This inspection took place on 17 December 2018 and was unannounced. Heatherley - Care Home with Nursing Physical Disabilities is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of our inspection there were 40 people living at the service.

Heatherley - Care Home with Nursing Physical Disabilities is a care home that provides a range of services including nursing care and in-house physiotherapy treatment. The home is registered to provide support for up to 41 adults with physical disabilities. People live either in the main building or in one of six self-contained bungalows located within the grounds. People who live in the bungalows use the facilities in the main building any time of day or night. People living at Heatherley may have an acquired brain injury, stroke, cerebral palsy or multiple sclerosis.

At the time of our inspection there was an experienced 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.

At our last inspection of the service on 10 January 2017 we rated the service overall as ‘Good’ and 'Requires Improvement' in Well-led. This was because repairs to the home environment had not always been addressed promptly and some had the potential to impact on people's safety or wellbeing. Following the inspection, the provider submitted an action plan detailing the action they had taken to address the breach of Regulation 15 of the Health and Social Care Act (Regulated Activities) 2014. At this inspection we found improvements had been made and the breach of regulation had been met.

Risks to people were assessed and managed safely. Medicines were managed, administered and stored safely. People were protected from the risk of abuse and staff knew what action to take to ensure people’s safety. There were systems in place to ensure people were protected from the risk of infection and the home environment was clean and well maintained. Accidents and incidents were recorded, monitored and acted on appropriately. There were safe staff recruitment practices in place and appropriate numbers of staff to meet people’s needs in a timely manner.

There were systems in place to ensure staff were inducted into the service appropriately. Staff received training, supervision and appraisals. There were systems in place which ensured the service complied with the Mental Capacity Act 2005 (MCA 2005). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People’s nutritional needs and preferences were met. People had access to health and social care professionals when required and staff worked well with health and social care professionals to meet their needs.

People were treated respectfully and staff ensured their privacy and dignity was maintained. People’s diverse needs were met and staff were committed to supporting people to meet their needs with regard to their disability, race, religion, sexual orientation and gender. People were involved in making decisions about their care. There was a range of activities available to meet people’s interests and needs. The service provided care and support to people at the end of their lives. People’s needs were reviewed and monitored on a regular basis.

There were systems in place to monitor the quality of the service provided. People’s views about the service were sought and considered. The provider worked in partnership with the l

This was an unannounced inspection which took place on 10 January 2017.

Heatherley is a home providing a range of services (including nursing care). The home is registered for up to 40 adults with physical disabilities. People live in either the main building or one of six self-contained bungalows within the grounds. People who live in the bungalows use the facilities in the main building during the day. At the time of the inspection 37 people lived at the service. People living at Heatherley may an acquired brain injury, stroke, cerebral palsy or multiple sclerosis. All people living at the service are wheelchair users and the majority require a hoist to assist in moving them.

During our inspection the registered manager was present. 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.

Heatherley was last inspected on 22 December 2014 and 3 February 2015 when it was given an overall rating of ‘Requires Improvement.’ Three breaches of Regulations were identified and requirement notices were issued. These related to infection control, staffing and records. At this inspection we found that the requirement notices were met and improvements had been made in all areas. Systems for the management of infection control had been reviewed and staff followed safe procedures. Many aspects of the environment had been altered to promote good infection control. These included changes to equipment and facilities. Audits had been completed to monitor safe systems of work were being followed. Staff levels had increased and additional staff allocated of a breakfast time in order that sufficient staff were available to support people. We did observe a period of time when there was no staff presence in the lounge. We have made a recommendation about this in the main body of our report. There had been a complete review of the record keeping procedures at the service. Peoples care records were very organised, easy to follow and accurate.

Everyone that we spoke with said that the registered manager was a good role model. Quality assurance systems were in place to monitor the quality of service provided. However, the registered provider had not ensured action was always taken promptly when shortfalls were identified. Many fire doors and surrounds were badly damaged and could impact on their effectiveness in the event of a fire. Other doors were also damaged and had not been repaired or replaced despite these issues being identified over three months ago. This was a breach of Regulation 15 of the Health and Social Care Act (Regulated Activities) 2014.

Information of what to do in the event of needing to make a complaint was displayed in the home. During our visit we observed staff assessing if people were happy as part of everyday routines that were taking place. Some people felt that concerns were not always responded to in a way they would like. We have made a recommendation about this in the main body of our report.

People said that they felt safe. Staff had received safeguarding training and were able to explain the reporting procedures they would follow if they thought people were at risk of harm. Potential risks to people were assessed and information was available for staff which helped keep people safe.

Staff had received training relevant to the needs of people who lived at the service. Staff said they were fully supported by the registered manager. They received group and one to one supervision. Recruitment checks were completed to ensure staff were safe to support people.

People said that they consented to the care they received. Mental capacity assessments were completed for people and their capacity to make decisions had been assumed by staff unless

An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

At the time of our inspection, the service provided care and support to 37 people, and one person was living at the service for respite care. Some were not able to tell us about their experiences of living at Heatherley because of their communication difficulties; however, we did receive feedback from seven people who used the service. We also spoke with six members of staff, as well as the registered manager as part of this inspection.

We reviewed records that related to the management of the service which included support plans, policies and daily records.

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

Is the service safe?

We saw that risk assessments were in place to provide information to staff to help minimise the risk of any harm to people. For example, in relation to mobility.

The provider had ensured that staff were provided with information that related to safeguarding vulnerable adults. Staff were able to tell us what they would do if they had any concerns. One member of staff told us, “We have a flowchart to show us how we would report any concerns we had.”

Is the service effective?

Our observations told us that staff had a good understanding of people's needs. The people we spoke with who used the service confirmed this. We heard how one person may be able to go home and another whose mobility had improved during the time they had been at Heatherley.

The service had in-house physiotherapy and occupational therapy sessions available for people. This helped people maintain or improve physically.

Is the service caring?

People were encouraged to be independent but were helped when they needed any support. The staffing rotas showed us that the staff number each day matched what we had been told. We did not specifically witness people waiting to be assisted, but some people that we spoke with told us they would like to see more staff on duty.

We heard how people were treated with respect and dignity. One person told us, “All over the staff are very caring.”

Is the service responsive?

The service worked with other healthcare professionals or agencies. We saw, for example, in a care plan, and also heard from the manager how the service had worked with external and internal health professionals in relation to one person.

Is the service well-led?

There were meetings for the people who lived at the home as well as staff. Staff told us the manager encouraged them to make suggestions on how to improve the service. We saw that the results of the latest satisfactions were used to create an action plan to help improve the service.

During our visit we spoke with seven people who lived at Heatherley, nine staff members and one volunteer. We observed support and interactions between staff and people who lived there. We read three care plans and looked at other documents for specific information.

People who lived there told us the staff were “very helpful” and “kind.” One person said “it’s good here, I like living here.” One person told us the physiotherapy was "excellent."

We saw the records with regard to the specific abilities and needs of the people who lived there did not contain all the information necessary to ensure staff knew how to deliver care and support. There were no records of these documents having been reviewed to ensure this information was up to date.

People described the food as “very good” and said they had enough choice. We saw the support and assistance people required was given respectfully.

There were safe systems in place for the management of medicines. Some of the records required were not completed fully.

The necessary information to ensure staff were fit to carry out their work was present. Staff were supported and trained.

People told us they knew how to complain should they wish to do so and issues they had raised had been quickly resolved.

People who used the service told us staff treated them with respect, listened to them and supported them and were always available if they needed them. They told us they liked living at the home and that there were plenty of things to do. People we spoke with told us staff were polite, friendly, and helpful and that they felt supported to maintain their independence. One person told us: “We go out to lots of places and often go out to eat.” During our visit we saw staff treated people with dignity and spoke to them with respect. We observed staff encouraging people to make independent choices about the care they received.

We observed people receiving safe and effective care that was based on detailed care plans and risk assessments. People who used the service told us they were aware of which medications they took, how much and why, and that they discussed medication and treatment with their key worker. People told us they had no complaints about the service they received but that they had been made aware of the provider’s complaints procedure. We spoke with care staff who demonstrated a good understanding of the support needs of people who used the service and were clear about their responsibilities with regards to keeping people safe and the processes in place for reporting suspected abuse. The registered manager told us staff received ongoing training and supervision to meet the needs of the people they were supporting.

People living at the home told us they felt safe living there and that staff were always available when they needed them. They felt the staff knew what they needed and knew how they liked things done.

People we spoke with told us they were involved in making decisions about the way they lived their lives and the care they received. They felt the staff always respected their privacy and dignity. Staff knew the people living at the home well and had a good understanding of their care needs.

People told us that liked living at Heatherley - Care Home with Nursing Physical Disabilities.

Heatherley is a home providing a range of services (including nursing care). The home is registered for up to 39 adults with physical disabilities, of which 30 people can live in the home and six in self-contained bungalows within the grounds. People who live in the bungalows use the facilities in the main building during the day. At the time of the inspection 36 people lived at the service. People living at Heatherley have an acquired brain injury, stroke, cerebral palsy or multiple sclerosis. All people living in the home are wheelchair users and the majority require a hoist to assist in moving them.

The home is run by a registered manager, who was 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.

This was an unannounced inspection which took place on 22 December 2014 and 3 February 2015.

People were looked after by staff who knew them. Staff were kind and caring people and care plans were personalised. They reflected people’s individual assessed needs. However, care plans were not always up to date or did not contain the correct information. We have made a recommendation to the provider in relation to a couple of incidents when we felt staff had not treated people with dignity.

Improvement was required in relation to cleanliness and maintenance. Staff did not follow good infection control processes.

There were not always enough staff to look after people which affected when they were able to get up and go to bed. Staff felt rushed and people told us they had to wait to go to bed or to get up in the morning.

Although the registered manager understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) we found some best interest decisions had been made but not recorded in an easily accessible way. We have made a recommendation to the provider.

Staff were supported and received training to enable them to meet people’s individual requirements. However, staff did not receive training specific to the medical conditions of the people who lived at Heatherley which may have assisted staff to understand people’s changing health needs.

Staff had a good understanding of the various forms of abuse and knew what to do if they suspected anyone was at risk. Risk assessments were in place to keep people safe.

There was an emergency plan in place should the home have to be evacuated. This included guidance for staff to follow.

Medicines were managed safely and staff made sure people received the medicines they required in the correct dosage.

People were supported to take part in a range of activities of their choice and maintain their own friendships and relationships.

Staff had been safely recruited by appropriate checks being carried out before they commenced employment.

People had access to healthcare professionals. This included a GP, district nurses, dietician and chiropodist. Healthcare professionals told us staff referred people in a timely way when their health needs changed. There was a physiotherapist, occupational therapist and speech and language therapist based at the home.

People had a choice of food and drink throughout the day. Staff monitored people’s nutritional needs and responded to them appropriately.

The provider had undertaken a satisfaction survey and the results of this were used to make improvements in the home. There was evidence of quality assurance checks carried out by staff to help ensure the environment was a safe place for people to live. Complaint procedures were accessible to people.

During the inspection we found some breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We have also made a recommendation about people’s dignity. You can see what action we told the provider to take at the back of the full version of the report.