This inspection took place on 18 and 19 October and was unannounced. There were no concerns at the last inspection of August 2016. The Heathers provides accommodation, nursing and personal care for up to 30 people. At the time of our visit there were 25 people living at the service.

At our last inspection, we rated the service Good. At this inspection, we found evidence continued to support this rating and in addition, we found the service had improved to outstanding in caring and responsive.

Why the service is rated outstanding:

People continued to receive a service that was safe. The registered manager and staff understood their role and responsibilities to keep people safe from harm. People were supported to take risks, promote their independence and follow their interests. Risks were assessed and plans put in place to keep people safe. There was enough staff to safely provide care and support to people. Checks were carried out on staff before they started work to assess their suitability to support vulnerable people. Medicines were well managed and people received their medicines as prescribed. People were protected by the homes infection control policy and procedures

The service remained effective in meeting people’s needs. Staff received regular supervision and the training needed to meet people’s needs. Arrangements were made for people to see a GP and other healthcare professionals when they needed to do so. The registered manager and staff understood the principles of the Mental Capacity Act (MCA) 2005 and, worked to ensure people's rights were respected. People were supported to enjoy a healthy, nutritious, balanced diet whilst promoting and respecting choice.

The service was exceptionally caring and put people at the heart of everything they did. We were introduced to people throughout our visit and they welcomed us. They were relaxed, comfortable and confident in their home. The feedback we received from them was extremely positive throughout. Those people who used the service expressed great satisfaction and spoke highly of all staff. Staff had a good awareness of individuals' needs and treated people in a warm and respectful manner. They were knowledgeable about people's lives before they started using the service. Every effort was made to enhance this knowledge so that their life experiences remained meaningful.

The service was exceptionally responsive to people’s health and social needs. People received person centred care and support. Regular monitoring and reviews meant that referrals had been made to appropriate health and social care professionals. Where necessary care and support had been changed to accurately reflect people's needs and improve their health and wellbeing. People were offered a range of activities both at the service and in the local community. People were encouraged to make their views known and the service responded by making changes.

People benefitted from a service that was very well led. The director, registered manager, deputy and staff team maintained a clear focus on continually seeking to improve the service people received. Everyone demonstrated strong values and, a desire to learn about and implement best practice throughout the service. Good quality assurance systems were in place and based upon regular, scheduled audits, which identified any action required to make improvements. This meant the quality of service people received was monitored on a regular basis and, where shortfalls were identified they were acted upon.

Further information is in the detailed findings below.

This inspection took place on 28 July 2016 and was unannounced. The previous inspection of The Heathers was in September 2013. At that time there were no breaches of the legal requirements.

The Heathers is a care home with nursing, registered to accommodate up to 30 predominately older people. At the time of our inspection there were 28 people in residence. People have general nursing care needs but may also be living with a mild to moderate degree of dementia. The home is a converted older property with the facilities spread over two floors. There are 20 bedrooms for single occupancy and five shared rooms with screening in place to provide privacy. The home has a communal lounge area but does lack a dining room.

There was a registered manager in post but they were not available on the day we visited, however one of the directors and the deputy were available. 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 were kept safe. The staff team were knowledgeable about safeguarding issues and protected people from coming to harm. They knew what to do if concerns were raised about a person’s welfare and who to report those concerns to. All staff had received training in safeguarding adults.

Risks were assessed as part of the overall assessment of each person’s care needs and appropriate management plans put in place to reduce or eliminate that risk. Where people needed to be assisted to move, their moving and handling needs were assessed and a safe manual handling plan was devised. The management of medicines was safe and people were administered their medicines safely. All the appropriate checks to maintain the premises and facilities were completed on a regular basis.

Staffing numbers on each shift were sufficient to ensure each person’s care and support needs were met. There was a qualified nurse on duty at all times along with senior care staff and care staff, catering and domestic staff. Staff were provided with regular training and were supported by their colleagues, the deputy and the registered manager to do their jobs effectively.

People enjoyed the food and drink they were served. Any preferences and food allergies were taken in to account and people were provided with the sort of food they liked and were able to eat. Where concerns had been identified with weight loss, food and drink intake and body weight was monitored. Arrangements were made for people to see the GP and other healthcare professionals as and when they needed to.

The staff team had good relationships with the people they looked after and also with the families who visited. The staff spoke about people in a respectful manner. We found the staff to be caring and friendly. They ensured people’s privacy and dignity was maintained at all times. People were involved in making decisions about their care and relatives were included where this had been agreed.

People received personalised care and support that met their specific needs. They were encouraged to express their views and opinions and have a say about how they wanted to be looked after. The staff acted upon any concerns they had in order to improve the service. Those people who had end of life care needs were supported to remain at The Heathers and their care was managed by the GP and the qualified nurses.

The quality and safety of the service and the care delivered was monitored using a range of different measures to check how things were going. Feedback from people and their families and health and social care professionals was sought to identify areas where they could do better. The staff team were provided with good leadership and management by the registered manager the deputy and the director who was based at the service.

The manager and deputy were available throughout the day and both were very knowledgeable about people in their care, the policies, procedures and systems in place to ensure the continued smooth running of the home.

People shared with us their experiences about living in the home and we spoke with four people at length. Everyone expressed positive comments.

People told us, "I am very happy and I love my room. The staff are very kind and respect what I want to do”, “Nothing is too much trouble for the staff" and "We were very nervous but we made the right choice”.

We spent time in various parts of the home, including communal areas and individual bedrooms so that we could observe the direct care, attention and support that people who lived at the home received. There was a constant interaction between staff and people in the home. Everyone was relaxed, happy and comfortable in each other's company.