This inspection took place on 5 December 2018 and was unannounced.

Heathfield Residential Home 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. Heathfield Residential Home accommodates 34 older people, some of who were living with dementia in one adapted building. Accommodation is arranged over two floors and there is a lift to assist people to get to the upper floor. There were 33 people living at the service at the time of our inspection.

At the time of our inspection, there was a 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.

Heathfield was last inspected 14 November 2017. At that inspection it was rated as 'Requires Improvement’ overall. One breach of Regulation was identified during that inspection. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question(s) Safe, Effective, Responsive and Well-led to at least good.

At this inspection we found some improvements had been made, however we found one continued, and one new breach of the regulations.

Audits and checks were regularly carried out; however, they did not identify the shortfalls we found during our inspection. These included health and safety checks, which were regularly completed, however action had not been taken to reduce the water temperature within the service when it was identified as being too hot, and placing people at risk of scalding.

Medicines were not consistently safely managed. Records associated with medicines administrations were not consistently up to date containing the relevant information, and body maps were not in place to indicate the site application for Transdermal patch. Prescribed creams and ointments had not been dated on opening to ensure they did not exceed the manufactures expiry date.

People were supported to engage in activities to reduce the risk of social isolation, however people’s feedback about the quality and consistency of the activities was mixed.

Staff received training in safeguarding adults, and showed a good understanding of how to protect people from potential harm and abuse. Risks associated to people and the environment had been assessed and mostly mitigated. People told us staff understood how to deliver the care they needed. When things went wrong, staff discussed learning and how to prevent the accident or incident in team meetings.

There were sufficient numbers of staff deployed to meet people’s needs and keep them safe. Provider recruitment records confirmed that they followed staffing process to ensure the staff employed had the relevant experience and were of good character. New staff completed the providers induction programme which involved shadowing more experienced staff to get to know people. Following this there was an ongoing training and supervision programme for staff to ensure they had the skills to support people’s needs.

People’s needs were assessed by the registered manager, using recognised tools and good practice guidance. People were complimentary about the food, and received sufficient amounts to eat and drink. Staff worked within and externally to ensure people had access to healthcare services and on-going care and support. Suitable arrangements had been made to obtain people's consent to the care and treatment they received.

Since our last inspection there had been some improvements to the service. There was a new decking area to the rear of the property, which people told us they enjo

This inspection was carried out on 14 November 2017 and was unannounced.

Heathfield Residential Home 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. Heathfield Residential Home accommodates 34 people in one adapted building. Accommodation is arranged over two floors and there is a lift to assist people to get to the upper floor. There were 32 people living at the service at the time of our inspection.

A registered manager was leading the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the care and has the legal responsibility for meeting the requirements of the law. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Potential risks to people’s health had been identified and assessed. However, there was not always clear, detailed guidance for staff to follow to mitigate the risks to people. This did not impact on people, as staff knew people and took action to keep them as safe as possible.

There were no environmental risk assessments available for us to see at the inspection. Following the inspection, the provider sent us environmental risk assessments. Potential risks to people posed by the environment had not always been managed to keep people safe. Staff had not identified that people were at risk where a bath had been removed in a bathroom people used leaving pipes exposed. The area had not been cordoned off by staff. During the inspection, action was taken to reduce risk; the bathroom was locked to prevent people entering the room.

Staff completed regular checks and audits on equipment and all areas of the service. The audits had not identified shortfalls found at this inspection, for example, in care plans and risk assessments. When shortfalls had been identified, action plans had not been put in place, with who was responsible and when the action should be completed. Some shortfalls had been rectified but there was no record of how or when this had been completed.

Each person had a care plan, the person’s profile contained information about their life, choices and preferences. However, the care plans did not always contain details about how to support people in the way they preferred and reflect the care being given. Staff knew people’s preferences and people told us they received support in the way they preferred.

The registered manager met with people before they came to live at the service and carried out an assessment, to ensure staff were able to meet the person’s needs. The assessments did not include information about people’s equality and diversity needs, this was an area for improvement.

People’s care was planned following best practice guidelines. Staff monitored people’s health and people were referred to specialist healthcare professionals when needed. People had access to professionals including opticians, dentists and chiropodist to support them to be as healthy as possible. Staff worked with health and social care professionals to ensure people received the support they needed. People were supported to eat and drink enough to maintain a balanced diet.

People were protected from abuse and discrimination. Staff knew how to report concerns and felt confident that action would be taken. Staff knew how to keep people safe and understood their responsibilities for reporting accidents and incidents. The registered manager analysed accidents and incidents, to identify any patterns or trends and took action to mitigate the risk of them happening again. People’s medicines were managed safely and people received them on time.

Staff ensured people were protected from the risk