The inspection was completed on the 19 April 2018 and was unannounced.

Heron Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates up to 35 older people some of whom may be living with dementia in one building. At the time of the inspection, there were 30 people living at Heron Court.

Heron Court is a large detached house building in a quiet rural area in Hutton, Brentwood. The premises is set out on two floors and there are adequate communal facilities available for people to make use of within the service.

At the last comprehensive inspection in February 2016, the service was rated good. Subsequently in May 2017 we completed a focussed inspection in response to information of concern we had received regarding poor quality catheter care. At that inspection, we found the concerns unfounded and the rating remained good. At this inspection, we found the service continued to be good and the rating remains the same.

There was a registered manager in post. 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.

People were protected from the risk of abuse as staff had received training in safeguarding and were aware of their responsibilities and how to report any concerns.

Individual risks to people had been assessed and regularly reviewed. Management plans were in place to support staff to keep people safe. Medicines were safely managed by staff who had been trained and assessed as competent.

There were sufficient staff employed who had been safely recruited. Lessons had been learned and improvements in infection control practices and staffing levels had been made to promote the safety and wellbeing of people.

Staff received training, supervision and appraisals of their practice to equip them with the skills and knowledge required to support people effectively.

People were supported to have enough to eat and drink and had access to healthcare and treatment when their health needs changed. The home environment was warm and welcoming and met the needs of the people who lived there.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff were kind and caring and treated people with dignity and respect. Staff knew people well and people were included in decisions about their care and support. Independence was supported and encouraged.

Visitors were made welcome at the service, which meant that people were supported to maintain relationships that were important to them.

Care plans were personalised and were regularly reviewed with people to reflect their current needs and wishes. If people had particular wishes for end of life care these were also discussed and recorded.

People were provided with opportunities to engage in a range of activities at the service and in the community. The service had formed links with the local community to facilitate social inclusion.

We made a recommendation about supporting people to engage in activities that are meaningful to them.

People and staff were included in the running of the service. People’s opinions were sought and the service responded positively to feedback to make any necessary improvements.

Quality assurance systems were in place to monitor the safety and effectiveness of the service and drive improvements. There was robust oversight of the service and clear lines of accountability at staff, management and provider lev

We carried out an unannounced comprehensive inspection of this service in February 2016 at which time the service was rated as good in all domains.

Following on from that inspection we received information of concern in relation to the safe care and treatment of people, specifically regarding catheter care and management and treatment of urinary tract infections. As a result we undertook a focused inspection on 4 May 2017 to look into those concerns.

This report only covers our findings in relation to those topics at that time. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Heron Court on our website at www.cqc.org.uk.

Heron Court is a residential care home which is registered to provide accommodation and personal care for up to 35 people. There was a registered manager in post. 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 inspection we found that people’s care records did not always adequately reflect risks or provide sufficient detail for staff on how to manage those risks with regard to catheter care and risk of urinary tract infection (UTI’s). However, risks were mitigated as staff knew the people they cared for very well. Staff demonstrated an excellent awareness of the risks to people and knew how to manage them to keep people safe .

Staff had received training in catheter care and were knowledgeable about urinary tract infections. They knew the signs to look for, could identify people at high risk and knew how to test for infections. Staff were aware of the importance of sharing this information with health professionals to ensure people received appropriate and timely treatment.

Whilst risks to people were alleviated by staff knowledge and experience, the potential for risk existed. Therefore we have recommended the service review how it ensures the safe and effective management of catheter care and UTI prevention.

This inspection took place on 1st February 2016 and was unannounced. The last inspection of

this service took place on 7 May 2014 and at that time was meeting all the required standards inspected. The service provides care and accommodation for up to 35 people, some of whom are people living with dementia. On the day of our inspection there were 31 people living at the home.

There was a registered manager in place. 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.

People were safe as the service had comprehensive systems in place for monitoring and managing risks to promote people’s health and wellbeing. There were suitable arrangements in place for medication to be stored and administered safely. There were sufficient numbers of staff with the relevant skills and knowledge to effectively meet people’s needs. People were encouraged to exercise choice and control in their daily lives and were involved in making decisions about the care and support they received. Where people experienced difficulties with decision-making, they were supported appropriately in accordance with current legislation. The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLs). Appropriate mental capacity assessments and best interest decisions had been undertaken. This ensured that any decisions taken on behalf of people were in accordance with the Mental Capacity Act (MCA) 2005, DoLs and associated codes of practice.

People were supported to maintain their health as had regular access to wide range of healthcare professionals. A choice of food and drink was available that reflected people’s nutritional needs, and took into account their preferences and any health requirements.

Staff had good relationships with people and were attentive to their needs. People’s privacy and dignity was respected at all times. People were treated with kindness and respect by staff who knew them well and who listened and respected their views and preferences.

People were encouraged to follow their interests including religious practices and beliefs and were supported to keep in contact with their family and friends. There was a strong management team who encouraged an open culture that listened to people and staff. Staff enjoyed working at the service and felt that they were included in the running of the service and that their views were valued. The management team had robust systems in place to ensure the quality and safety of the service and to drive improvements and respond appropriately to complaints and feedback.

On the day of this inspection there were 33 people living at Heron Court.

This is a summary of what we found based on our observations during the inspection. We looked at written records, which included people's care records, staff personnel files, medication systems and quality assurance documentation. We spoke with seven people who lived at the home and we spoke with the manager, the administration manager and four members of care staff.

We considered our inspection findings to answer the five questions we always ask: Is the home caring? Is the home responsive? Is the home safe? Is the home effective? Is the home well led?

If you want to see the evidence supporting our summary, please read the full report.

Is the home caring?

We spoke with seven people who lived at the home. One person said to us, "We are well looked after here. You can always ask if you need something and the staff will always help you." Another person said, "The staff are great; we have a good laugh."

We observed the care and attention people received from staff. All interactions we saw were patient, respectful and friendly and there was a calm atmosphere throughout the home. People's dignity and independence was respected.

Is the home responsive?

We saw that care plans and risk assessments were informative, kept up to date and regularly reviewed. People living at the home and the representatives had signed their care plans. The manager responded in an open, thorough and timely manner to complaints. Therefore people could be assured that complaints were investigated and action was taken as necessary. Staff told us the manager was approachable and they would have no difficulty speaking to them if they had any concerns about the home.

Is the home safe?

The home was warm, clean and suitably maintained. People were protected by effective staff recruitment systems. The provider had systems in place that ensured the safe receipt, storage, administration and recording of medicines.

People were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent it from happening. There was a robust process in place to assess people's capacity and to protect people's liberties in accordance with the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS).

Is the service effective?

People we spoke with were satisfied with the care and support they received. No one raised any concerns with us. All of the staff we spoke with were knowledgeable about individual people's care needs, and this knowledge was consistent with the care plans in place.

Is the service well led?

Staff said that they felt well supported by the manager, there was a good team ethic and they were able do their jobs safely. The provider had a range of quality monitoring systems in place to ensure that care was being delivered appropriately by staff, that the service was continuously improving and that people were satisfied with the service they were receiving.

During our inspection of Heron Court on 15 July 2013, we saw evidence that staff had made every effort to identify and act on the wishes of people who lived there. One person told us, “Staff always ask me for permission before doing anything.”

Records we looked at showed that people’s care needs and requirements had been thoroughly assessed, documented and reviewed. A healthcare professional said, “Staff have a good knowledge of the residents and I have never seen anyone unhappy.”

People were provided with a good choice of food and drink in a way that both encouraged and promoted a healthy balanced diet. We also saw that people were given appropriate levels of support where necessary to help them eat and drink. One person told us, “The food is ok here and we are never without a drink.”

We saw that people were cared for in a clean environment and that procedures had been put in place to reduce the risk of infection. People we spoke with during our inspection told us that Heron Court was ‘spotlessly clean’ and that bedrooms were thoroughly cleaned on a daily basis.

A complaints policy and procedure had been put in place and we saw evidence that people’s comments, feedback and suggestions had been regularly sought. Everyone we spoke with during our inspection told us they knew how to make a complaint but had never had any reason to do so.

We were unable to communicate with some people using the service to gather information as a result of their limited verbal communication or poor cognitive ability. We spent time directly observing care or listening to everyday interactions to help us to determine what it was like for people living there. We found that staff interactions with people who live at the home were positive. Staff were noted to listen effectively and to respond appropriately to people's communications.

People we spoke with told us that their privacy and dignity was always respected and they were able to make everyday choices and decisions. People told us they felt safe living at the home. One person said, “I do feel safe here, staff treat me properly”.

People also told us they were satisfied with the care and support they received. One person said, “The staff here are really very good, they are able to do the job. They always respond quickly to the call bell. I have been in two other homes for respite but this is definitely the best. Everyone is friendly, including the housekeepers and those who cook, they know you by name. We have activities with the activities person, we do lots of quizzes.”

People told us that the premises met their needs and was clean, comfortable and homely. They also enjoyed the food at the home. One person said, “The food is very good and there is plenty. We have a choice and an alternative. I like both tea and coffee and while staff do get to know you and what you like, I am always asked what I would like. The cook walks through the dining room so you can always say to them about the meals.”

The people we spoke to at Heron Court told us that they were happy there. They said that the care and support received met their care needs and the staff and manager were all nice. Comments made included “They do look after me – I do say that” and “It is lovely here”. One relative could not speak more highly of the home and its staff.

People told us they liked the food at the home and were offered choice on what they wanted to eat. People’s bedrooms had been personalised and many chose to spend their day in their rooms.

People with whom we spoke stated that the home was clean and tidy and they had no concerns. They were positive about the staff who worked at Heron Court and one person said “I was very surprised to find such a lovely and caring home.”

They were happy with the care they received from the staff and knew how to raise any concerns they may have. Compliments the home had received included “We would like to say how much we appreciate the efforts of the manager and her staff. They are always patient and caring to the residents and create such a lovely atmosphere in the home” and “The manager, the management team and all the staff that you employ at Heron Court are always welcoming, very efficient and helpful.”