity Act 2005. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The registered provider’s policies and systems supported this practice.

People were assisted to maintain their health by being provided with a balanced diet and supported to access a range of health and social care professionals.

Positive and supportive relationships had been developed

This inspection took place on 8 and 12 December 2016. This was an unannounced inspection which meant the staff and provider did not know we would be visiting. The service was last inspected on 30 July 2015 and was not meeting the requirements of the three regulations; Regulation 12, Safe care and treatment, Regulation 18, Staffing and Regulation 17, Good governance. At this inspection we checked to see if sufficient improvement had been made. We found that sufficient improvement had been made to meet the three regulations.

Heeley Bank Care home is a nursing service that provides care for up to 67 people. It is a purpose built care service. At the time of our inspection 62 people were living at the service.

There was a registered manager at the service. 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.

People told us they felt safe and were treated with dignity and respect. Relatives spoken with felt their family member was in a safe place.

Our discussions with staff told us they were aware of how to raise any safeguarding issues and were confident the senior staff in the service would listen.

People we spoke with told us they were satisfied with the quality of care they had received and made positive comments about the staff. Peoples comments included: “We can always have a good laugh with the staff. I love them,” and “The staff always knock on my door and give a shout before they come in,” and “The staff keep a really close eye on me. It's lovely here.”

Relatives we spoke with made positive comments about the care their family members had received and about the staff working at the service.

Our observations during the inspection told us people’s needs were being met in a timely manner by staff. People told us staff responded to their call for assistance when they used their call bells.

At the last inspection we found the service did not have appropriate arrangements in place to manage medicines, so people were not protected from the risks associated with medicines. We saw that improvements had been made.

Since the last inspection the provider had introduced an electronic medication administration record system in place. We saw that some staff were still adjusting to using the new electronic system and would benefit from additional support and training. We shared this feedback with the registered manager; they assured us that appropriate action would be taken to provide additional support and training to staff.

People and relatives spoken with did not express any concerns regarding the cleanliness of the service. The service was clean and had a pleasant aroma.

We observed staff giving care and assistance to people throughout the inspection. They were respectful and treated people in a caring and supportive way.

Robust recruitment procedures were in place and appropriate checks were undertaken before staff started work. This meant people were cared for by suitably qualified staff who had been assessed as safe to work with people.

There was evidence of involvement from other professionals such as doctors, dentists, opticians, tissue viability nurses and speech and language practitioners in people’s care plans.

Individual risk assessments were completed for people so that identifiable risks were managed effectively. We saw one person’s care plan needed to be more prescriptive and give staff clear guidance on what do if the person was getting agitated. We shared this information with the registered manager, they told us the person’s risk assessments and care plan would be reviewed.

People’s nutritional needs were monitored and actions taken where required. People made positive comments about the food. Preferences and dietary needs were being met.

Staff told us they enjoyed caring for people living at the ser

This inspection took place on 30 July 2015. This was an unannounced inspection which meant the staff and provider did not know we would be visiting. The service was last inspected on 10 June 2014 and was meeting the requirements of the regulations we checked at this time.

Heeley Bank Care home is a nursing service that provides care for up to 67 people. It is a purpose built care service. At the time of our inspection 63 people were living at the service.

There was a registered manager at the service. 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.

There was a calm and friendly atmosphere in the service. The service was clean and had a pleasant aroma. During the inspection we heard people and staff singing along to music.

Most people spoken with told us they were satisfied with the quality of care they had received and made positive comments about the staff. Most relatives spoken with also made positive comments about the care their family members had received and about the staff working at the service.

Our observations during the inspection told us people’s needs were being met in a timely manner by staff. People told us staff responded to their call for assistance when they used their call bells. Some relatives felt the staffing level on the first floor was too low.

We observed staff giving care and assistance to people throughout the inspection. They were respectful and treated people in a caring and supportive way.

People told us they felt safe and were treated with dignity and respect. Our discussions with staff told us they were fully aware of how to raise any safeguarding issues and were confident the senior staff in the service would listen.

The service did not have appropriate arrangements in place to manage medicines so people were not protected from the risks associated with medicines.

Robust recruitment procedures were in place and appropriate checks were undertaken before staff started work. This meant people were cared for by suitably qualified staff who had been assessed as safe to work with people.

People had a person centred care plan in place. Individual risk assessments were completed for people so that identifiable risks were managed effectively. There was evidence of involvement from other professionals such as doctors, dentists, opticians, tissue viability nurses and speech and language practitioners.

People’s nutritional needs were monitored and actions taken where required. Most people made positive comments about the food. Preferences and dietary needs were being met.

Staff told us they enjoyed caring for people living at the service. Staff were able to describe people’s individual needs, hobbies and interests, life history, likes and dislikes. Although staff told us they felt supported, we found that staff had not received regular supervision or an annual appraisal.

People had personalised their rooms and they reflected their personalities and interests. We saw the service promoted people’s wellbeing by taking account of their needs including daytime activities. There was a range of activities available which included: musical bingo, arts and crafts and games. A group of people had gone to a local park on the day of the inspection in the service’s mini bus.

The provider had a complaint’s process in place. We found the service had responded to people and/or their representative’s concerns, investigated them and had taken action to address their concerns. However, one relative spoken with told us they felt their concerns had not been listened to effectively by one of the provider’s senior managers at a recent meeting to discuss a complaint.

Regular residents and relatives meetings were held at the service. However, we noted that people living at the service had not attended the last two meetings so they had not been actively involved. A copy of the latest relatives meeting minutes was available for people and visitors to the service to read. This meant people and their relatives or representatives were kept informed about information relevant to them.

Accidents and untoward occurrences were monitored by the registered manager to ensure any trends were identified. There were systems in place to monitor and improve the quality of the service provided. However, we found some checks were ineffective in practice and required improvement.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we told the provider to take at the back of the full version of this report.

On the day of the inspection an adult social care inspector and a specialist advisor visited the home. We spoke with eight people and two people’s relatives during the inspection. We also spoke with the registered manager, the quality team manager, two nurses, five care workers, two domestic staff and a maintenance worker. We also reviewed a range of records.

We considered all the evidence against the outcomes we inspected to help answer our five key questions; 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?

People spoken with told us staff treated them with dignity and respect. All the people told us they felt “safe” and did not have any concerns. One person commented: “I feel safe when the carers are here”.

We found people were protected from the risk of infection because appropriate guidance had been followed.

The manager operated an effective recruitment procedure and carried out the relevant checks when they employed staff.

Staff had received training in the Mental Capacity Act 2015 and Deprivation of Liberty Safeguards (DoLS).

Is the service effective?

We reviewed five people’s care plans across the three units in the home. There was some variation in the quality of the finer detail in care plan documentation, both between and within the units but we found evidence that care plans and risk assessments had been reviewed regularly. We saw evidence of involvement from other professionals such as doctors, opticians, district nurses, tissue viability nurses and speech and language practitioners.

Is the service caring?

During the inspection we were not able to speak with some people using the service because we were unable to communicate verbally with them in a meaningful way. Therefore we used a formal method to observe people in one of the lounge areas. Staff were respectful and treated people in a caring and supportive way. Staff also explained their actions to people and gained consent.

People told us they were satisfied with the quality of care they had received. They also made positive comments about the staff. Their comments included: “I haven’t any complaints about anything, they [the staff] are very good about everything”, “the staff are very good at looking after you” and “they [the staff] are kind”. People told us that they had choice which included choosing what to eat and where to have their meals.

We spoke with two relatives who were very satisfied with the quality of care their family member had received. They also made positive comments about the staff. Their comments included: “I think they’re [the staff] marvellous, they look after [family member] perfectly, they’re very kind” and “they [the staff] look after every aspect of her care”.

Is the service responsive?

We looked at the service complaints log and we found a comprehensive system in place to respond to complaints. People spoken with told us that they felt ‘safe’ and did not have any concerns about the care they had received or staff. They told us if they had any concerns they would raise these with the staff or the manager or speak to a relative.

People told us that staff responded promptly when they used their call buzzer’s to call for assistance during the day or night. Peoples comments included: “I don’t have to wait long for staff to come when I use the buzzer” and “I ring my buzzer and they [the staff] come very quickly”. However, we found one person did not have a call buzzer in place. We spoke with the quality team manager who told us that all the people living at the home should have access to a call buzzer unless it presented a potential risk to them and assured us this would be put in place.

Is the service well led?

We saw there was a range of quality monitoring checks in place to make sure the manager and staff learned from checks. The manager also completed a monthly accident and incident analysis. This enabled the service to look for any trends or causes.

The provider’s quality team manager regularly visited the home to carry out an audit and produced an action plan for the manager to complete.

The home held regular staff meetings. This helped ensure that key information from all aspects of the service was shared with staff to enable the service to continually improve and reduce the risk of unsafe care and support.

The home held regular resident and relative’s meetings. This showed the home actively sought the views of people or their representatives to improve the quality of service provided.

We spoke with nine people and they told us that they were treated with respect. They told us that their opinions were sought so that they were involved in decisions and that they had choice.

We spoke with one relative and they told us they were very satisfied with the quality of the care that had been provided to their family member.

All the people we spoke with made positive comments about the staff and were satisfied with the quality of care that they had received. Their comments included: “they (staff) are all very different ages and in their own way smashing”, “I feel confident when they move me in the hoist” and “the new manager joins in with everything”.

We found that staff were clear about what their roles and responsibilities were and what action they would take if they saw or suspected any abuse. People told us that they felt "safe" and that they had no worries or concerns. They all said that if they had any concerns or worries they would speak to staff or a family member.

We saw that the service had processes in place to assess and monitor the quality of service provision.

In this report the name of the registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

Some people living at the home had complex needs and were not able to verbally communicate their views and experiences to us. Due to this we have used a formal way to observe people in this review to help us understand how their needs were supported. We call this the Short Observational Framework for Inspection (SOFI).

Throughout the SOFI we saw all staff treat people with respect and courtesy. The atmosphere in the home was relaxed and during our observation we saw frequent positive and friendly interaction between staff and people who use the service. We saw that people who use the service were given choices and supported to make decisions and staff took their time to understand people where they had communication difficulties.

We were able to speak with three people who use the service and a visiting relative. The people we spoke with told us they were very happy at the home and we received comments such as “The staff look after us really well”, “I get muddled sometimes but the staff are very kind and help me” and “The food is really good”.

A relative we spoke with told us they came frequently to visit their relative who was currently residing at the home. They told us that their relative was happy at the home and that the staff were knowledgeable and approachable. They felt they were involved in the care of their relative and staff kept them informed of any changes. They had no complaints or concerns about the care provided.