Herons Lea is a residential care home for 20 people with dementia and conditions associated with old age and frailty. The service provides and care and support without nursing. Herons Lea is a detached home in a rural setting with large grounds. The service is set over two floors with communal lounges and dining areas all on the ground floor.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. The key question of caring has been rated as outstanding at this inspection. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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Why the service is rated as good.

People said they enjoyed living at Herons Lea and felt safe and well cared for. Comments included

“It's very good. It was difficult at first being independent. I find it very satisfactory - the carers have a lot of compassion and are a happy bunch, very caring. I just accept their way of doing things now. They know what they're doing and I trust them - they're very helpful” and “I think it's one of the best places we've got around here. I kept falling over and I didn't like my [daughter] getting upset when I fell down stairs and in the shower room it was awful. I miss home but I'm safe here.”

People were supported to maintain their independence and live fulfilling lives doing the things they enjoyed and being encouraged to try new things.

The home had a registered manager. A registered manager is a person who has registered with the CQC 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.

Staff were exceptionally caring and knowledgeable about people’s needs, wishes and preferred routines. This helped them to plan personalised care. People, their families and visiting healthcare professionals were positive about the caring and compassionate nature of staff.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Care and support was person centred and well planned. Staff had good training and support to do their job safely and effectively.

Risk assessments were in place for each person. These identified the correct action to take to reduce the risk as much as possible in the least restrictive way. People received their medicines safely and on time. Accidents and incidents were carefully monitored, analysed and reported upon.

There were effective staff recruitment and selection processes in place. People received effective care and support from staff who were well trained and competent.

Quality assurance processes and audits helped to ensure that the quality of care and support as well as the environment was closely monitored. This included seeking the views of people and their relatives.

Further information is in the detailed findings below

This unannounced comprehensive inspection took place on 22 October 2015. Herons Lea is registered to provide care and support for up to 20 older people. At the time of the inspection there were 20 people living at the service.

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.

People and their relatives were very positive about their experiences of living at Herons Lea. Comments included ‘‘Staff are lovely, angels, I can’t fault them.’’

People said they felt safe and well cared for. One relative said ‘‘The staff all know my relative so well, they are very kind and skilled at what they do.’’

Staff were experienced and knowledgeable about how to meet people’s individual needs. Care and support was being delivered in a caring and sensitive way. People were being offered choice throughout the day about when they wished to be supported to get up, how they spent their day and what meals and drinks they wished to have. People’s health care needs were well met and staff ensured they were eating and drinking sufficient to maintain good health.

Staff had training, support and supervision to help them understand their role and provide care in a safe way. Staff felt their views were listened to and understood the ethos of the home. This was to provide a safe, homely environment for people to enjoy. Where possible, people were supported and encouraged to be independent. People had equipment such as walking aids to assist them with their mobility.

Some people lacked capacity, and this had not always been fully considered in light of the 2014 supreme court ruling, covering mental capacity and the need to consider Deprivation of Liberty Safeguards (DoLS). Following further discussion with the registered manager, she agreed there were some people who should be considered for this and was in the process of applying for these following our inspection visit.

People were protected by the service having a robust recruitment process, which ensured only staff suitable to work with vulnerable people were employed. Medicines were being well managed which also helped to protect people.

There were a range of audits to ensure the environment was safe, clean and homely.

When we visited the home on the 02 June 2013 we raised concerns with the registered manager about how the home was ensuring people’s consent to care and treatment was being sought and the records of people’s care were current and reflected people’s needs. We asked the registered manager to address these concerns and send us an action plan on how they were going to address these concerns. They told us they would have achieved this by the end of July 2013.

We contacted the registered manager in the July to ensure they were on track. We returned on the 12 November 2013 to review the progress that had been made and to ensure the changes agreed by the action plan had been achieved and put in place.

On the day we visited we were advised that there were 20 people living in the home. We reviewed nine records kept by the home that included people’s care plan (the detail of how they wanted or needed to have their personal care needs met), daily records and logs of people’s care for those who were poorly and required a higher level of care and support. We did not speak to people who lived in the home or family. We did however speak to the registered manager for the first half hour and a senior carer after that during our visit. We could also hear and observed how staff communicated with people.

We found that people’s consent to care and treatment were in place and the records of people’s care plans were up to date and reflected people’s current needs.

We spoke with four people who lived at Herons Lea residential home. People told us, “The staff are all very kind”, “its like a home from home”, “can’t fault anything” and “they are all very friendly, willing to help”.

A relative told us, “Its wonderful here” and “I wouldn’t have X anywhere else”.

As part of our inspection we also spoke and met with the registered provider, the registered manager, care staff, a member of the housekeeping staff, and the chef.

During our inspection, we observed all staff interacting with people in a kind, compassionate, supportive and appropriate manner.

We found, people's needs were assessed and care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

People were cared for in a clean, hygienic environment.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

Appropriate checks were undertaken before staff began work and there was an effective complaints system available.

Where people did not have the capacity to consent; the provider did not always act in accordance with legal requirements. We also found people were not fully protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not always maintained.

We visited Heron’s Lea on Thursday 3 May 2012 between 10am and 5:45pm. We visited four people who lived there in their private rooms and spoke with or observed all other people in the lounge or dining room. We met with three people who were friends or relatives of people in the home and who had visited frequently.

We met with the registered manager and three staff on duty. We also looked at the daily records relating to the care and support people received. Later we phoned District Nurses who had visited regularly.

One person said, “I can’t fault anything. The staff are nice, the food is nice – I’ve never eaten so much in my life.” This person liked to eat in their room, but would go to the lounge when there was musical entertainment.

One relative thought their family member had “a lovely room, staff they enjoy and good company”. They confirmed that at the time of admission they were given a contract and they were aware that the home might not always be able to suitably care for a person if their care needs increased significantly.

We saw, after serving lunch, care staff brought their packed lunches to the lounge, and sat with the people who lived in the home. They gently coaxed and encouraged people who were still eating to eat their food, with cheerful smiles.

Health care professionals who had visited the home regularly told us that they had always found staff to be helpful and caring, and had observed a good standard of care.

Staff said they found that confidentiality was respected.

Staffing levels at night had been increased so that there were two awake staff (rather than one awake and one sleeping-in in case they were needed). This was so that they could meet the increased needs of more highly dependent people.

Suitable arrangements for storing medication had been provided. Although we saw that staff worked with care, a system of delivering medication was in use that is not approved by professional bodies, and may result in unsafe delivery of medication.