This inspection took place on 8, 9, 11 and 25 October 2018 and was unannounced on the first day.

Our last comprehensive inspection took place on 18, 19, 28 January and 1 February 2016. We found no breaches in the Regulations at that inspection.

The Heathlands Village is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided and both were looked at during this inspection.

The Heathlands Village provides a wide range of care services for up to 214 older people from both the Jewish and Non–Jewish community. The Heathlands Village is divided into six units. Beach House, residential dementia, Wolfson, residential, Unit 2 residential, First Floor residential, the Simon Jenkins nursing unit and Oakwood nursing dementia unit. The Heathlands Village is situated in extensive well-maintained grounds. At the time of our inspection visit the service was undergoing extensive restructure and design and only 121 people were using the service.

The service had a registered manager in place. A registered manager is a person who has registered with CQC 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 our last inspection in January 2016 we rated the service as ‘good’, with an ‘outstanding’ rating for the key question, ‘is the service responsive?’. At this inspection we found the evidence continued to support the rating of good and the service could demonstrate continuous improvement.

We found concerns about the safe control of substances hazardous to health (COSHH) on the new dementia unit, Beach House. The registered provider acknowledged that this was a result of people moving around the service. The registered provider’s maintenance team acted to rectify this issue immediately.

Overall, people’s medicines were safely managed. However, we raised some concerns about the storage of non-medicated creams and thickeners as well as the recording of thickeners that were not on the computerised medicines system. We were aware that the service was in the process of changing their supplying pharmacist and computerised medicines systems. The registered manager assured us that they would address the shortfalls we found with the new pharmacist and additional medicines cabinets would be provided. Minor issues were addressed immediately by the provider.

Recruitment procedures were sufficiently robust to protect people from the risk of unsuitable staff. However, improvements were needed to the registered providers application form to ensure a full employment history was maintained. This was addressed immediately by the provider during our inspection.

Staff had received training in safeguarding adults and knew the correct action to take should they witness or suspect abuse taking place. Improvements had been made to the security systems of The Heathlands Village.

We saw further improvements had been made to strengthen moving and handling procedures and health and safety training for staff in line with Health and Safety Executive (HSE) guidance.

The service was clean and tidy throughout and no malodours were detected.

We saw that the service had made changes to the site to make it more dementia friendly and provide a quieter area for people to live who were receiving end of life care. The registered provider had completed refurbishment of an existing area to create a new smaller dementia unit which was to a very high standard. This was to be the blue print for other areas of the home. It was recognised that these changes did not suit everyone. However, action had been taken by the registered provider to help minimise the impact.

There were adequate numbers of staff to support

This inspection took place on 31 May 2017 and was announced. The provider was given 24 hours’ notice because we needed to be sure that we were able to speak with the providers of the service who were registered with the Care Quality Commission (CQC).

This inspection was prompted by information we received about an incident following which a person using the service later died. This incident was subject to a police investigation and as a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC indicated potential concerns about how the service managed the risks of falls when moving and handling people using lifting equipment such as a hoist.

This report only covers our findings in relation to these concerns. The concerns raised form part of the two domains; is the service safe and is the service well led. Our findings are reported under these domains.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘The Heathlands Village’ on our website at www.cqc.org.uk.

The Heathlands Village provides a wide range of care services for up to 214 older people from both the Jewish and Non–Jewish community. The Heathlands Village is divided into six units and is situated in extensive well maintained grounds. It is close to the village of Prestwich and there is easy access to local shops, public transport and the motorway network.

At the time of our inspection, 129 were using the service and of those 33 people were being transferred by the use of a hoist or a stand aid.

There was a registered manager in place and they were available throughout this 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 discrepancies between the policy and procedure in relation to the frequency of moving and handling people refresher training and the certificate validation, which was addressed following our inspection.

Care records, risk assessments and systems were in place to help direct staff to use the correct hoist and sling that people had been assessed to use.

Staff had received the moving and handling training they needed to help ensure the safe transfer of people. Refresher moving and handling people training was available and the majority of staff had undertaken this training. Competence checks were undertaken to check that staff practice was safe; however, there was no centralised system to enable us to confirm which staff had been assessed. We recommend that a central log of competency checks is maintained to help ensure and track that these important checks have been carried out.

Systems were in place to ensure that lifting equipment was maintained as specified by the legal requirements of the lifting operations and lifting equipment regulations (LOLER).

The registered provider had invested in a dedicated moving and handling people training room. The room and equipment cost over £6,000 and was set up in January 2017. A wide range of equipment was seen to have been made available for staff to use for moving and handling training purposes.

The service, where able, had followed the principles of the Duty of Candour, following the incident. The Duty of Candour sets out some specific requirements that providers must follow when things go wrong with care and treatment, including informing people about the incident, providing reasonable support, providing truthful information and an apology.

The provider had taken prompt action to help prevent a similar incident occurring. The board had commissioned an independent external advisor to undertake a root cause analysis of the incident.

This was an unannounced inspection visit, which took place on 18, 19, 28 January and 1 February 2016. The last inspection of this service took place on 24 January 2014, which was to check concerns that had been raised with us. We found no breaches in the regulations that we reviewed.

The Heathlands Village provides a wide range of care services for up to 214 older people from both the Jewish and Non–Jewish community. The Heathlands Village is divided into six units and is situated in extensive well-maintained grounds. It is close to the village of Prestwich and there is easy access to local shops, public transport and the motorway network. At the time of our inspection visit 154 people were using the service. The low number was due to ongoing improvements being made to the site.

The service had a registered manager in place. A registered manager is a person who has registered with CQC 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 this inspection we found no breaches in the regulations that we reviewed.

People who used the service told us “I feel safe in here. There's plenty of people in here,” “I feel safe here because there's always somebody around,” and “If you arrive after hours I have a phone number to be let in. You don't have to wait. There's 24 hour reception” and “I've always felt safe in here.”

Staff we spoke with told us that, “All staff get safeguarding training,” “If someone complained to me I would write everything down and report it to the team leader immediately” and “There are eyes and ears everywhere at Heathlands.” Staff had received training in safeguarding adults and knew the correct action to take should they witness or suspect abuse taking place.

Recruitment procedures were sufficiently robust to protect people from the risk of unsuitable staff and there were adequate numbers of staff to support people safely and effectively.

People’s medicines were safely managed.

People who used the service and relatives said, “It's like a five star hotel,” “The home is clean and her bedroom is clean. It is always clean in here,” “They do clean the public areas and my bedroom every day. My bedding is also kept clean” and “Cleaners are around all the time.”

The registered manager had a good understanding of the Mental Capacity Act. Authorisations for non-urgent Deprivation of Liberty Safeguards were ongoing with the local authority. Improvements were in the process of being undertaken to clearly identify when people had given their consent and for what reason.

Staff had received or had access to training to help them support and care for people safely and effectively.

People enjoyed the food that was offered which was overseen by the Shomer for the service to ensure that religious and cultural requirements were met. People who used the service told us, “I like the food here. You get a good choice of food.” “The food is excellent. It is very nicely cooked. The food is pretty good,” “There's plenty of choice. I like the evening meal best. It's a good end to the day,” “The food is excellent. Its Kosher” and “We get enough fruit and vegetables. There is a reasonable choice of food.”

One person told us, “If I'm poorly a doctor will come to see me. I have seen a doctor when I ask for one. I saw the doctor yesterday. There is a surgery on the premises. You can use the emergency doctor otherwise. I have access to other medical professionals when needed.

We saw frequent and friendly exchanges between staff and people who used the service and the atmosphere was calm and relaxed.

People who used the service told us, “The staff treat me with respect. They are very kind to me.” “On the whole they are decent. They do knock before coming into my room. Staff are kind to my relative and sometimes offer them a drin

The purpose of this inspection was to investigate concerns that had been brought to our attention anonymously. The person made allegations in relation to inadequate staffing levels, inadequate training, unsafe recruitment of staff, inadequate support from senior staff and insufficient equipment.

We focused our inspection on one of the residential units of the home in Eventhall House. This was because of information we had been given several weeks prior to the inspection, by the home’s registered manager. Our inspection identified that the allegations were not substantiated. The provider was meeting the essential standards of quality and safety in the outcomes areas that we inspected.

We found that arrangements were in place to ensure that people using the service were cared for, and supported by, sufficient skilled and experienced staff. A relative told us they felt the staffing levels had improved recently and that their relative was well cared for.

Inspection of documentation and a discussion with newly appointed staff showed that arrangements were in place to ensure that people using the service were cared for by staff that were safely recruited and were properly trained, supported and supervised.

We found that adequate equipment and adaptations were available to promote people's independence and comfort and assist in their safe moving and handling.

During our visit to the home we spoke with three people using the service. We asked them to tell us how they felt they were being cared for. People told us they were content with the care and treatment they received. Comments made included;

“Very happy here, the staff are very good” and “No problems here, well cared for”.

The design, layout and maintenance of Heathlands Village ensured that people using the service, staff and visitors, were kept safe.

People's care records contained enough information to show how they were to be supported and cared for.

Suitable arrangements were in place to help protect people using the service from abuse.

People were cared for by staff that were properly trained, supported and supervised.

Regular monitoring of the service and facilities provided was in place to help protect people against the risks of inappropriate or unsafe care.

We did not speak to people using the service during this visit. We looked at people's care records to check if they were accurate and up to date. We also checked to see if staff took action when a person using the service had unexplained weight loss.

We saw that staff took appropriate action when any weight loss was identified. We also saw that the care records contained detailed information about the care, treatment and support needs that people had.

We spoke with three people using the service and with one relative. One person we spoke with told us they had a choice in how they spent their day. We were told they preferred to spend their day in their own room and felt more comfortable staying in bed.

People's care records contained detailed information to show how they were to be supported and cared for. People told us they were well looked after. They told us; “All very nice” and “I am well looked after”. A relative told us; “I have no concerns, the care is very good and the staff are very kind”.

The medication system was safe and one person told us they received their medicines when they needed them. We were told; “Yes, they know I need them and they do not forget”.

An effective complaints procedure was in place and people knew how to make a complaint.

We spoke with seven people about their medicines and their general care needs. All said they were well looked after and raised no concerns about the way their medicines were being handled.

The residents that we spoke to told us that they were very happy with the way that they were looked after. They told us that the staff were very thoughtful and kind.

A resident told us that the care workers made sure their medicines were handled properly. We were also told that the call bells were answered promptly when a resident asked for their ‘when required’ medicine.

The people that we spoke to about the care and services provided at The Heathlands Village were complimentary about the staff. They felt that they were kind, polite and helpful. They felt that the Jewish religious and cultural needs of people were considered to be of great importance, and they found this pleasing and comforting.