We carried out an unannounced inspection of the service on 12 December 2016. The Heights is registered to provide accommodation and nursing care for up to 36 older people, with a range of medical and age related conditions, including arthritis, frailty, mobility issues, diabetes and dementia. On the day of our inspection 33 people were using the service, including one person receiving respite care and one person who was being treated in hospital.

The previous inspection was carried out on the 8 and 13 April 2015, when shortfalls were identified and the service was found to require improvement regarding person centred care and staff support and training. Following that inspection, we asked the provider to send us an action plan to say how they would address these issues. During our latest inspection we found the necessary improvements had been made.

There was a registered manager in post, although not able to be present on the day 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.

Staff training was inconsistent and did not always ensure staff had the necessary knowledge, confidence and competence to effectively meet people’s needs. People were not consulted or consistently involved in decisions regarding what they eat or drink.

There were policies and procedures in place to assist staff on how keep people safe and individual risk assessments were kept up to date. Staff told us they had completed training in safe working practices. We saw people were supported with patience, consideration and kindness and their privacy and dignity was respected.

Staff were deployed in sufficient numbers to ensure people received safe and personalised care and support. Staff received one-to-one supervision meetings with their line manager. Formal personal development plans, such as annual appraisals, were in place.

People’s needs were assessed and their care plans provided staff with clear guidance about how they wanted their individual needs met. Care plans were person centred and contained appropriate risk assessments. They were regularly reviewed and amended as necessary to ensure they reflected people’s changing support needs. People were able to access health, social and medical care, as required.

Thorough recruitment procedures were followed and appropriate pre-employment checks had been made including evidence of identity and satisfactory written references. Appropriate checks were also undertaken to ensure new staff were safe to work within the care sector.

Medicines were managed safely in accordance with current regulations and guidance by staff who had received appropriate training to help ensure safe practice. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). In accordance with the principles of the MCA, people were supported to make decisions in their best interests.

People were provided with appropriate food and drink to meet their health needs and were happy with the food they received. People’s nutritional needs were assessed and records were accurately maintained to ensure people were protected from risks associated with eating and drinking. Where risks to people had been identified, these had been appropriately monitored and referrals made to relevant professionals, where necessary.

There were quality assurance audits and a formal complaints process in place. People were encouraged and supported to express their views about their care and staff were responsive to their comments. Satisfaction questionnaires w

We carried out an unannounced inspection of the service on the 8 and 13 April 2015.

The Heights provides accommodation for up to 36 people who require nursing or personal care. On the day of our inspection 29 people were using the service as the service had stopped admitting new people whilst the passenger lift was out of action.

There is 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 told us they felt safe living at the home and with the staff who supported them. Comments included, "I feel safe; staff are nice they wouldn’t dare bully me."

Risk assessments were in place that identified where people may be at risk. Action was taken to minimise risk without impacting on the person’s independence.

Staff told us how they had received training on how to recognise abuse and they understood their responsibility to keep people safe. Staff knew what was expected of them by the registered manager and people were supported to be as independent as possible, whilst maintaining their safety.

There were sufficient staff employed but they were not deployed in the most effective way to meet the needs of people. Staff understood the needs of the people they supported and what was expected of them to maintain standards of care within the service.

Medicines were managed safely to ensure people received them when they were needed.

The registered manager and staff had received training on the Mental Capacity Act 2005 and worked with health and social care professionals to ensure people who used the service were not restricted or restrained inappropriately.

Overall people expressed satisfaction with the service at The Heights. However some peole commented that they thought the home had deteriorated in the last few months. One person said, "It was better when I first came in, it’s passable put it that way"

People told us they had enough to eat and drink but one person commented that, "The food is not bad, but it could do with changing around a bit." Staff monitored people to ensure they had enough to eat and drink and referred people to the health care professionals if they identified people may be at risk of poor nutrition.

People were supported to see doctors or nurses if they felt unwell and staff acted on health professionals’ advice.

During the inspection we observed staff interact with people in a positive manner. They were kind and patient never rushed people. However staff were more positive on the first floor that the ground floor and showed more attention to meeting people’s dignity. People who used the service told us staff were kind and considerate and they treated them with dignity when they provided personal care. All rooms at the home were used for single occupancy.

The service employed two activity organisers who supported people to access their interests and hobbies. Some activities such as outside entertainers had been curtailed as a result of the lift being out of action.

People told us they found the senior managers approachable and were able to tell us who they would speak with if they needed to complain.

There were systems in place to assess and monitor the quality of the service. This included gathering the views and opinions of people who used the service and monitoring the quality of service provided.

The service had serious issues over the last 10 months with the passenger lift not working. It had been out of action permanently since December 2014 and repairs were due to start in May 2015. The provider told us that the lift should be working by June 2015. A contingency plan had been put in place in the event the repairs were ineffective.

During the inspection, we spoke to several staff, people who lived in the care home and their relatives. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. Below is a summary of what we found.

Is the service safe?

People were treated with dignity and respect by the staff. Safeguarding procedures were robust and staff understood how to safeguard the people they supported. Systems were in place to ensure that managers and staff learnt from incidents such as accidents. This reduced the risks to people and helped the service to continually improve. People were protected against the risks associated with the unsafe use and management of medicines.

The home had policies and procedures in relation to the Mental Capacity Act, (MCA) 2005 and Deprivation of Liberty Safeguards, although no applications had been submitted since our last inspection. All staff had been trained to understand when an application should be made, and how to submit one. The MCA documentation was available in people's care files and there was evidence of best interest meetings being held to ensure people were being safeguarded.

Staff had received up to date training in all mandatory areas, as well as those specific to their job role. Staff recruitment procedures were thorough and in accordance with the provider's policy. Staffing levels were determined based on the individual needs of each person. Policies and procedures were in place to make sure unsafe practices were identified and people were protected.

Is the service effective?

Staff had the skills and knowledge to meet people's needs. Managers gave effective support to staff including induction training, supervision and a substantial training programme. We saw that staff were continuously assessed to make their skills and knowledge met the needs of the people living in the care home. The care home worked effectively with other agencies and services to ensure a co-ordinated approach to people's care.

Is the service caring?

People living in the care home were supported by kind and attentive staff. They were cared for sensitively and given encouragement. People's preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

The complaints procedure was understood by staff, people living in the care home and relatives. The registered manager was offering encouragement to relatives to become further involved in voicing their opinions about the care offered.

Is the service well led?

There was a quality assurance process in place. Records showed that any adjustments needed were actioned promptly. This enabled the quality of the service to continually improve. Staff told us they were clear about their role and responsibilities. All of the staff we spoke to said they were strongly supported by the managers.

On the day of our site visit to The Heights there were 32 people living at the home. Of these 25 people were receiving nursing care and 7 people were in receipt of residential care.

We spoke with two people who live at the care home. They told us that: “The staff are very nice, everyone is very friendly, and if I need any help, I just need to ask.” Another person said: “I can’t complain, I’ve got a nice rom, and I’m very comfortable. The staff are all very nice, and the food is lovely”

We carried out a Short Observational Framework for Inspection (a SOFI) during this inspection visit. This involved us sitting in the dining room and observing for an hour over the lunch period. This enabled us to see how the staff spoke with people who live at the home, and how they offered help and support. This observational technique is also very useful for identifying issues relating to privacy, dignity and respect. Our observations showed that people were treated with respect, and that staff had good relationships with the people who live at the care home. We saw staff offering support and encouragement in a pleasant, friendly and helpful manner.

We looked at eight outcomes from the Health & Social Care Act (2008). We found the staff to be knowledgeable, and our observations showed staff to be caring and focussed on the people who live at The Heights.

On the day of our visit to The Heights there were 33 people living at the care home.

We spoke quite briefly with people who live at the care home. Some people have dementia while others were busy in the home. The people we did speak with were positive in their comments, and observations showed that there was a calm and relaxed atmosphere.

We spoke with two people who live at The Heights specifically about their care, and both said they thought they were well cared for. One person said: “The staff are very kind, they really look after me well.” Another person said: “I’m quite happy thank you, the staff are looking after me.”

Our observations during our inspection visit did not raise any questions or issues with regard to peoples’ safety at the care home.