Headlands is a care home which provides care and accommodation for up to 34 older people, some of whom are living with dementia. On the day of the inspection there were 31 people using the service. We carried out this inspection on 14 February 2017. The service was last inspected in May 2015 when it was rated as ‘Good’.

The service is required to have a registered manager and at the time of our inspection a registered manager was in post although they were not working at the service. 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 and associated Regulations about how the service is run. The service was being overseen by an interim manager from another Cornwall Care home.

People told us they were happy with the care they received and believed it was a safe environment. There was a relaxed and friendly atmosphere and we observed people sitting in small groups chatting together and laughing and singing with staff. Some people were unable to tell us verbally about their experiences and we observed they were at ease with staff. Staff sat with people when they had the time and spoke with them kindly.

There were sufficient numbers of suitably qualified staff on duty to meet people’s needs in a timely manner. Staff completed a thorough recruitment process to ensure they had the appropriate skills and knowledge for their role. Staff had received safeguarding training and knew how to recognise and report the signs of abuse. They were confident any concerns would be dealt with. The interim manager had taken action to ensure staff had access to contact information for the local authorities safeguarding team.

People received their medicines on time. Medicines administration records were accurate and consistently completed. Staff supported people to access to healthcare services such as occupational therapists, GPs, chiropodists and dieticians.

People were assessed in line with the Mental Capacity Act (2005) where relevant and the management team followed the legislation to help ensure people’s human rights were protected. Best interest meetings were held when people had been assessed as not having capacity to make specific decisions. These involved other professional and family members to help make sure people’s voices were heard.

Care plans were up to date and relevant and staff told us they were a useful and accurate tool. Any risks in relation to people’s care and support were identified and integrated into the care plans. Risks specific to people’s individual health and social needs were identified. Staff described to us how they would support people in particular circumstances, for example, if they became unwell. Their descriptions were in line with the guidance in care plans.

People were supported to follow their own daily routines and make day to day decisions about where they spent their time and when they got up and went to bed. Activities were arranged on a daily basis by staff. An activity co-ordinator was employed part time to organise planned sessions, events and trips out. There were plans for them to have additional training to enable them to develop the activities programme and help ensure all people were supported to take part in meaningful pastimes.

There was a management structure in the service which provided clear lines of responsibility and accountability. Although the management arrangements were temporary, staff told us they felt well supported and had confidence in the management team and the higher organisation. Staff morale was good and staff frequently referred to the importance of working as a team.

The inspection took place on 19 May 2015 and was unannounced. The last inspection took place on 22 and 23 January 2015 when we identified breaches of legal requirements relating to care and welfare and premises. We found care and treatment did not always meet people’s identified needs and ensure their health and welfare. The premises were not adequately maintained. Following the inspection in January 2015 the provider sent the Care Quality Commission (CQC) an action plan outlining how they would address the identified breaches.

Headlands is a care home which offers care and support for up to 34 predominately older people. At the time of the inspection there were 26 people living at the service. Some of these people were living with dementia.

The service is required to have a registered manager. 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 was a registered manager in post at the time of the inspection.

Staffing levels had improved since the previous inspection with the service relying less on relief staff who might be unfamiliar with people’s needs. However people, relatives and staff said it was not always possible to meet people’s social needs particularly those of people who did not want to take part in group activities. There was a programme of planned activities in place, however this could be dependent on the availability of care staff to organise them. Trips out were planned which were arranged in line with people’s interests and hobbies. Relatives told us they thought the range and availability of activities had improved over the past few months.

Improvements to the building were in progress at the time of the inspection. Some areas had been newly decorated and hand washing facilities had been installed in a sluice room to minimise the risks associated with infection control. The premises were clean and action had been taken to minimise the disturbance associated with the refurbishing programme. People and relatives had been involved in choosing colours for the redecoration. Following a resident and relatives meeting it had been decided to rename one room The Seaside Room and decorate it with a coastal theme.

Risk assessments in people’s care files covered a wide range of areas including falls. We identified a lack of consistency in the way in which peoples risk of falls was assessed. We have made a recommendation about staff training on the subject of falls assessment tools.

People and their families told us they considered Headlands to be a safe and caring environment. Staff received regular safeguarding training. However, an external professional told us they felt there was a lack of understanding within the service about the safeguarding processes they should follow.

People told us they enjoyed the food and people got the support they needed at mealtimes. One person said they would like a curry and we heard staff discuss how this could be organised for them. Mealtimes were flexible and where people had appointments or chose to eat later, arrangements were made to accommodate this.

People and relatives told us the staff were; “Very good.” The deputy manager had responsibility for training and had set up a detailed schedule. This was to help ensure staff kept up to date in areas identified as necessary for the service, as well as additional areas specific to the needs of people living at Headlands. Staff at all levels told us they felt well supported by a system of induction, supervision, appraisal and regular meetings.

Staff were caring and considerate in their approach to supporting people in day to day routines. We saw positive interactions between people and staff with staff checking frequently on people’s well-being. People were supported to make decisions about how and where they spent their time and maintain their independence. When people were unwell or anxious staff reassured them and offered both emotional and practical support.

Relatives told us they were involved in the planning of care and kept up to date regarding any changes in people’s needs. No-one had needed to make a formal complaint and people and relatives told us any issues were dealt with as they occurred.

There were systems in place to assess and monitor the quality of the service which involved all stakeholders. These included regular audits of all aspects of the service, care reviews, staff meetings and meetings for residents and relatives.

Some of the people who used the service were not able to comment in detail about the service they received due to their healthcare needs, but we did speak with three people who lived at Headlands who told us that they were pleased with their care and one person said “there is nowhere better to be”.

We saw people chatted with each other and with staff and people’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care. Care records showed people were at liberty to decline care or activities.

People experienced care, treatment and support that met their needs and protected their rights, people were protected by the home’s management of medicines and people were protected by the home’s robust recruitment procedures.

Records were largely accurate, up to date and stored securely.

We reviewed all the information we hold about this provider, carried out a visit on 15 September 2012, observed how people were being cared for, talked with people who used services, talked with staff, and checked records.

We spoke to four people who lived at Headlands, two visitors, and the staff and manager. All the comments we received from people who lived at Headlands were positive. Comments from people included “When our relative asks when she is coming home, we say no dear we are moving in with you”, “there's always someone there if you need help” and “they cook me whatever I ask for”.

We saw people’s privacy and dignity being respected and staff being helpful. We saw that residents were spoken with in an adult, attentive, respectful, and caring way. We saw and heard staff greeting people in passing, “hello Mr *” or “hello sir”.

Staff confirmed the training they had done and also confirmed that they were supervised. Staff said that they enjoyed working at Headlands.

This inspection was carried by one inspector over two days. During the inspection, the inspector worked to answer three key questions; is the service safe, effective and caring? We spoke with eight people who lived at the service, five relatives, one visitor and an external healthcare professional. We also spoke with eight staff members. We looked at two regulated areas at this inspection, care and welfare and premises.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

No, overall, on the day of the inspection we judged the service was unsafe. This was primarily because the home had not followed infection control guidance as published in the ‘Prevention and control of infection in care homes, published by the Health Protection Agency. The premises appeared generally clean and odour free. The exception to this was the kitchen, where we did find areas not well maintained or clean. Infection control procedures at the home were not consistently followed and this posed a risk to peoples’ safety.

Records were generally to a satisfactory standard.

Is the service effective?

No overall, on the day of the inspection we judged the service was ineffective.

People said staff did not always meet their needs and staff did not respond promptly when people needed assistance.

People all had an individual care plan which set out their care needs. Care plans contained satisfactory information and were accessible to staff.

Is the service caring?

No, overall, on the day of the inspection we judged the service was not caring.

Our observations of the care provided, discussions with people and records we assessed, enabled us to conclude individual wishes and needs were not consistently taken into account and respected. People did not always experience care, treatment and support that met their needs. The dignity of people at the home was not always respected by staff. There were very little meaningful activities for people living at the home. A significant number of people told us there were a lack of consistent stimulating activities offered at Headlands and this led to feelings of ‘frustration and boredom’. We saw people mainly spent time either in their rooms or in the lounge area watching the television or talking to other people. Some of the staff we spoke with did not understand the care needs of the people they supported. This was primarily because of a high dependence on a relief bank of staff who were less familiar with the home.

Most people who used the service said staff were caring. One relative of a person who lived at Headlands told us, ”They are a committed staff group”.