The unannounced inspection took place on 6 and 7 October 2016. A previous inspection on 15 April 2014 found that the standards we looked at were met.

Heathwood Care Home provides accommodation and personal care to up to 29 older people. The home specialises in the care of people who have a dementia. There were 24 people resident at the time of the inspection.

Heathwood Care 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 benefitted from a service run in accordance with current, research based, best practice in dementia care. It informed staff practice in how to support people in a way which valued each person’s individuality. The registered manager said, “We make sure the (condition of) dementia comes second to how people want to live their lives.” Through this approach people were able engage with every day community events, such as shopping and visiting a rugby club. Difficulties were overcome so that people’s strengths and desires were promoted.

Dementia care good practice influenced the home environment, which was designed to help people maintain their independence, safety and help them feel at home. It also fed into the home’s quality monitoring arrangements, with the use of tools designed specifically to understand the experience of people unable to talk about their feelings. Staff took time and knew how to engage with people so as to find what really mattered to them. They promoted their feelings of value and well-being by listening to their views and supporting them to achieve. For example, people wanted a record player, so they held an event to get the funds and then bought the item they wanted themselves.

There was a very wide choice of activities for people to engage in. These included arts and crafts, gardening, quizzes, sport, entertainment and current affairs. People’s behaviour differences were understood and supported, in a risk managed way. Staff negotiated with people so they could do as they wished as safely as possible.

People, their family members, staff and health care professionals spoke highly of the home. One health care professional said of the registered manager, “I found the manager caring, on the ball and it is a really well run home.” The registered person and the registered manager worked closely together to provide a very caring and effective service which put the person at the heart of decision making.

The service ethos was to provide a home from home for people. People’s family members told us, “It makes people feel it is their home” and “He’s happy here. He thinks this is his home.” To this end staff shared their time with people, wearing the same clothing (including nightware), eating together and sharing experiences, such as sports both within the home and outside at sports venues.

Staff respected people's privacy and dignity at all times and interacted with people in a caring, respectful and professional manner. Staff had made close relationships with people.

People were protected through safe recruitment practice and a high ratio of staff to people using the service. There were enough staff to support people in activities within the home, in the community and for their general safety and well-being. One staff member was seen helping people wind wool for their knitting. Multiple activity groups were held with enough staff to support each group.

The Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions, and where it is considered necessary to r

We inspected Heathwood Care Home on the 15th April 2014 to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe. We found that staff knew how to report any concerns they had regarding people's safety and that the provider responded appropriately to any concerns in order to protect people.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve. The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This means that people would be safeguarded as required.

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk.

People told us there were enough staff to meet their needs. One staff member told us "there are enough staff and people help out whenever needed". The registered manager set the staff rotas and we saw that a consistent level of staffing was provided. This helps to ensure that people’s needs are always met.

Is the service effective?

People's needs were assessed and plans drawn up to meet their individual needs. We found that people were supported in line with these plans. One staff member we spoke with told us "all the staff treat people well, as individuals and people".

People’s health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. Where people's needs meant they were unable to be involved in this, care was taken to involve others such as other professionals and family representatives to ensure people's best interests were taken into account.

People’s needs were considered with signage and the layout of the service enabling people to move around freely and safely. The premises had been sensitively adapted to meet the needs of people with physical impairments.

Visitors confirmed that they were able to see people in private and that visiting times were flexible.

Is the service caring?

People were supported by kind and attentive staff. We spoke with people using the service who told "the staff are nice" and "the staff care". We spoke with family representatives of two people who told us they were happy with the care, treatment and support of their relative. We observed people being cared for and supported throughout the day. We saw that care workers showed patience and gave encouragement when supporting people.

People using the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People completed a range of activities in and outside the service regularly. We looked at the activities planner for the week. This was clearly displayed in the lounge area. We saw that the activities on offer were those planned for the day. People told us they enjoyed the activities offered. One person said "I like the gardening group". Family representatives we spoke with told us they felt there were enough activities for their relatives.

The provider had in place systems to assess and monitor the quality of service provided. We were told of changes that had been put in place as a result of comments and complaints and learning from accidents and incidents. People can therefore be assured that complaints are investigated and action is taken as necessary.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system, records showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuously improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes. We were told by staff that "we get lots of support". We saw that staff received training. We were told by family representatives that "we are listened to and kept informed". This helped to ensure that people received a good quality service at all times

Many people were unable to fully express their views verbally due to a cognitive impairment. We spent time observing care practices to ensure people were cared for safely.

Throughout the day we observed staff were respectful and kind in their manner towards people. The people we talked with were positive about the staff and the way they were supported by them. One person told us, “I like it here." The manager told us," we offer several activities each morning and afternoon so people have real choices about how they want to spend their time."

We reviewed three people's care plans so we could find out how people were supported with their care needs. We saw people had individual care plans which described their preferences and routines. We saw the plans were well maintained by the staff team. We asked people about the care and support that they received. One person told us, "the staff are nice."

We saw the premises were well maintained. The toilets were clean and hygienic and all communal areas were tidy and organised.

People and their relatives told us they knew how to make a complaint and were confident the manager would resolve any complaint they had. A staff member told us,” if someone makes a complaint to me or I can see something is upsetting one of the residents then I tell the manager. Some people here can't tell us if they are unhappy about something so we need to keep a careful eye on them."

During our inspection we were able to meet with everyone who lived at the home and all care staff on duty. Many people were unable to fully express their views verbally. Therefore in addition to speaking with people we spent time observing care practices and talking with staff.

Throughout the day we observed that staff spoke with people in a friendly and respectful manner. We saw that when people required assistance it was provided in a discreet manner. We noted that staff assisted people to go to a bathroom or their bedroom when they required support with personal care. This ensured that people’s privacy and dignity were protected.

We saw that people were offered choices of drinks and food in a manner that was appropriate to their ability and understanding.

One person told us “I decide what time I get up and I can go to bed whenever I like.” Another person said “It’s lovely here, you can do what you like within reason.”

People who were able to express their views said that they were happy with the care that they received. One person told us “They are very good at helping you” another person said “I’m well looked after.”

We saw that people were well dressed and presented demonstrating that staff took time to support people with personal care. When staff assisted people we noted that they explained everything that was happening to the person they were supporting and offered ongoing reassurance. One person told us “The staff are always very gentle with you.”

We saw that people received support and assistance in a timely manner. All support was person centred and not task focussed, which meant that people received social stimulation as well as physical care. Staff demonstrated great patience when supporting people and took time to make sure that people were comfortable and content.