This inspection was completed on the 18 and 23 July 2018 and was a planned comprehensive inspection looking at all five key questions. Prior to this, the last inspection was completed as a responsive focussed inspection which took place in March 2018. This was in response to a specific incident of someone swallowing a hazardous substance. The Care Quality Commission (CQC) wanted to ensure people were safe and systems were in place to prevent any further incident occurring. In March 2018 we only looked at the key questions of safe and well-led. We did not identify any areas of concern and the service improved to a rating of overall good.

Heanton is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Heanton accommodates up to 52 people in one adapted building. The service is divided into three separate units which the service calls ‘houses’ by the name of Watersmeet, Exmoor and Williamson. Williamson is on the ground floor and caters for people living in the earlier stages of dementia. Also on the ground floor is a smaller house - Exmoor. This caters for people with complex needs due to their dementia needs. Upstairs there is one house - Watersmeet for people living with dementia who were in a repetitive stage or advanced stage of their dementia. The provider has developed and implemented this care model based on the household model of care pioneered in the USA by LaVrene Norton, Action Pact and Steve Shields. At the time of the inspection there were 51 people living at the service.

The service had 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.

Staff offered care and support which is exceptionally caring and compassionate. People mattered and staff had a detailed understanding of people’s likes, preferences and wishes. People were asked to think of a wish and staff went out of their way to achieve this. Some staff came in on their day off to take people out for trips and meals out. Staff visited people in hospital in the own time, to keep in contact and show they cared. Staff knew people and their families well and worked in a person centred way.

The visions and values were imaginative and people were at the heart of the service. The registered manager and senior leaders led by example. The service was really well led and creative in the way they developed the service. They had developed bespoke training which gave staff the enthusiasm to embrace their vision and values to provide a family and home like environment where people felt safe and loved. This was evident in our observations, in records and in the way staff spoke passionately about people. There were strong links with the local community. The management team looked for ways to ensure people, their family and staff were involved in the running and improvement of the service.

The service was exceptional at helping people to express their views so that all staff understood their views, preferences, wishes and choices. They did this by ensuring staff had the skills to understand and interpret people’s complex ways of communicating.

There were sufficient staff with the right skills and understanding of people’s needs and wishes. Some concerns had been expressed following the inspection about insufficient staff on duty. The provider was open and honest in identifying there had been times when they had been short on their preferred numbers in the last month or so. However, the provider, registered manager and staff team all agreed that people’s needs and safety were not compro

This inspection was a focussed inspection which took place on 13 March 2018 and was unannounced.

We completed this inspection to check on the welfare and safety of people following an incident where one person had swallowed a harmful substance. We wanted to ensure this type of incident could not occur again and lessons had been learnt. We had also been made aware by the provider that one person had sustained an injury following a fall from their wheelchair. We wanted to check that people had up to date risk assessments and where appropriate staff were using a lap belt on wheelchairs to help prevent people falling out of them.

The team inspected the service against two of the five questions we ask about services: is the service well led and is the service safe? This report only covers our findings in relation to this topic. You can read the report from out last comprehensive inspection, by selecting the ‘all reports’ link for Heanton on our website at www.cqc.org.uk

No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

When we last inspected the service in April 2017 we focussed on one key question- Safe. This was because we had received some information of concern via the local safeguarding team. This information related to issues relating to infection control practices, people's care needs not being met, staff attitude, lack of respect and dignity and people being placed at risk from lack of hygiene and continence support. None of the concerns raised to the Local Authority Safeguarding Team were upheld. We observed people being treated with respect, dignity and the staff observed were caring and compassionate on the day we inspected. We did still rate this key question as requires improvement because we observed some key times in specific areas where there may not have been enough staff to meet people’s needs. We made a recommendation for the service to review the deployment of staff which they responded to. They reduced the number of staff taking breaks together so staffing levels remained consistent throughout the day.

Heanton is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Heanton is registered to provide care support and treatment for up to 52 people. At the time of this inspection there were 47 people living at the service.

They mainly support people living with dementia. The service is divided up into three houses. Williamson is on the ground floor and caters for people living in the earlier stages of dementia. Also on the ground floor is a smaller house- Exmoor. This caters for people with complex needs due to their dementia needs. Upstairs there is one house for people living with dementia who were in a repetitive stage or advanced stage of their dementia. The provider has developed and implemented this care model based on the household model of care pioneered in the USA by LaVrene Norton, Action Pact and Steve Shields.

Heanton has 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.

Following the incident of one person swallowing a harmful substance, the provider had reviewed their policy and procedures to ensure this type of incident could not occur again. A harmful substance had been temporarily removed from a locked cupboard to a cupboa

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions.

This inspection was unannounced and took place on 24 April 2017 in response to some information of concern received by the local authority safeguarding team. This information related to issues relating to infection control practices, people’s care needs not being met, staff attitude, lack of respect and dignity and people being placed at risk from lack of hygiene and continence support. None of the concerns raised to the Local Authority Safeguarding Team have been upheld. We observed people being treated with respect, dignity and the staff observed were caring and compassionate on the day we inspected.

This report only covers our findings in relation to the areas of concern identified in the information of concern we received. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Heanton Nursing Home on our website at www.cqc.org.uk.

When we last inspected on the 3 and 6 February 2017 we rated the service as overall ‘requires improvement’ with two breaches in regulation. These related to safe care and treatment. In particular we identified issues in relation to the safe storage of medicines and accuracy of records of medicines administered. We had also observed one incident where a person had not been fully supported to prevent their risk of choking. We also issued a requirement in relation to good governance. We found that although audits were in place they had not picked up on some of the environmental issues we identified and there had not been medicine audits for six months. We asked the service to send us an action plan to show how the breaches in regulation were going to be met and what improvements they intended to make. We received this action plan within the timescales requested. At this inspection we checked compliance with regulation 12, safe care and treatment and found this was met. We did not check on regulation 17, good governance, as we judged there to be insufficient time to enable the service to demonstrate that their audits and quality assurance improvements were embedded. This was because it was less than two months since the last comprehensive inspection took place. As part of this inspection we did review and discuss audits relating to medicines and dignity as these were areas we were reviewing at this inspection.

Heanton is registered to provide nursing and personal care for up to 52 people. They mainly support people with dementia. At the time of this inspection there were 46 people living at the service.

The provider has developed and implemented a care model based on the household model of care pioneered in the USA by LaVrene Norton, Action Pact and Steve Shields. This had resulted in the environment being divided into smaller houses to support small group living. Groups were determined based on the stage of the dementia of the person living at the home. There were four 'houses' (distinct areas within the building) which provided care for people at early stages of dementia, and people living with dementia who were experiencing an altered reality. The third area was for people who were living with dementia who were in a repetitive stage and the fourth house was designated for people who were living with advanced dementia. The provider had implemented this model with the support of specially recruited dementia practitioners. This implementation was still work in progress with staff still learning about the model of care and the environment still being adapted to suit each of the houses.

The service had a manager who was in the process of registering with CQC. 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.

Since the last inspection the provider has introduced a new ‘hou

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

This inspection was unannounced and took place on 3 and 6 February 2017. There were 44 people living at the service. When we last inspected on 14 November 2016, in response to some concerns raised by family whose relative lived at Heanton, we found a number of areas where improvements were needed. This included environmental issues and support and supervision of staff to ensure they had the right skills. Following the November focussed inspection we met with the provider and their management and quality assurance team on 18 January 2017 to discuss the improvements needed and future actions to be taken by the service. This included a discussion about how they had prioritised ensuring people’s clinical needs were being met and that people were safe. The provider and the staff team are now working on implementing their new model of care via a year long training course to enable staff to understand the culture and ethos of the household model. The provider sent us an action plan showing how they intended to make improvements as detailed within the previous inspection. We used this information as part of this inspection to check how well embedded any new ways of working were and whether this had impacted on the quality of care and support people were receiving.

Heanton is registered to provide nursing and personal care for up to 52 people. They mainly support people with dementia.

The provider has developed and implemented a care model based on the household model of care pioneered in the USA by LaVrene Norton, Action Pact and Steve Shields. This had resulted in the environment being divided into smaller houses to support small group living. Groups were determined based on the stage of the dementia of the person living at the home. There were four 'houses' (distinct areas within the building) which provided care for people at early stages of dementia, and people living with dementia who were experiencing an altered reality. The third area was for people who were living with dementia who were in a repetitive stage and the fourth house was designated for people who were living with advanced dementia. The provider had implemented this model with the support of specially recruited dementia practitioners. This implementation was still work in progress with staff still learning about the model of care and the environment still being adapted to suit each of the four houses.

There was a manager in post who had been the interim manager since July 2016, but had only just put in an application to register with CQC. She had previously been approved as the registered manager at this service, but made the decision to deregister at the start of this year. This was because she had, at the time wanted to take a more hands on role within the home. She said she now felt ready to take on the responsibility of being the registered manager again. 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.

We found there were improvements needed with the safe storage of medicines to ensure they were being stored at the correct temperatures. We were told at the time of the inspection that medicine management had not been audited for up to one year. The provider has since said audit records show there had been some medicine audits but not as frequently as they should be. There were some gaps in the medicine administration records (MARs) which had not been picked up. Supervision records showed the manager had noted gaps in the way as needed medicines had been recorded, but this had not led to a full audit. We heard how two nurses

We completed this focussed inspection as a result of some information of concern we had received anonymously via our website. The information indicated people’s needs may not be met safely or in a timely way. We had also received some information from Heathwatch, with no timeline so some of this may have been historical, however it also indicated people’s needs may not be being met. Healthwatch England is the consumer champion for health and care. Each local Healthwatch exists to ensure the voices of people who use services are listened to and responded to. Care Quality Commission (CQC) has a duty in law to take account of the views and experiences of local Healthwatch. We work with the Healthwatch network to ensure that the views and experiences of local people inform the development, design and monitoring of CQC’s approach to regulating health and care services. This report only covers our findings in relation to the areas of concern identified in the information of concern we received. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Heanton Nursing Home on our website at www.cqc.org.uk.

This inspection took place on 14 November and was unannounced. Prior to this inspection, we completed a comprehensive inspection in April 2016 where the services was rated as overall good, with requires improvement in safe. This was because we identified improvements were needed to ensure the environment was safe and met people’s needs. We did not issue any requirement notices at this inspection. We had assurances from the provider that the areas we identified as needing improvement had been addressed or were being addressed. We also completed a focussed inspection in July 2016 as a result of receiving some information of concern about one person’s needs not being met and them being in a room which was too hot and described as being in a poor state of repair. The concern also detailed the one person appeared dehydrated and did not have access to drinks. We did not find evidence to show this was the case when we inspected in July. We found the room was suitable for the person and they had a call bell and access to drinks when needed.

Heanton is a registered to accommodate up to 52 people and provides personal care and support as well as nursing care. Most people using this service were living with dementia. At the time of this inspection there were 48 people living at the service.

The Provider has developed and implemented a care model based on the household model of care pioneered in the USA by LaVrene Norton, Action Pact and Steve Shields. This had resulted in the environment being divided into smaller houses to support small group living. Groups were determined based on the stage of the dementia of the person living at the home. There were four 'houses' (distinct areas within the building) which provided care for people at early stages of dementia, and people living with dementia who were experiencing an altered reality. The third area was for people who were living with dementia who were in a repetitive stage and the fourth house was designated for people who were living with advanced dementia. The provider had implemented this model with the support of specially recruited dementia practitioners. This implementation was still work in progress with staff still learning about the model of care and the environment still being adapted to suit each of the four houses.

There was a manager in place who was in the process of applying to us to become the registered manager. She had previously been approved as the registered manager at this service, but made the decision to de-register at the start of this year. This was because she had at the time wanted to take a more hands on role within the home. She now said she is ready to take on the challenge of registered manager again, so is re-applying to register with CQC. A registered manager is a person who has registered with the

We carried out an unannounced comprehensive inspection of this service on 5 and 6 April 2016. We found that although care and support was being well planned, details about whether someone’s liberty was being deprived and whether the service was operating under the principles of the Mental Capacity Act 2005, were less clear within the electronic care plans. Staff were not always aware of who may be subject to a Deprivation of Liberty safeguard (DoLS) or who had an application for such a safeguard awaiting approval. Also, some improvement was required to the safety of the premises. The provider already had plans in place to make significant improvement to the home environment. Neither of those issues were looked at within this focused inspection.

After the April 2016 inspection we received concerns in relation to one person’s room and a possible negative impact from them being in that room. As a result we undertook this focused inspection, on 27 July 2016, to look into those concerns. This report only covers our findings in relation to this topic. Other aspects of the concern, relating to staff practice issues, were investigated by the provider. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk.

Heanton is a registered to accommodate up to 52 people and provides personal care and support as well as nursing care. Most people using this service are living with dementia. The Provider has recently developed and have begun to implement best practice care delivery based on the household model of care pioneered in the USA by LaVrene Norton, Action Pact and Steve Shields. This has resulted in the environment being divided into smaller houses to support small group living. Groups are determined based on the stage of the dementia of the person living at the home. There were four ‘houses’ (distinct areas within the building) which provided care for people at early stages of dementia, people living with dementia who were experiencing an altered reality. The third area was for people who were living with dementia who were in a repetitive stage and the fourth house was designated for people who were living with advanced dementia. The model of care is known as the household model. The provider has implemented this model with the support of specially recruited dementia practitioners.

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. At the time of the inspection there was not a registered manager in post. The provider said they had interviewed prospective managers but the recruitment process was still not complete. Senior management in the organisation was overseeing the service, visiting some days, and there was a clinical lead overseeing the day to day running of the home.

Arrangements were in place for staff at the home to recognise and mitigate risks associated with hotter than average weather. However, the design of one person’s room meant there was probably little throughput of air, which may have led to the person using it experiencing discomfort.

People’s needs with regard to adequate fluid intake were met. People had drinks available to them and during the hot weather staff had encouraged people to take more fluids and exert themselves less.

People were offered a choice of room where possible. Where a small room was considered the safest option for one person, this had been arranged; they said they were happy with it.

The one room we looked at had a working nurse call system in place, a working smoke alarm and a few small holes in the wall. However they were not impacting on the person’s use

This was the first comprehensive ratings inspection for this provider. Previously this home had been registered under a different legal entity. The new registration took on February 2016. The representatives of the new legal entity were aware of improvements that needed to be made to the home following the last inspection under the previous legal entity. The inspection was unannounced and completed over two days on the 5 and 6 April 2016.

Heanton is a registered to accommodate up to 52 people and provides personal care and support as well as nursing care. Most people using this service are living with dementia. The Provider has recently developed and have begun to implement best practice care delivery based on the household model of care pioneered in the USA by LaVrene Norton, Action Pact and Steve Shields. This has resulted in the environment being divided into smaller houses to support small group living. Groups are determined based on the stage of the dementia of the person living at the home. There were four ‘houses’ (distinct areas within the building) which provided care for people at early stages of dementia, people living with dementia who were experiencing an altered reality. The third area was for people who were living with dementia who were in a repetitive stage and the fourth house was designated for people who were living with advanced dementia. The model of care is known as the household model. The provider has implemented this model with the support of specially recruited dementia practitioners.

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. At the time of the inspection there was a registered manager in post, however she has decided to apply to deregister with the Care Quality Commission and instead take a more active nursing role within the home. There was an interim manager already in place who had experience of managing similar services.

At the time of the inspection there were 39 people living at the service. Some of the people who had been living at this service for some time had recently been moved to different areas depending on their needs in relation to their dementia. Some relatives spoke with us about their concerns about the moves for people. Some were still getting used to different rooms, floors and staff. One relative said ‘‘I understand why they have made these moves and I think it is a good idea, but I and (name of person living at the service) were used to being downstairs and knew the staff well.’’ Another gave a more positive view saying “I can’t fault the staff they are all lovely. They look after my relative and me for that matter in a very kind and caring way”

We found that although care and support was being well planned, details about whether someone’s liberty was being deprived and whether the service was operating under the principles of the Mental Capacity Act 2005, were less clear within the electronic care plans. Staff were not always aware of who may be subject to a Deprivation of Liberty safeguard (DoLS) or who had an application for such a safeguard awaiting approval. The senior managers agreed the care files were not explicit enough in this area but were certain staff worked within the main principles of ensuring people’s rights and consent was always considered in their everyday practice. We saw examples of care delivery which supported this. For example staff checked with people they were happy and understood what was happening, before providing support to them. Since the inspection the manager has provided evidence to show care electronic care plans now include whether DoLS have been applied for and/or authorised.

Improvements were needed to ensure the environment met people’s needs.