The Heathers 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 home can accommodate up to 24 people in one adapted building. At the time of the inspection they were full. The home had six short stay beds. These beds were used by people who were transferred from the local hospitals for rehabilitation, prior to their returning home. The expectation was that the short stay people would stay at the home for six weeks but some of them stayed longer. At the time of the inspection one of these people had been resident at the home since January 2018.

We inspected The Heathers on 27 and 28 June 2018. The first day was unannounced. It was a comprehensive inspection. The last inspection had been on 15 February 2015. At that time we rated the service as Good.

People were happy at the home and felt that they received good care. There was a system of policies and audits in place. However, on review of the documentation we found some risk assessments had not been updated, to reflect changes in people’s care needs and some of the people did not have essential risk assessments in place. Similarly, some of the care plans did not reflect the care people were receiving and some people did not have relevant care plans. The impact of this was minimised, as the staff knew the people under their care and the care each person required. However, this lack of up to date risk assessments and care plans, could potentially put people at risk, of receiving inadequate or inappropriate care. The management team were implementing changes, to improve the standard of the documentation. However, at the time of the inspection these changes had not insured that all people had contemporary and complete records. You can see what action we told the provider to take at the back of the full version of the report.

At the time of our inspection a registered manager was 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 registered manager was based at the sister home and was not available on the day of the inspection. The day to day management of the home was the responsibility of the care manager. The home had a system of audits and quality assurance in place. However, these had not improved the quality of the documentation in regards to personal risk assessments or care plans.

There was a system in place for determining the level of dependency of the different people and thereby calculating the number of staff required. However, there was little flexibility within the staff numbers. On occasions when people’s dependencies changed staff were very busy and it impacted on the ability of the care manager to complete the more administrative parts of their role, for example reviewing and updating the care plans.

There were environmental risk assessments in place and the home had been adapted to suit the needs of the people living there, with a lift between the different floors. The home was clean and tidy and was odour free and people enjoyed an enclosed garden. There was an infection control policy in place and we saw evidence of the use of personal protective equipment, including gloves and aprons.

There was a comprehensive training schedule for all staff. This included training on safe-guarding and the Mental Capacity Act (MCA). All staff received supervision and appraisals at regular intervals. There was a system in place for orientating and supporting any new member of staff. New staff had the appropriate checks, prior to starting work, to ensure they were appropriate for the

The inspection took place on 15 December 2015 and was unannounced.

The Heathers provides accommodation and care for up to 25 people with a range of health needs. At the time of our inspection, there were 22 people living at the home. The Heathers is a large detached house on the outskirts of Worthing, situated close to public transport and within walking distance of local shops. All rooms are of single occupancy and the majority have en-suite facilities. Communal areas include a sitting room with sun lounge extension, dining room and smaller sitting area. The home is undergoing refurbishment and redecoration. Accessible gardens surround the home.

A registered manager was 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 day-to-day running of the home was the responsibility of the senior care manager.

People were protected from avoidable harm and abuse and felt safe living at the home. Staff were trained to recognise signs of potential abuse and knew what action to take. Risks to people were identified, assessed and managed so that staff knew how to mitigate people’s risks. Accidents and incidents were reported and action taken as needed. Premises and equipment were managed to keep people safe. There were sufficient staff on duty at all times and before new staff commenced employment, the provider undertook all necessary checks, to ensure they were safe to work with adults at risk. People’s medicines were managed safely and staff were trained in the administration of medicines. People were protected from the risk of infection and the provider had infection controls in place.

Staff were trained in all essential areas and additional training was provided as needed. New staff followed the Care Certificate, a universally recognised qualification. Staff received regular supervision from senior staff and attended staff meetings. They had a thorough understanding of the requirements of the Mental Capacity Act 2005 and associated legislation and put this into practice. People had sufficient to eat, drink and maintain a balanced diet. They spoke highly of the quality of the food provided. People had access to healthcare professionals and services as required. They were encouraged to personalise their rooms and the provider was undertaking planned improvements across the home.

People were cared for by kind and caring staff who knew them well. One person said, “I enjoy living here; they are very kind and helpful here”. They went on to say, “The staff seem to get on well here too. I can’t complaint at all”. Staff knew people’s preferences, their likes and dislikes and how they wished to be cared for; they treated people with respect. People were involved in planning their care and care plans and risk assessments were reviewed monthly and signed by staff. As people reached the end of their lives, staff looked after them with kindness, respect and dignity.

People received care that was responsive to their needs. Before they moved into the home, the management team undertook pre-assessments to ensure everything was in place to meet people’s assessed needs. Care plans provided comprehensive, personalised information about people. There was a programme of activities organised by a part-time activities co-ordinator. External entertainers came to the home and outings into the community were organised for people. Complaints were dealt with promptly and managed in line with the provider’s policy.

The home was well led and staff felt supported by the management team. People and/or their representatives were asked for their views about the service by an independent social care consultant and action was taken as needed. Residents’ meetings took place. The provider had a range of internal systems and audits in place to measure the quality of the service overall. The consultant also undertook regular inspections of the home and an independent audit and any recommendations were acted upon by the provider.

The people we spoke with told us that they had been involved in the development of their care plans. One person said, "The service here is excellent. I do not have any complaints."

People told us that they felt they were well cared for and the staff members understood the needs of people well. One staff member said, "Care plans contain a lot of helpful information, we record everything we do and keep care plans up to date."

All the people we spoke with said enough staff were available to support them to fulfil their needs.

We found people's nutritional needs were being met and supported.

Staff were only employed following a structured recruitment and interview process and relevant checks were carried out prior to them starting work.

The home maintained good standards of cleanliness throughout

We found people's independence was promoted in the way they were cared for People told us they decorated their rooms and one person described it as living away from home. During the visit we observed the people were able to make choices, for example about where to have their meals.

One person told us they were treated with dignity and the staff knocked on their doors before entering. This person said ''they have been great I would recommend it.''

The people we spoke with were complimentary about the food and the chef. We were told that the chef did that little bit more than expected and one person commented though meals were not always bang on time, ''the chef was marvellous.''

Staff told us people were assessed and the appropriate resources used to meet their needs. We observed that equipment designed to meet the people's needs were readily available.

We found staff were supported and received appropriate training to deliver care to meet people's needs.

The provider told us that feedback from the people, their representatives and other health professionals was used to assess and monitor the quality of the service delivered and to make changes. We noticed safety information was prominently displayed around the home.

During the visit we observed people engaged in an activity, which they appeared to be enjoying. We saw that staff interacted with the people in warm and caring manner. People appeared relaxed and the atmosphere was pleasant and calm.

People told us that they had been involved and consulted about the care they received.

Everyone that we spoke with said that the home was meeting their needs.

People told us that they felt safe and staff treated them well.

Everyone expressed satisfaction with the staff who worked at the home.

People told us that their views were sought in a variety of ways including questionnaires and residents’ meetings.