Heathfield (Horsham) Limited 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. The Heathfield (Horsham) Limited can accommodate up to 36 people. It has two respite beds. Care is provided over two floors. There are communal areas including a dining area and a lounge which led onto a conservatory. There is a large enclosed garden. At the time of our inspection there were 34 people living at the home, one of whom was on respite.

We inspected Heathfield (Horsham) Limited on 6 April 2018. This was an unannounced inspection. We carried out our last comprehensive inspection on 13 May 2015. At this time we rated the service as Good overall, but asked the provider to improve the provision of meaningful activities. At this inspection they had met this requirement. They had employed an activities lead and had arranged visits to local places, including taking people out for a pub lunch and afternoon tea in the local park. They had also made an activities corner, where people could find jigsaws and colouring. The activity lead was in the process of reviewing the activity programme and had sent a survey to people to ask what activities they liked best.

At the time of the inspection a registered manager was not in post. The previous registered manager had not been in post since August 2017. 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 care manager who, at the time of the inspection, had been in post for three weeks. They were planning to register with the CQC to become the new registered manager; however, at the time of our inspection, no application to register had been received.

There were regular Trustee reviews which involved talking to staff and people within the home. The Trustees did act upon concerns raised, but had not addressed the full impact caused by the changes in management. There was also no system of gaining regular feedback from the people, their relatives or the staff through regular meetings with the different groups. The home had audits and quality assurance systems, however, these had failed to consistently drive change or sustain improvements. Risks assessments relating to the individual did not always have sufficient details and this had not been identified by the management team. There were no personal emergency evacuation plans (PEEPs), which could affect people’s safety in the event of an emergency. We have made a recommendation in relation to this.

Staff had not received regular supervision or appraisals. However, they continued to receive regular training and were aware of safeguarding principles and the Mental Capacity Act (MCA). The staff were able to talk through how they would overcome barriers to communication, although there was no formal Accessible Information Standard (AIS) in place.

People felt safe within the home. There were personal and environmental risk assessments in place, medicines were administered appropriately and the environment was clean and tidy. The home had a good recruitment process and there was enough staff on duty. Staff reported they felt able to complete their work and knew the people they were looking after. There was a discrimination policy in place and staff told us they treated everyone with the same level of respect. We observed friendly and caring interactions between the people and the staff. There was a formal complaints procedure in place and the people felt able to voice their concerns.

People’s care needs were recorded clearly in care plans. These included details of

We inspected Heathfield (Horsham) Limited on 13 May 2015. This was an unannounced inspection. The service was registered to provide accommodation and personal care for up to 36 older people, with a range of age related conditions, including arthritis, mobility issues and dementia. On the day of our inspection there were 33 people living in the home, who required varying levels of support.

People received care from staff who were appropriately trained and confident to meet their individual needs and they were supported to access health, social and medical care, as required. However, there was a lack of stimulation and meaningful, person-centred activities, which put people at risk of social isolation.

This represented a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of this report.

A registered manager was in post and 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.

People’s needs were assessed and their care plans provided staff with clear guidance about how they

wanted their individual needs met. Care plans we looked at were person centred and contained appropriate risk assessments. They were regularly reviewed and amended as necessary to ensure they reflected people’s changing support needs.

There were procedures in place to keep people safe and there were sufficient staff on duty to meet people’s needs. Staff told us they had completed training in safe working practices. We saw people were supported with patience, consideration and kindness and their privacy and dignity was respected.

Safe recruitment procedures were followed and appropriate pre-employment checks had been made

including written references, Disclosure and Barring Service (DBS) checks, and evidence of identity had also been obtained.

Medicines were stored and administered safely and handled by staff who had received appropriate training.

People’s nutritional needs were assessed and records were accurately maintained to ensure people were protected from risks associated with eating and drinking. Where risks to people had been identified, these had been appropriately monitored and referrals made to relevant professionals.

Staff received Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) training to make sure they knew how to protect people’s rights. The manager told us that to ensure the service acted in people’s best interests, they maintained regular contact with social workers, health professionals, relatives and advocates. Following individual assessments, the manager had recently made DoLS applications to the Local Authority, for 10 people and was awaiting decisions.

There was a formal complaints process. The provider recognised that, due to their dementia not all people could raise concerns or complaints and their feedback was sought through regular involvement with their keyworker.

People were encouraged and supported to express their views about their care and staff were responsive to their comments.

The organisation’s values were embedded within the service and staff practice. The manager told us they monitored awareness and understanding of the culture of the service by observation, discussion and working alongside staff. Staff said they were encouraged to question practice and changes had taken place as a result.

The manager assessed and monitored the quality of service through regular audits, including

health and safety and medication. Satisfaction questionnaires were used to obtain the views of people who lived in the home, their relatives and other stakeholders.

On this inspection we only looked at medicine management to follow up on a warning notice we had issued because at a previous inspection we were unable to reconcile doses administered against quantities held from the records. We found on this occasion the service had implemented new systems to address this. We spoke to three people who were all happy with the way their medicines were managed. People who were able to and wished to self medicate were supported to do so.

During our visit we spoke with eight people using the service and one of their relatives. People’s comments included,

“I don't think there could be a better place.”

“It's great. Staff are friendly and helpful.”

We also gathered evidence of people’s experiences of the service by indirectly observing the care they received from staff. We observed staff addressing people by their preferred names. Personal care was carried out in private and staff were discreet when asking about care needs.

We also spoke with the administrator, manager and three care staff.

We were concerned that people were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines. For example, we found recording errors which meant it could not be confirmed that medicines had been administered correctly.

People we spoke with told us that they were very happy living in the home. People told us that that they were well cared for by staff that were friendly and helpful.

One person said, “I would not want to live anywhere else”.

Another person said, “I am very happy here, I like the staff and I am able to choose what I want to do”

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 and that the staff helped them to remain as independent as possible. Staff knew the people living at the home well and had a good understanding of their care needs.

Feedback on surveys given out by the home and completed by the people who live there were positive.