We carried out an unannounced inspection of Heightside House Nursing Home on 7 and 8 November 2018.

Heightside House Nursing Home is a care home which is registered to provide nursing care and

accommodation for up to 78 adults with mental ill health. People in care homes receive accommodation and nursing 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.

Accommodation is provided in four separate 'units.' The House, The Mews, Close Care and The Gate House. There is also a separate rehabilitation/activities centre.

The House is an adapted premises and incorporates the High Dependency Unit and has both single and double bedrooms over four floors. Some bedrooms have en-suite facilities. There are two lounges, one lounge/dining room, a separate dining room and a room for people who smoke. A passenger lift provides access to all floors. The Mews is purpose built and consists of one six bedded unit, shared bungalows and flats. Close Care is a purpose built premises and includes a seven bedded unit and a bungalow accommodating four people. The Gate House is an adapted building and can accommodate up to three people. All the bedrooms are single occupancy and there are communal lounges/dining areas.

The service was managed by a registered manager; however, they were not available at this 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.

At our last inspection on the 19, 20 and 21 February 2018 the overall rating of the service was Requires Improvement. The provider was in breach of two regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014. The breaches related to a lack of robust processes for mitigating and managing risks to individuals, also quality monitoring and oversight.

We also found some further progress was needed with acting upon people's views, ideas and suggestions, we therefore made a recommendation on this matter. Following the inspection, we received an action plan from the provider outlining the action they would take to make improvements. As this was the third time the service had been rated Requires Improvement, we held a meeting with the provider to discuss their plans going forward and their governance arrangements at the service.

At this inspection we found the provider was in breach of three regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014. The breaches related to a lack of robust processes for managing risks to individuals, unsafe medicines management and a lack of person centred care planning. This was the fourth consecutive time the service was rated as Requires Improvement. You can see what action we told the provider to take at the back of the full version of this report.

There was a management team in place to provide leadership and direction of the service. The provider had introduced better processes for monitoring and checking the service and making improvements. Some of these processes were new, therefore time was needed to show how they worked and if they would ensure there was effective monitoring and development at the service.

We again found some individual risk assessments had not been properly completed or regularly reviewed. We could see some improvements had been made, but progress had been slow in ensuring risks to people’s well-being and safety were identified and managed. We also found improvements were needed with supporting people safely with their medicines.

Processes for planning and delivering people’s care required improvement, to make sure it was personalised to them and met their individual needs, goals an

We carried out an unannounced inspection of Heightside House Nursing Home on 19, 20 and 21 February 2018.

Heightside House Nursing Home is a care home which is registered to provide nursing care and accommodation for up to 78 adults with mental ill health. People in care homes receive accommodation and nursing 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.

Accommodation is provided in four separate ‘units.’ The House, The Mews, Close Care and The Gate House. There is also a separate rehabilitation/activities centre. The House is an adapted premises and incorporates the High Dependency Unit and has both single and double bedrooms over four floors. Some bedrooms have en-suite facilities. There are two lounges, one lounge/dining room, a separate dining room and a room for people who smoke. A passenger lift provides access to all floors. The Mews is purpose built and consists of one six bedded unit, shared bungalows and flats. Close Care is a purpose built premises and includes a seven bedded unit and a bungalow accommodating four people. The Gate House is an adapted building and can accommodate up to three people. All the bedrooms are single occupancy and there are communal lounges/dining areas.

The service was managed by 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.

At our last inspection on the 22 and 23 February 2017 the overall rating of the service was ‘Requires Improvement’. We found progress was needed with medicines management, checking systems and provider oversight of the service. We therefore made recommendations on these matters.

During this inspection we found the provider was in breach of two regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014. The breaches related to a lack of robust processes for mitigating and managing risks to individuals, also quality monitoring and oversight. You can see what action we told the provider to take at the back of the full version of this report. We also found some further progress was needed with acting upon people’s views, ideas and suggestions and have therefore made a recommendation on this matter. This was the third consecutive time this service has been rated Requires Improvement.

We found there were good management and leadership arrangements in place to support the day to day running of the service. However it was not clear the provider had proper oversight of the service. We noted there was a lack of information to show how they assured themselves about the quality and safety at the service.

Systems were in place to maintain a safe environment for people who used the service and others. Processes were in place to prevent and control the spread of infection. We found some matters were in need of attention and the registered manager commenced action to make improvements.

There were safe processes in place to support people with their medicines, but some improvements were needed.

Recruitment practices were in place to make sure appropriate checks were carried out before staff started working at the service. There were enough staff available to provide care and support and staffing arrangements were kept under review.

Staff were aware of the signs and indicators of abuse and they knew what to if they had any concerns. Staff had received training on safeguarding and protection matters. They had also received training on positively responding to people’s behaviours. The service monitored incidents and accidents and to ensure there was a proactive ‘lessons learned’ approach.

Arrangements were in place to

The inspection was carried out on 22 and 23 February 2017. The first day of the inspection was unannounced.

Heightside House is registered to provide nursing care for up to 78 people who have mental health care needs. The service provides long and short term care/support and rehabilitation. There are extensive grounds with walkways, lawns, gardens and a greenhouse. There is access to public transport at the bottom of the drive. At the time of the inspection there were 55 people accommodated at the service.

Accommodation is provided in four separate units: The House, The Mews, Close Care and The Gate House. There is also a separate rehabilitation/activities centre.

The House incorporates the High Dependency Unit and has both single and double bedrooms over four floors. Some bedrooms have en-suite facilities. There are two lounges, one lounge/dining room, a separate dining room and a room for people who smoke. A passenger lift provides access to all floors.

The Mews consists of one five bedded unit, shared bungalows and flats. Close Care includes a seven bedded unit and a bungalow accommodating four people.

The Gate House can accommodate up to three people. All the bedrooms are single occupancy and there are communal lounges/dining areas.

The service was managed by 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.

At the previous inspection on 12 and 13 August 2015, we asked the provider to make improvements in relation to: effective and safe staff recruitment procedures, the safe management of medicines, preventable and avoidable risks of harm to individuals, the safety and security of premises and equipment, the processes for receiving and acting on complaints and the processes in place to ensure the service is operated effectively. We received an action plan from the provider indicating how and when they would meet the relevant legal requirements. At this inspection we found sufficient improvements had been made in rectifying these matters. However further progress was needed with medicines management and some checking systems for provider oversight of the service. We have therefore made recommendations on these matters.

People spoken with did not express any concerns about the way they were treated or supported. We did not observe anything to give us cause for concern about people’s wellbeing and safety. People had access to information on abuse, protection and safeguarding. Individual risk assessments had been carried out and staff were given instructions about how to manage any risks to help keep people safe. Staff expressed a good understanding of safeguarding and protection matters; they knew what to do if they had any concerns.

Recruitment practices made sure appropriate checks were carried out before staff started working at the service. There were enough staff at the service to provide people with support and changes to staffing levels could be made if needed.

There were some good processes in place to manage and store people’s medicines safely. We found some improvements were needed; we have therefore made a recommendation about the management of medicines. Staff responsible for supporting people with medicines had completed training. This had included an assessment to make sure they were capable in this task.

Arrangements were in place to promote the safety and security of the premises, this included maintenance, servicing and checking systems. We noted refurbishment had been carried out to up-grade and improve the environment; however we requested that some areas were attended to during the inspection.

People’s needs were being assessed and planned for before they moved into the servic

At the scheduled inspection of 05 June 2013 we found that we could not determine if staff training was up to date. We conducted this follow up inspection to check if staff training and training records were up to date. We talked to the manager and four staff members. Staff told us, “I have been bombarded with training. It has been crammed into a short space of time”, “It has been all go and quite intense. With updating the care plans as well it has been hard work” and “I have completed some refresher training and I am booked on another course next week for the mental capacity act and deprivation of liberties training”.

We found the training matrix had been updated and staff had undergone training in topics relevant to the service to ensure there was a well trained staff team. All four members of staff we talked with said they had undergone a lot of training over the last few months. Some staff told us they were also booked on further courses to update their knowledge.

We looked at four care plans because the manager said part of the training had been to upgrade and improve the plans. We found the plans had been standardised between the three different units and had been greatly improved. The improvement was in the quality of the forms used, regular review and the inclusion of people who used the service.

All the people we spoke with said they thought care was good and staff were caring. Two people commented, "Staff talk to me a lot and we sometimes talk about my care or health”. Staff talk to me about my care and I can say what I think”. Recently returned questionnaire results were generally very positive about the care and services provided.

Plans of care contained sufficient detail for staff to follow good practice.

People who used the service told us, "I am happy here. I enjoy doing what I want. I really enjoy helping out in the garden when I can “ and " I like it here. I can come and go when I like". People were able to follow their activities and hobbies if they wished.

There was an accessible complaints procedure which enabled people who used the service to voice any concerns.

Two staff members we spoke with told us, "I love working here. There is a good atmosphere" and "I like working here. It is different every day. We have a good staff team and we all work well together. I enjoy looking after people". Staff were motivated to look after the people accommodated at the home.

We conducted this inspection to follow up on the compliance action we made at the scheduled inspection of August 2012 regarding Regulation 9 Outcome 4. Care and welfare of people who use services. We found that the service had improved their systems to ensure peoples' care needs were reviewed on a regular basis. This ensured that the social, mental and physical health care needs of people who used the service were up to date.

We looked at records, observed care, talked to three people who used the service and two staff members during this inspection.

People who used the service told us they were happy living at this care home. They made comments such as, "I like living here", "I am happy at Heightside" and "There is nothing more I could wish for".

Three people who used the service said they were happy with the choices and lifestyle offered to them. They said they were able to live independently with staff support and made choices within a risk based framework. Comments included, "I moved to a bungalow a few years ago and like doing the laundry and looking after myself", "I enjoy working in the garden. I cook and clean for myself" and "I do most things for myself".

People told us they were treated with privacy which helped protect their dignity.

One staff member and the manager said they were happy working at the home. One staff member commented, "I love working here. There is a good staff team and we all support each other".

The inspection was carried out on 12 and 13 August 2015. The first day of the inspection was unannounced.

Heightside House is registered to provide nursing care for up to 78 people who have mental health care needs. At the time of the inspection there were 63 people accommodated at the service. The service provides long and short term care/support and rehabilitation. There are extensive grounds with walkways, lawns, gardens and a greenhouse .There is access to public transport at the bottom of the drive.

Accommodation is provided in four separate units: The House, The Mews, Close Care and The Gate House. There is a separate activities centre.

The House, incorporates the HDU (High Dependency Unit) and has both single and double bedrooms over four floors. Some bedrooms have en-suite facilities. There are two lounges, one lounge/dining room, a separate dining room and a room for people who smoke. A passenger lift provides access to all floors.

The Mews consists of one six bedded unit, shared bungalows and flats. Close Care includes a seven bedded unit and a bungalow accommodating four people. The Gate House can accommodate three people. All the bedrooms are single occupancy. There are various communal lounges and dining areas.

The service was managed by 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.

At the previous inspection on 1 October 2013 we found the service provider was meeting the legal requirements.

During this inspection we found there were breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Staff recruitment practices had not been properly carried out for the protection of people who used the service. Some environmental risks had not been identified, assessed and minimized. Some risks to individuals had not been properly assessed and planned for. This meant appropriate action had not been taken to reduce the risks to people’s well-being and safety. People’s medicines were not always managed appropriately, which meant there were risks they may not receive safe support. People’s concerns and complaints were not properly acknowledged, managed and responded to. There was also a lack of effective systems to assess, monitor and improve the quality of the service provided.

You can see what action we told the provider to take at the back of the full version of this report.

Staff spoken with expressed an understanding of safeguarding and protection matters. They knew what to do if they had any concerns. They had received training on safeguarding vulnerable adults and positively responding to people’s behaviours.

Arrangements were in place to maintain sufficient staffing levels. However, there was no structured process in place to asses staffing arrangements, to make sure there was always enough staff; the manager agreed to address this matter

People’s needs were being assessed and planned for before they moved into the service.

Healthcare needs were monitored and responded to. People were supported to keep appointments with GPs, dentists and opticians.

We observed examples where staff involved people in routine decisions. However we found the service needed to be more proactive in promoting rights and choices, by providing information and encouraging people to be involved in making individual and group decisions.

The MCA 2005 (Mental Capacity Act 2005) and the DoLS (Deprivation of Liberty Safeguards) sets out what must be done to make sure the human rights of people who may lack mental capacity to make decisions are protected. We found appropriate action had been taken to apply for DoLS and authorisation by local authorities, in accordance with the MCA code of practice and people’s best interests.

Staff were enthusiastic about supporting people with shopping and cooking for themselves. However, people spoken with had mixed views about the meals provided at the service. We found improvements were needed with the catering arrangements. We made a recommendation about supporting people with their nutritional needs.

We observed people being supported and cared for by staff with kindness and compassion. One person told us, “I find the staff are very kind and respectful to me.” Systems were in place to ensure all staff received regular training, supervision and support.

Although we found some of the accommodation in the units provided was satisfactory and people had been supported to personalise their rooms, some areas were in need of upgrading and refurbishment. Improvements were needed around promoting privacy and dignity; we therefore made a recommendation about this.

We found people had mixed views about the programme of activities/engagement at Heightside House. Some people told us they were bored in their daily lives. However we found plans to improve therapeutics and meaningful activities.

There were some systems in place for monitoring and checking the quality of the service. It was apparent they were lacking in effectiveness, however, we found further processes were being introduced.