About the service:

Heffle Court is a residential care home. There were 37 people living there at the time of the inspection. The service specialises in providing nursing and care to older persons who are living with dementia, some of whom may show challenging behaviours. Some of the people were also living with a range of care needs, including arthritis, diabetes and heart conditions. Most people needed support with their personal care and mobility.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

People’s experience of using this service:

• Staff had a good understanding of the risks associated with the people they supported. Risk assessments provided further information for staff. People were protected from the risks of harm, abuse or discrimination. Staff ensured they considered a range of areas to reduce people’s risk of harm. This included making sure people’s arms were fully protected when moving people using hoist slings and by making sure people sat on their own pressure relieving cushions in the lounge.

• If a person did have an accident or was involved in an incident, records were clear and, where relevant, there was 24-hour follow-up to review how they were.

• People were supported to take their medicines when they needed them. Records relating to medicines were clear, this included where people where prescribed medicines like Warfarin, where the dose can vary over time.

• There were enough staff on duty to ensure people received the support they needed. For example, the activities worker told us there were enough staff deployed to ensure people received the support they needed when they took people out on trips in the service’s minibus.

• Staff were supported and provided with the skills they needed to meet people’s needs, this included recent training in reporting and recording skills.

• People were supported in the way they needed to eat and drink. All meals, including liquidised meals, were attractively presented. All staff had been trained in supporting people who needed textured foods.

• Staff followed national guidelines on meeting people’s needs and had good relationships with GPs and other external professionals. For example, all staff on the residential floor had a good understanding of supporting people who were living with diabetes, this also included training and supervised practice on giving people insulin injections.

• Staff were aware of their responsibilities under the Mental Capacity Act (MCA) and Deprivation of Liberties Safeguards (DoLS).

• Staff were very aware of the importance of gaining consent from people before they supported them. For example, one person was leaning to one side in their chair and looked uncomfortable. The member of staff sought their permission to place a cushion on that side of their body, so they were not leaning too far. The also explained what they were doing and why.

• There was a relaxed atmosphere, with people who were able to, walking about as and when they wanted, choosing where to sit in sitting rooms.

• People had positive interactions with staff. For example, one member of staff was sitting with two people at a table, there was lots of laughter and engagement between the three of them and all three clearly enjoying each others' company.

• Staff were always polite to people. One person came out of their room suddenly, the member of staff who was passing the person’s room pushing a trolley, stopped and said, “Did I startle you, I am sorry.”

• One person was confused about where they were, the time and day of the week. A member of staff held a calm relaxed conversation with them, orientating them to what was happening and where they were.

• People had clear care plans which outlined how their needs were to be met, in a person-centred way.

• Staff sought people’s permission to be involved with activities and supported them with engagement.

• The registered manager was keen to develop a range of ways to receive peopl

This inspection took place on 9, 10 and 16 August 2016. It was unannounced. There were 38 people living in the home when we visited. People cared for were all older people who were living with dementia, some of whom needed nursing care. They were also living with a range of other care needs, including arthritis, diabetes and heart conditions. Most of the people needed support with their personal care, mobility and nutritional needs. The registered manager reported they provided end of life care at times. No one was receiving end of life care when we inspected.

Accommodation was provided over two floors, with lifts to support people in getting between floors. There were lounges and dining rooms on each floor. The first floor provided nursing care, and the ground floor residential care, each had a deputy manager in charge. The home was situated close to the middle of the Heathfield in East Sussex.

Heffle Court 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. The providers for the service were Caring Homes Healthcare Group Limited, a national provider of care.

Heffle Court was last inspected on 30 March 2015. It was rated as Requires Improvement. At that inspection we found three breaches in the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and made one recommendation. The provider had addressed all three breaches and most of the recommendation, with only one part of the recommendation still to be addressed.

At the last inspection we recommended that further guidance was sought with regard to signage making the environment more user friendly and comfortable for people living with dementia. The registered person had provided signage across the home. The registered person had identified that the building needed up-grading both internally and externally and had developed a two year plan about this. However their plan did not identify how they would follow guidelines on making the environment more user friendly and comfortable for people who were living with dementia. The registered manager had identified deteriorated furniture in their last three audits, the provider had not responded to their audit to outline how these matters identified by the registered manager were to be actioned.

At the last inspection, we identified that the registered person had not ensured there were always sufficient numbers of suitably qualified, skilled or experienced persons employed. This had been addressed in full. People and staff reported there were enough staff, with the necessary skill mix to meet their needs. This was confirmed by our observations, which included busy times of day, like lunch times.

At the last inspection the registered person had not ensured that care had been provided in a safe way for people. This had been addressed in full. People had full assessments of risk, these were updated regularly. People had care plans, which staff followed, to ensure risk for them was reduced. Information from audits such as accident returns were used to reduce people’s risk. There were safe systems for supporting people in taking their medicines, and full records were maintained.

At the last inspection, the registered person had not ensured there was adequate assessment and monitoring of the quality of service provision. This had been addressed in full. The registered manager had full systems for assessment and monitoring of service provision, this included feedback from people and audit of services provided. Audits included maintenance, hygiene and documentation. The registered manager ensured action was taken where issues were identified during their audits.

People had full assessments o

This inspection took place on 30 March 2015 and was unannounced.

Heffle Court is a purpose-built care home offering residential and nursing care for older people. There is a designated floor in the service for people who need nursing care. Nursing and residential care is provided for up to 41 people living with Alzheimer's disease and other progressive dementias. This is for long term care, or a period of short term or respite care. There were 36 people living in the service on the day of our inspection.

During the inspection the registered manager was on annual leave, but came in to be part of the inspection. 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.

There were not always sufficient numbers of suitable staff to keep people safe and meet their care and support needs. People's individual care and support needs were assessed before they moved into the service. However, we found for one person their care needs had not been fully identified to ensure all their care needs were met. Care and support plans provided guidance on the personalised care to be provided and based on the identified needs of each individual. However, although care staff were aware of the care to be provided staffing levels had not always ensured that personalised care could be delivered. People’s care and support plans and risk assessments were detailed and reviewed regularly. However, some risk assessments on the nursing floor lacked guidance in meeting specific health needs such as epilepsy.

People were able to join in a range of activities in the service to help them with their social care needs. However, when the activities co-ordinator was not on duty care staff had limited time to run activities in their absence. This meant there were periods of time when people were not able to join in activities.

People were supported to take their medicines safely. However, where medicines were given covertly current guidance had not all been followed to fully protect people.

There was a maintenance programme in place for the repair and renewal. The environment was spacious which allowed people to move around freely without risk of harm. However, areas were identified in need of repair or renewal.

Whilst there were quality assurance systems in place they had not identified that people’s safety was potentially at risk from inadequate staffing levels that impacted on care delivery and raised potential risks to people’s safety. This meant that the people had not been protected against unsafe care and treatment by the quality assurance systems in place.

Where people were unable to make decisions for themselves the service had considered the person’s capacity under the Mental Capacity Act 2005, and had taken appropriate action to arrange meetings to make a decision within their best interests.

People were treated with respect and dignity by the staff. They were spoken with and supported in a sensitive, respectful and professional manner.

People and their visitors told us they knew who they could talk with if they had any concerns. They felt it was somewhere where they could raise concerns and they would be listened to. The registered manager also told us that they operated an 'open door policy' so people living in the service, staff and visitors could discuss any issues they may have.

Staff told us they were supported to develop their skills and knowledge by receiving training which helped them to carry out their roles and responsibilities effectively. Training records were kept up-to-date, plans were in place to promote good practice and develop the knowledge and skills of staff.

People’s individual’s dietary requirements formed part of their pre-admission assessment and people were regularly consulted about their food preferences. People had access to health care professionals. All appointments with, or visits by, health care professionals were recorded in individual care plans. Healthcare professionals, including speech and language therapists had been consulted with as required.

Staff told us that communication throughout the service was good and included comprehensive handovers at the beginning of each shift and regular staff meetings. They confirmed that they felt valued and supported by the managers, who they described as very approachable.

People were asked to complete an annual satisfaction questionnaire, and had the opportunity to attend residents meetings. The registered manager told us that senior staff carried out a range of internal audits, and records confirmed this.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which correspond to breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the back of this report.

On the day of our inspection, the registered manager was called out to an exceptional emergency and the deputy manager was on annual leave. We spoke with the regional manager, the administrator, the activities co-ordinator, and five members of staff. We talked with six people who used the service and five of their relatives. We looked at the service's policies and procedures, staffing levels, staff training schedules, audits and quality assurance documentation, and eight care files for people who lived in Heffle court.

We found that people or their representatives had expressed their views and were involved in making decisions about their care and treatment. There was an outstanding programme of activities and a commitment to promoting people's involvement with their community. One relative told us, "The activities are second to none".

We found that people were provided with written statements specifying terms and conditions in respect of fees. A relative told us, "Everything was quite clear from the start".

People's care was delivered in line with their assessed needs. A person who lived in Heffle Court told us, "The staff are taking very good care of me". A relative of a person who used the service said, "I rate this home as 100 out of 100 for the quality of care they provide".

We found that the service took appropriate steps to ensure there were sufficient numbers of suitably qualified, skilled and experienced persons employed. People were not rushed and their requests for assistance were addressed without delay. The regional manager told us, "We staff to 120%".

We saw that a robust system of audits was in place to ensure that good quality of care was delivered and risks to people who used the service were identified and minimised. The regional manager had been in their post only three weeks and had already carried out an extensive appraisal of the service to monitor its efficiency. They told us, "The system is reliable".