The Heathers Nursing Home

The Heathers is a nursing home providing accommodation, personal care and nursing for up to 30 people. At the time of the inspection there were 24 people living at the home. This is a Georgian home that has been converted and extended over three floors. There were two communal lounge/dining areas. People also have access to a courtyard garden area.

People’s experience of using this service and what we found

We were assured that health and safety policies and procedures including fire safety measures helped to protect people. Where improvements were required appropriate action had been taken to prevent recurrence and promote best practice. The training update programme was underway as Covid- 19 restrictions had started to decrease.

People were protected by the homes infection control policy and procedures. Various visitor arrangements for family were constantly reviewed and supported based on government guidelines. Following updated, recent guidance people were supported to leave the home whilst maintaining their safety and risk assessments were in place.

Prior to any visits people were informed of the procedures they should expect on arrival. People were asked not to visit the service if they displayed any symptoms related to Covid-19. Prior to entering they received a lateral flow test (LFT). Everyone provided contact details to support the track and trace system. Visitors were shown to the area of the home they were visiting, by the shortest and most direct route.

The emotional wellbeing of people and their families had been supported throughout the pandemic. Contact was maintained through various initiatives. They were sensitive to people's feelings including anxiety, sadness and loss. Positive activity provision continued, including celebrating special events.

The provider and management were proud of their staff and recognised the difficulties for them during the pandemic. The increased pressures of Covid- 19 meant that staff at times were challenged and tired. All staff continued to work well as a team and support each other.

People continued to receive prompt medical attention when they became unwell and relationships with health professionals remained good. The vaccination programme for people and staff had been well received.

Social distancing was encouraged throughout the home. Where this was not achievable, for example those people with dementia, staff were aware of the need for enhanced cleaning of frequently touched surfaces and people were supported to wash their hands regularly. The housekeeping team contributed to keeping people safe during the pandemic.

There were clear policies, procedures and contingency plans in place. Audits were undertaken, and actions were taken to ensure improvements were made. Staff had received Infection Prevention and Control (IPC) training and regular updates were provided. Spot checks took place to check staff understanding and compliance with the use of Personal Protective Equipment and IPC practices.

Rating at last inspection

The last rating for this service was outstanding (published in December 2018).

Why we inspected

This inspection was prompted in part due to concerns received about some areas around health and safety including fire safety measures. A decision was made for us to inspect and examine those areas of risk. We found no evidence during this inspection that people were at risk of harm from the concerns raised. Please see the Safe section of this report.

We also looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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.

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.

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.