The Heights

Updated 5 February 2019

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service and to provide a rating for the service under the Care Act 2014.

This inspection took place on 13, 14 and 19 November 2018 and was unannounced. The inspection was carried out by two inspectors and an Expert by Experience. The Expert by Experience’s area of expertise was the care of older people and people living with dementia.

Before the inspection, we reviewed notifications and any other information we had received since the last inspection. A notification is information about important events which the service is required to send us by law. After the inspection we reviewed the Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

We spoke with five members of care staff, three nurses, two administrators, the activities coordinator, the provider’s dementia specialist, a chef, the deputy manager of The Heights, the regional manager and the registered manager. We also spoke with the home manager of Downley Lodge, 12 people, four relatives and a healthcare professional.

We reviewed records which included 11 people's care plans and 15 staff recruitment and supervision records. We also looked at records relating to the management of the service such as the development plan known as the ‘Manager’s Workbook’, resident meeting minutes, staff meeting minutes, staff rotas, medicines administration records and the provider’s statement of purpose. After the inspection we reviewed further evidence sent to us by the provider which included the staff training matrix, evidence of activities and further quality assurance audits.

Updated 5 February 2019

This inspection took place on 13, 14 and 19 of November 2018 and was unannounced.

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

The Heights is registered to provide nursing and residential care for up to 90 adults with a range of needs including younger adults living with a physical or learning disability and older adults with a range of needs including dementia, epilepsy and diabetes. Younger adults had complex care needs and lived in a separate accommodation called Downley Lodge, which was adjacent to the main building. Downley Lodge had its own staff team and entrance.

At the last inspection we rated the service as outstanding. At this inspection we found that the service remained outstanding overall. The service remained outstanding in well led and had improved from good to outstanding in effective. The service the service no longer meets the criteria for outstanding in responsive and is now good in responsive.

The home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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.

There was an extremely positive culture at the home because staff put people at the heart of their practice. Staff provided outstandingly effective care as they were highly skilled, dedicated and passionate in their approach. People received highly individualised care as staff were committed to cultivating a thorough understanding of people’s health, wellbeing needs, social histories, important relationships and preferences. Staff treated people as individuals, celebrated their life histories and enabled them to access meaningful experiences.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The registered manager encouraged and supported staff in their training and career development. Staff completed a comprehensive induction, the Care Certificate and training specific to the needs of people living in the home. The registered manager facilitated training opportunities for staff and continually reviewed their development through a supervision system. It was clear they believed in the abilities and potential of their staff as without exception, staff members told us they felt incredibly well supported. All departments of the staff team were valued and were included in daily handover meetings. This helped staff maintain a detailed oversight of people’s needs and of service developments and changes.

The chef took a collaborative approach to menu planning and held regular meetings with people and their families to ensure foods were nutritious and enjoyable. People at risk of malnutrition were provided with immediate support to maintain a healthy weight.

The home was light, spacious and extremely well decorated and contained furniture and possessions from people’s own homes as well as quiet seating areas with objects of interest. This provided attractive, appealing spaces for people and their families to relax in.

Staff were highly skilled at liaising with professionals from different agencies to provide people with timely support. They worked in partnership with professionals to ensure people received the highest possible standards of care.

Without exception, staff told us they were given support by the registered manager. Staff told us the registered manager welcomed and encouraged suggestions for improvements to the service and acted upon these to deliver excellent care. The registered manager was passionate about developing clinical knowledge to provide the best outcomes and had engaged in several research projects with local health services and universities.

Staff at the service were highly successful in integrating with the local services and organisations. They had developed good working relationships with local services including a school, nursery and supermarket and held regular fundraising events in the community. This helped people continue to remain a part of the community they had lived in prior to moving to the home.

Staff had a highly detailed understanding of the Mental Capacity Act and gave several examples of how they applied this when providing care and support to people. For those who were unable to make certain decisions, evidence showed that decisions made were in people’s best interests. People’s care plans contained detailed records of meetings held with people, their families and relevant professionals.

People and their relatives gave us positive feedback about the service provided. People told us staff were always available to them and always displayed a caring attitude. The provider ensured that there were enough staff available to meet people’s needs and uphold their wellbeing.

Through developing respectful caring bonds with people, staff learned about their personal histories, desires and ambitions and helped them to fulfil these. They saw people in terms of their positive traits and abilities and aimed to ensure they enjoyed life enhancing experiences.

People’s skills were celebrated and staff supported people to develop physical abilities whilst living at the Heights. Staff saw people’s time at the home as a phase of their life where they could grow and develop new friendships.

The registered manager was highly trained. They were a registered nurse with advanced nursing qualifications and minor illness management training. This enabled them to promptly detect and respond to changes in people’s health and refer them to the appropriate professionals such as GPs and district nurses. They shared their expertise with their staff team and ensured they completed appropriate training updates. Professionals we spoke with praised staff at the Heights for their skill, judgments and professionalism and told us that the skilled assessments completed by staff at the Heights had prevented conditions worsening in some people.

The registered manager was highly adaptable in their approach to delivering care and used technology in innovative ways to promote inclusion and reduce loneliness. They reflected on their practice and used learning to improve outcomes for people living in the home. They had developed an in-house television ‘live cast’ so those unable to leave their rooms could still feel included in activities. They had also taken part in telemedicine clinical trials and had provided feedback to local health care commissioners about this.

The service had plans in place for supporting people and meeting their needs in their last days and after their passing. Sensitive discussions were held with people regarding the place they wished to remain in in their last days and the type of treatment they preferred and needed.