This inspection took place on 11 and 12 December 2018, and was unannounced. At the last inspection completed on 13 June 2017, we rated the service as Requires Improvement.

At this inspection we found some improvements had been made but more were needed and the provider was not meeting the regulations for safe care and treatment, consent and governance arrangements. You can see what action we asked the provider to take at the end of this report.

The Heathers Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal 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.

The Heathers Nursing Home can accommodate up to 53 people in one adapted building, over two floors. At the time of the inspection there were 39 people using the service.

There was a not a registered manager in post at the time of our 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.

The registered manager was still employed by the company but had stepped down to a deputy role and was making an application to deregister. The provider has plans in place to recruit and an interim arrangement for management was in place. This was the third inspection where the location was rated Requires Improvement. The provider was not meeting the regulations. You can see what action we asked the provider to take at the end of the full report.

People were not supported to manage risks to their safety. People’s health needs were not monitored and concerns escalated to relevant health professionals. People were not supported to have maximum choice and control of their lives and staff were not aware of how to support them in the least restrictive way possible; the policies and systems in the service were not supportive of this practice. Governance systems had not been used to identify concerns or drive improvements.

People were not always protected from the risk of cross infection from dirty equipment, however staff were observed using effective infection prevention practices. People were not always supported by sufficient staff. Staff were not always receiving training and they sometimes lacked skills to be effectively supporting people.

Staff were not providing consistent support. People were not consistently supported to eat and drink safely.

People received support from staff that were caring. However, improvements were needed to make sure that this was consistent. People’s communication needs were planned for but staff did not always follow the plans. People’s preferences were not consistently documented. People did not have access to meaningful activities.

People had not discussed their end of life wishes and these were not always documented in their care plans. We found people’s views were shared but action was not consistently taken to make improvements. People were engaged in checking the quality of the service.

People felt safe and were safeguarded from potential abuse. Medicines were administered as prescribed. Staff had been safely recruited. Accidents were investigated and learning was in place to prevent further occurrences.

The environment was suitable for people. People were treated with dignity and respect. People understood how to make a complaint. Notifications were submitted as required and the manager understood their responsibilities.

This inspection visit was unannounced and took place on 13 June 2017. At our last inspection visit on 4 January 2017 we asked the provider to make improvements to wound care, staffing levels, the care plans and stimulation on offer and the auditing and managing of the service. The provider sent us an action plan in February 2017 explaining the actions they would take to make improvements. At this inspection, we found some improvements had been made, however further improvements were required.

The service was registered to provide accommodation for up to 47 people. People who used the service had physical health needs and/or were living with dementia. At the time of our inspection 43 people were using 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.

At our previous inspection we asked the provider to make improvements to various areas in the home. At this inspection we saw that some improvement shad been made, however further improvements were required to meet the regulations.

Audits relating to the environment and the practical aspects of care had not always been completed or followed through to ensure the changes required had been made. Some staff felt supported, other staff felt there could be more communication and opportunities to consider how they worked to support people. We saw when people lacked capacity an assessments had not been completed to consider how decisions should be made. These decisions were not always decision specific and this was an areas the manager was developing.

Care plan content had improved since our last inspection. However further improvements were required to ensure they were up to date and reviewed, with the people who were important to those using living in the home. Some people felt they would like more opportunities to follow their interests and to reduce the risk of isolation. People had a mixed meal experience and the manager acknowledged this was an area for development. We saw that there were sufficient staff to support peoples basic care needs, however people and relatives felt that staff were not always able to be responsive and spend time with them for the little things like have a chat or a walk in the garden. Medicine was not always managed safety, we saw that the stock had not been checked and that information relating to people medicine was not always accessible.

People felt safe and there were risk assessments completed to cover both the environment and the individual’s needs. People felt the care staff were kind and thoughtful. They felt their needs were respected and dignity upheld.

We saw that the previous rating was displayed in the reception of the home as required. The manager understood their responsibility of registration with us and notified us of important events that occurred at the service; this meant we could check appropriate action had been taken.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

This inspection visit was unannounced and took place on 4 January 2017. Since our previous inspection the provider has changed, however, the registered manager and staff remained the same so we have made reference to the previous inspection visit on 28 January 2016. At that inspection we asked the provider to make improvements to the safety aspects of people’s care, supporting people when they lacked capacity and systems to support the running of the home. The provider sent us an action plan on 6 April 2016 explaining the actions they would take to make improvements. At this inspection, we found improvements had not been made in all these areas.

The service was registered to provide accommodation for up to 47people. People who used the service had physical health needs and/or were living with dementia. At the time of our inspection 43 people were using 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.

The provider had not ensured that the risks to people's health and safety had been assessed and the information cascaded to ensure consistency of support was offered. There was not sufficient staff to support people’s needs. People had to wait when they required support with their personal care needs. The service was not consistently meeting the requirements of the Mental Capacity Act 2005. Assessments had not been completed and we could not be assured that when people lacked capacity their needs had been considered in line with the Act. People were not always given choices about their meals and beverages. Some people felt the food was good quality and they had meals they enjoyed.

Peoples care was not always documented to ensure people received care that met their needs. When people had behaviours that challenged these were not supported to provide staff with clear guidance and support.

There was mixed feelings about the activities provided to support stimulation and people’s hobbies or interests. Some people received limited stimulation and others received a range of support and access to outings and events.

The provider had not completed audits to support the development of improvements or to consider any trends in areas of concern. People’s views had not been considered to develop the home and peoples experience.

There were systems in place to reduce the risk of abuse. People felt supported with their medicines and the provider had established systems to support checks were competed to maintain safety. Staff were checked to ensure they were suitable to work with people

People's health care needs were monitored and any changes in their health or wellbeing prompted a referral to their GP or other health care professionals. Staff had the training and skills they needed to meet the needs of the people they were supporting.

We saw that the previous rating was not displayed in the reception or on the company website. The manager understood their responsibility of registration with us in relation to notifications to us of important events that occurred at the service.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.You can see what action we told the provider to take at the back of the full version of the report.