About the service: Heathfield Residential Home is a care home that provides accommodation and personal care for up to 25 ladies. The home is a large Victorian three-storey privately owned care home in the village of Grappenhall in Warrington.

People’s experience of using this service: People living at Heathfield Residential service benefitted from an outstandingly caring and responsive service. The people we spoke with consistently told us they were very happy, felt safe and were treated with exceptional kindness. The home was warm, welcoming and homely with a luxurious feel.

Without exception, people and their relatives told us that the staff were kind, caring and went over and above what you would expect in a care home.

There were enough staff to meet people’s needs and provide companionship to the people that lived there. People were empowered to retain their independence and live their life in the way they chose.

Medicines were safely managed and those who were assessed as able to self-medicate were encouraged to do so.

Staff showed a detailed knowledge of the lives of people who lived there. They knew their parents’ names, where they grew up and engaged in meaningful conversations about people’s lives and histories. Staff were particularly sensitive to times when people living there needed reassurance and compassion.

The service used a variety of tools to communicate with people and their representatives. Relatives of people who lived there were encouraged to be as involved in their relatives care as they wished. The service offered regular social events that included open invitations to friends and relatives.

There were varied and innovative activities that incorporated the use of new technology and worked in collaboration with academic research. People who wished to go out were taken to the places of their choosing, examples included the beach, the theatre, the pub and many more.

People told us they enjoyed the food and were offered a variety of choices made with fresh ingredients. During the inspection we saw that the food was appetising and mealtimes were a friendly, sociable time. People who wished to eat alone were supported to do so.

The registered provider was working in collaboration with academic researchers at Lancaster University to develop innovative, interactive technology to improve the lives of people living with dementia.

The service used assistive technology to keep people safe. Extra security measures had been researched and implemented. These included door alarms, a second half-door outside the main door, hall sensors and a GPS tracker bracelet for people who were at risk of trying to leave the building.

People were supported to maintain their diverse needs and preferences. Staff were aware if people followed a faith and empowered them to continue to do this. The service had its own chaplain and retained links with other religious communities.

People who lived at the service and staff, spoke highly of a fair, supportive and approachable management team.

Staff who had been identified as strong in certain areas were asked to take the lead in certain aspects of care and advise the management team where improvements could be made.

More information is in the full report

Rating at last inspection: At the last inspection the service was awarded an outstanding rating. (Published 10 September 2016)

Why we inspected: This inspection was a planned comprehensive inspection. We had not received information of concern prior to or during the inspection.

The inspection took place on 4 and 8 February 2016 and was unannounced. At our previous inspection in November 2013 we found that the provider was meeting the regulations in relation to the outcomes we inspected. There were 22 people living in the home at the time of our inspection.

Heathfield is a care home that provides accommodation and personal care and support for up to 22 older people. The accommodation is provided over three floors in a Victorian building which has been converted and adapted for use as a residential care home. The home has 22 bedrooms of varying size, 11 of which have an en-suite facility. There is a range of communal spaces including: lounges; dining rooms and sitting areas. Toilet and bathroom facilities are dispersed throughout the building. There is a car park provided for visitors and staff. The home is situated in a quiet residential area of Warrington.

The home 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.

People who lived in the home and their relatives spoke of the outstanding care delivery. They told us that the provider and staff of the home went above and beyond to ensure they received a person centred service. Staff maintained people’s privacy and dignity ensuring that any care or discussions about people’s care were carried out in private. We saw that interactions between staff and people who used the service were caring and respectful with staff showing patience, kindness and compassion. We observed that staff knew and understood the people they cared for and ensured that people were provided with choices in all aspects of daily life. Comments made included “The real beauty of Heathfield is the simple fact that the owners and staff constantly refer to it as a ‘Home’ in the truest sense of the word. You cannot believe how good it is to hear and then see that philosophy in action”.

There was a warm cosy atmosphere within the home and it was clear that a lot of thought had been given to creating as homely an atmosphere as possible.

Innovative assistive technology had been introduced to enable people who lived in the home to keep up to date with news and events and have regular electronic contact with family and friends.

The home had worked with Lancaster University to develop specialist software to support dementia care and had introduced this system into the home as part of effective care support and to promote family engagement. Relatives told us that this system enabled them to enjoy effective electronic contact with people who lived in the home.

The home used ‘if I could I would’ form which held details of the wishes expressed by people who lived in the home as what they wished they could do. We saw that the staff worked hard to make some of these a reality such as going to a tea dance or a local swimming pool.

Staff were well trained and used their training effectively to support people and assist them with their daily life and help them to retain their independence. Staff told us that the provider had developed some extra training events for relatives of people who used the service to enable them to enjoy effective communication for people who are living with dementia.

Staff understood and worked within the requirements of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards. Staff were able to demonstrate an excellent understanding and knowledge of people’s support needs so as to ensure people’s safety and protect their human rights.

Staff were recruited through a rigorous procedure.. As part of the recruitment process the provider used value based recruitment techniques, a clearly defined culture statement and staff competency a

We considered our inspection findings to answer questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

This is a summary of what we found-

Is the service safe?

Records showed that staff had received training to include safeguarding, dementia care and moving and handling and they told us they felt confident in being able to maintain people's safety.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The staff had a good knowledge base regarding these safeguards. Staff had access to appropriate policies and procedures including guidance on the Mental Capacity Act. These policies are necessary to ensure the protection of vulnerable people who lacked the ability to consent on various issues.

Is the service effective?

People told us they were happy with the care that had been provided and they felt their needs were being met. We observed the support being provided and saw examples of good communication and patience by staff. Staff discussed the individual needs of people they supported and described the support they provided on a day to day basis including daily choices. Staff were knowledgeable about people's needs and requests and were therefore able to provide effective services.

The service had developed areas within the environment to support people with dementia. They had developed an open plan sun lounge; an open plan dining area and quiet lounge sitting areas. They had also developed specialised picture signs as a way of advising people regarding where services were located such as; toilets, bathrooms and each person's bedroom. These signs helped people with dementia to be orientated and reminded about their surroundings.

Is the service caring?

People told us that they or their relative had been involved in discussions about the care and support provided and that the care plans were discussed and updated if any needs changed.

We observed the support provided to people living at the service and we noted various examples of good practice. We observed staff respectfully speaking with people as they approached them so they were aware who was supporting them. We saw various examples of good communication and patience by staff who interacted with each person in a friendly and positive manner.

Several people said the food was plentiful and tasty. One person said "The food is really nice and I enjoy it, especially the chicken meals" and another person said "The food is always wonderful, the chef is amazing. He has meetings with us all to see what food we want on the menu".

Is the service responsive?

People living at the service had a detailed care plan in place to help to show how their needs would be met while living at Heathfield. These records were detailed and showed that people's choices and diverse needs were identified and care plans were regularly reviewed. People told us that they were able to discuss arrangements made for their care and they said that they were happy and content with the manner in which their care and support was provided.

During our visit we noted that people were being provided with assistance and support in a timely manner and although staff appeared to be very busy they were able to provide services which met the needs of the people living in the home.

We noted a mixture of 'in house' training was provided via the home manager who had undertaken external courses to enable her to cascade training sessions to staff. The external courses included training provided by Warrington Collegiate in respect of managing advanced dementia. The course content gave insight into behaviour management, challenging behaviours and de-escalation techniques and staff told us this training was most useful in understanding the actions of the people who lived in the home and where appropriate providing responsive interventions.

Is the service well-led?

People told us they were always kept informed and updated regarding their support and needs. A recent survey sent to relatives and people living at the service provided positive results regarding their opinions about Heathfield.

The provider undertakes fortnightly audits on the staffing levels and services provided and takes appropriate actions to ensure the home is run in the best interest of the people who live there.

People using the service at Heathfield confirmed they were treated with respect and their dignity was maintained.People also told us that they were satisfied with the standard of care provided and felt that staff understood their needs.

Comments received from people who used the service included:"I am happy & well looked after here". "We've never had it so good" "They can't do enough for you".

Likewise feedback received from four relatives included "The staff are very good, professional,welcoming,friendly" "I was impressed with it from the start". "They stimulate them as much as they can do.There is something going off every day" "She has a choice about her food, its very good.They accommodate her preferences".

Systems were in place to offer protection to the people who use the service from abuse and people spoken with confirmed that they felt safe and had no concerns regarding the care provided.

People using the service at Heathfield confirmed that they were treated with respect and their dignity was maintained. People also told us that they were satisfied with the standard of care provided and were of the opinion that staff understood their needs.

Comments received from people using the service included: “The staff are very kind and caring people”; “I’m very happy. I would say if I was not. I am treated as an individual and can’t fault the care provided”; “I have no issues. I am well looked after”; “I am of the view the staff are attentive to my needs and understand the things I need help with” and “The food is brilliant. There are activities most days and the staff are wonderful.”

Likewise feedback received from two relatives included: “I am happy with the standard of care provided” and “The home has a friendly atmosphere and visitors are always made to feel welcome.”

Systems were in place to offer protection to the people who use the service from abuse and people spoken with confirmed that they felt safe and had no concerns regarding the care provided. No concerns, complaints or allegations were received from the people using the service during our visit to Heathfield.

We spoke with eight people who were living in the home.

People said they had been asked what their needs were before admission and the manager had discussed with them the care the home could provide. They told us staff consulted them about their individual needs and involved them in decisions about their care and treatment.

Most of the people we spoke with said they received the help they needed. Comments included "I’m quite satisfied”; "I’m quite happy to end my days here"; "It’s a lovely place"; “I can’t grumble”.

People we spoke with told us that they felt safe in the home. We asked them if they would know how to raise a concern about something that was worrying them. They expressed confidence that if they had a problem they would be able to discuss it with the registered manager and that it would be taken seriously.

All the people we spoke with said the staff treated them well and that there were enough staff to support them to fulfil their needs, although two people said they had to wait a while for staff to answer the call bell at night. Comments included "They’re all very good", and “They’re very helpful and very caring".

People also told us there was a range of activities they could participate in, such as film shows, dominoes, card games, board games and quizzes. One person said “There’s something to do every day except at the weekends, but we do have a church service on Sunday.”