The inspection was unannounced and took place on 16 and 17 July 2018.

Heliosa Nursing Home (Heliosa) 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.

Heliosa can accommodate 42 people who require support with nursing needs. The home has two separate units with one providing care and support for people who are living with dementia and may display behaviour that is challenging. The second unit provides care and support for people who may be living with dementia or require nursing care. At the time of our inspection there were 33 people living in the home.

The service was last inspected in January 2017 when we found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. On this inspection we looked to see if improvements had been made and these breaches of regulations had been met.

We found improvements had been made and four of the previous breaches had been met. Although we highlighted areas for further improvement we found that people living at Heliosa were receiving safe care which also enhanced their quality of life. The management and leadership of the service was more established and consistent.

The home had a manager who was in the process of being registered at the time of our inspection visit. Following the inspection the manager was registered. 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.

We found mostly good systems in place for monitoring peoples medicines. However, we were concerned that insufficient safeguards were in place for people with swallowing difficulties who required ‘thickening’ agents to be added to drinks to reduce the risk of choking. There were also some recording issues with medicines which made it difficult to make an accurate check of medicines in stock. Some people who required extra administration and support plans for their medicines did not have these in place.

There was an internal quality assurance system in place to review systems and help to ensure compliance with the regulations and to promote the welfare of the people who lived at the home. This had been further developed by the manager since the last inspection and evidenced ongoing improvement to the service. We found however they did not fully identify or effectively monitor some of the issues we found. Some clinical records were not fully completed or were confusing.

You can see what action we told the provider to take at the back of this report.

Staff members we spoke with confirmed that they received regular training throughout the year and that this was up to date. The managers kept training statistics which confirmed this. We reviewed the induction training for staff and saw this did not meet the standards in the ‘Care Certificate’ which is the governments blue print for induction of staff working in care.

We made a recommendation regarding this.

At the last inspection we found a breach of regulations because risk assessments had not been completed in relation to environmental hazards which put people at potential risk of harm. We found improvements had been made to the assessments and monitoring of these risks. We did find two-bedroom fire doors propped open which had not been noted on the daily safety audit. This was addressed on the inspection. Daily audits were changed to include this check. There were a number of maintenance checks being carried out weekly and monthly. These included water temperatures as well as safety checks on the fire alarm system and emergency lighting. The previous bre

The inspection was unannounced and took place on 16 and 17 January 2017.

Heliosa Nursing Home (Heliosa) is a 42 bed home with nursing for older people: 39 of which are en-suite. The home has two separate units with one providing care and support for people who are living with dementia and may display behaviour that is challenging. The second unit provides care and support for people who may be living with dementia or require nursing care. The property is detached and set in substantial gardens and is two miles away from Congleton town centre.

The service was last inspected in October 2015 when we found the provider was meeting all the regulations and the service was rated as good.

The home has 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. At the time of our inspection there were 37 people living in the home.

We found six 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.

Risk assessments had not been completed in relation to the pond and we found that fire doors were propped open putting people at potential risk of harm. The provider had not considered the potential risk that these issues presented.

Sufficient numbers of suitably qualified, competent, skilled and experienced staff were not deployed to meet the needs of the people living in the service. We observed that people were left in bed as they were not sufficient staff to assist people out of bed and staff did not have time to respond appropriately to people living in the home.

We saw that the service had a safeguarding policy in place. This was designed to ensure that any safeguarding concerns that arose were dealt with openly and people were protected from possible harm. All the staff we spoke to confirmed that they were aware of the need to report any safeguarding concerns; however we found instances where safeguarding procedures were not followed when the manager was absent.

The service had a range of policies and procedures which helped staff refer to good practice and included guidance on the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. We saw that applications had been made appropriately and consent to care was considered in the written documentation, however staff were not seeking consent for day to day tasks and always giving people choices in relation to their care. Staff were not treating people with dignity and respect.

We asked staff members about training and they all confirmed that they received regular training throughout the year and that this was up to date, however some staff did not feel that the standard of the training always provided them with knowledge and skills to do their jobs effectively. Our observations confirmed that staff members did not always have the appropriate knowledge to carry out their jobs effectively.

People living in the home and their relatives gave us mixed feedback about the staff and the home. Some felt that the standard of care they received was good, whereas others felt that the care and compassion shown by staff was not consistent across the staff team.

People had care plans which were personalised to their needs and wishes. Most care plans contained information to assist support workers to provide care in a manner that respected the relevant person’s individual needs; however we found that the care given did not always reflect what was recorded in the care plan. People told us and we observed that there were very few activities taking place in the home that reflected people's preferences.

There was an internal quality assurance system in place

We spoke to twelve people living at Heliosa, four family members and a visiting Consultant Psychiatrist during our visit. Everyone who commented spoke positively about the home and the staff members working there. The visiting Consultant said; “There is a good relationship with this home, information is very good”.

The people using the service who were able to tell us said that they were happy living in the home. Comments included; “it is lovely here”, “I am happy with the home, happy with the staff and happy with the manager” and “beautiful, I can have a cup of tea at any time, day or night”.

We also received positive comments about the home and staff members from the visitors we spoke with. Comments included; “Brilliant, staff are very friendly and they always keep me informed” and “things get passed on if raised, staff seem to be very caring”.

The home had an adult protection procedure [now called safeguarding] that complied with all of the relevant legislation and good practice guidelines.

Information about the safety and quality of service provided was gathered on a continuous and on-going basis from feedback from the people who used the service and their representatives, including their relatives and friends, where appropriate.

When we carried out a previous inspection in January 2013 we found that despite work carried out by the provider to rectify hot water issues problems still persisted.

We told the provider to make improvements and they sent us a satisfactory action plan followed by information that a new boiler had been installed and improvements made to the plumbing.

We visited on 21 June to check that the hot water system was satisfactory. Staff told us that since the remedial work they now had enough hot water to carry out their duties.

We spoke to a person who lived there who said the water took a “while to run through” but that it was hot and their radiator was “now OK”.

We ran taps in several locations including those from which we had not been able to obtain hot water during our last visit and found that they all provided hot water.

When we carried out our unannounced visit we spoke to four residents. Someone who had been in the home for several years told us that they were looked after properly and that they “couldn’t speak highly enough; no complaints”. A second resident said that the home was “very good – excellent” and they did not “want for anything”. We asked if they were treated properly and they said “you can’t fault them”.

Another person told us that things were “fine” and when we asked if they were treated decently they said “yes”.

We looked at a sample of four care plans and noted that they were appropriately completed although some were in transition to a new system that was being introduced.

We looked at the home’s arrangements for protecting people from the risk of abuse and found them to be satisfactory.

We found the home to be clean, tidy and hygienic and the provider had appropriate arrangements in place to protect people from the risks of infection.

The home had made arrangements for the maintenance of the buildings and we saw evidence that these were adhered to and that the work was carried out by appropriately qualified contractors. However there was a problem with the inconsistent supply of provision of domestic hot water in some parts of the home that had an impact on the care provided.

We looked at the home’s procedures for the recruitment of staff and found them to be satisfactory with checks on staff carried out to the requirements of the regulation.

When we visited Heliosa Care Home one resident told us that the food was “very good”. Another said it “depends what you like, I like old fashioned food but there is usually enough choice”. They also said that is there was nothing they wanted the home would “sort something special out”.

We spoke to a resident about the care that was provided to them and we were told that the staff were “eleven out of ten”, “brilliant”, “kind” and that the person liked them. This person also volunteered the information that they were at risk of pressure sores and that they received good care to prevent them.

We spoke to another person who told us that the home was “great” and “safe”. They also said that the “activity lady does all sorts of things, it’s very good”.

A third person told us that the home was “all-right” and that they were able to have a laugh and a joke with the staff. They said that if they wanted something they told the staff and they usually got it.

We spoke to a resident about what they would do if they were worried about anything. They told us that they had no worries but if they did they would talk to the home’s manager. A second and a third person gave similar replies saying they would speak to the home’s manager.

We asked a resident about their experience in being washed. We were told that they were washed every day but when we asked about hot water we were told that it was not always available. Another resident said that there had been problems with the hot water which resulted in them missing out on being washed but that it was now sorted out.

We asked a resident about whether staff responded in good time to their needs and they told us that they were sometimes left waiting and that it “could be better”.

The inspection was unannounced and took place on 14 October 2015. This location was last inspected in January 2014 when it was found to be compliant with all the regulations which apply to a service of this type.

Heliosa Nursing Home (Heliosa) is a 42 bed home with nursing for older people. All rooms have en-suite facilities. The home has two separate units with one providing care and support for up to nine people who are living with dementia and may display behaviour that is challenging. The second unit provides care and support for up to 33 people who may be living with dementia or require nursing care. The property is detached and set in substantial private gardens and is two miles from Congleton town centre. There were 35 people living in the home at the time of our visit.

There are two floors with a passenger lift and staircase between floors. There are a variety of aids and adaptations around the building to allow people who use the service to move about independently.

There is a dining room, two lounges and a conservatory sitting area which overlooks the private gardens.

There is a registered manager at Heliosa. 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.

We found that care was provided by a long term staff group in an environment which was friendly and homely. People were well supported by experienced well trained staff. All staff spoken with said they had received good training to help them to understand and care for people who lived at Heliosa.

The relationships we saw were caring, respectful and dignified and the atmosphere was one of calm and comfort. Everyone in the service looked relaxed and comfortable with each other and with all of the staff.

Staff members developed good relationships with people living at the home and care plans clearly identified people’s needs, which ensured people received the care they needed in the way they preferred.

Activities were provided informally when people wanted them and reflected the hobbies and interests of the people living at Heliosa. However, staff were unable to provide a full activities programme due to their care commitments. The home was in the process of employing an activity co-ordinator to ensure activities were formally arranged.

Staff knew about the need to safeguard people and was provided with the right information to do this. They knew what to do if they had a concern. There were sufficient staff to meet the needs of the people who lived in the home.

The home was well-decorated and maintained and adapted where required. People had their own bedrooms which they could personalise as they wished.

The registered manager has been registered as manager with CQC since 2013 and was fully conversant with the policies and practices of the home. Staff told us that they were very well supported by the management team who were transparent, knowledgeable and reliable and that the home was run in the best interests of the people who lived there.