The unannounced inspection took place on 29 July and 2 August 2016.

West Heaton Residential Home is a family run care home which has operated for 25 years. It provides care and support for older people who may be living with dementia. The home is rurally located and can accommodate up to a maximum of 23 people. There were 22 people resident in the care home at the time of the inspection.

There are supported living units within the grounds and the premises and day care is provided. A domiciliary care agency operates from the premises. The provider therefore offers integrated care and support for older people in the local community. We do not regulate the day care service and this inspection was of the care home only.

The service is required to have 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. West Heanton Residential Home had a registered manager.

Our previous scheduled inspection of September 2014 found that proper steps were not always taken in a timely manner. This was in response to a change in people’s health care needs and systems in to identify, assess and manage risk, which were not always effective. This inspection found that most aspects of the service had been completed reviewed. People were safer and the staff team were completely engaged in continuous improvement to make people’s lives as good as possible.

Two community health care professionals described the care provided as “superb”.

Staff listened to people’s views and looked for ways to continually improve their lives. This included the introduction of snacks between meals. This had increased the amount of food and drink people who lacked appetite, were taking.

Where people had behaviours which challenged them and others, these were now reduced, through staff understanding the reality of the experience of people living with dementia. A very wide range of activities was provided, based on their background, and requests people made. Independence was fully promoted and restrictions were minimalized.

Staff were kind, caring and treated people with respect and dignity. Community nurses said the staff worked with “love and gentleness”.

The registered manager promoted a good ethos, putting people at the centre of how the home was run. The culture was one of kindness and caring.

Safety within the home environment was a high priority. People’s individual safety and comfort needs were well met, with risk understood and managed.

There was a high regard for ensuring people’s choice and liberty were not compromised. People’s legal rights were understood and the registered manager worked hard to promote them.

People were protected through robust staff recruitment and a wide range of staff training. The staffing arrangements were flexible and people’s needs were very well met. Staff had a very good understanding of how to protect people from abuse and harm.

Staff felt very supported and were working within an improved staffing structure, with key workers, to promote person centred care. Care plans were very detailed and provided staff with all the information they needed to meet people’s needs and wishes.

There were good systems in place for ensuring the service was well monitored.

As part of our inspection we spoke with people who lived at the care home and some visiting relatives. Comments included, “very nice on the whole”, “it’s excellent”, “staff are good, friendly” and “people are so kind and thoughtful”.

We also spoke with the manager, senior care staff, care staff, housekeeping and kitchen staff.

We found, where people did not have the capacity to consent the provider acted in accordance with legal requirements.

Care and treatment was planned and delivered in a way to ensure people’s safety and welfare.

People were protected from the risk of infection because appropriate guidance had been followed.

There were enough qualified, skilled and experienced staff to meet people’s needs.

There was an effective complaints system available.

People were not always protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained.

We carried out this unannounced inspection during one day, speaking with seven people who live at the home, three staff and the registered manager. We spent time observing how care and support was delivered. We also looked at some key records, these included care plans, staff recruitment files, risk assessments, medication records and minutes of meetings. This helped us to make a judgement about how well the home was being run.

We found that people’s care was being well planned. People were involved in making decisions about their care and treatment. People we spoke with said that they were happy with their care and support. Comments included ’Staff are very good, they try to accommodate us as best they can, and they know all our likes and dislikes.’’ ‘’We are looked after extremely well here.’’

We saw that the service ensured that any new staff had the right checks in place to ensure they were fit to work with vulnerable people, before they commenced employment.

The home had developed systems and checks to ensure that they reviewed and monitored the quality of care provided. This included involving and listening to people who lived at the home as well as staff.

We brought forward this review of compliance in response to some information of concern around health and safety issues and possible infection control issues.

We visited this service on the 24 January 2012 and spent approximately six hours speaking to people who lived at the care home as well as to people who received a service from their domiciliary care service. In total we spoke with nine people, six people who currently live at the care home and three people who have support from the domiciliary care service.

We also spent time talking to staff members including care staff in the home, one care staff from the domiciliary care agency. We looked at some key records including, care plans, risk assessments, staff training and recruitment records. We looked at all communal areas of the home and at six of the individual bedrooms. We also spent time observing how staff provided care and support throughout different times of the day. We had lunch with some of the people who used the service and spoke with nine people about their experiences of living at the home or of receiving domiciliary care from the agency.

We heard very positive comments from people we spoke with about the care and support they received. People told us

‘’The carers are all first rate, they make sure everything is well organised for me and make life so much easier.’’

‘’We have a lovely bunch of staff caring for us, they are all very nice.’’

‘’We are well catered for here, no complaints.’’

We spoke with three care staff from the home and one from the agency that provides support to people in their own homes. They had a good understanding of the needs, wishes and preferences of the people they provide care and support to. We heard from the care staff that in their opinion they were given good training opportunities and have regular support and supervision to ensure that have done their job properly.

We observed care staff provided care in a positive, kind and respectful way. We saw that peoples’ diverse needs were considered. For example we saw that tracking hoist equipment had been fitted in some bedrooms to allow less mobile people to be moved safely. One person in the home smoked and they had been given access to a small conservatory so that they had somewhere indoors to smoke. The registered manager told us, this area was not previously used by any other people in the home, so had not restricted the use of this area and there were still three other communal areas for people.

We saw that care was well planned for those living in the home and for people who received care in their own homes. The service had an electronic system for recording care needs, risk assessments and daily records.

We noted during our tour of the premises that in communal toilets there were material hand towels, and not paper disposable towels. We pointed out that this could present as a possible risk to infection control. The registered manager said he would address this. Since our visit to the service the manager has sent in photographic proof that they have installed paper towels in all communal toilets.

We checked the water temperature in two communal toilets and found the water was very hot. We were told that these were due to be decommissioned within the next month due to an extension and use of more spacious toilet facilities. As an interim measure the manager put up a sign to warn people that the water was very hot. We were also assured that those people who had dementia were unlikely to use these toilets without assistance.

We checked the staff training and recruitment files and found that the service had robust recruitment processes in place that helped to protect people.

These inspections visits took place on 3 and 30 December 2014 and were unannounced.

West Heaton Residential Home is a rurally located care home which provides care and support for older people who may be living with dementia. The home can accommodate up to a maximum of 23 people. West Heanton Limited is a family based business. The home does not provide nursing care. People's healthcare needs are met through the local community services, such as the district nurses and GPs. There were 23 people residing in the care home at the time of our inspection.

The service 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 and associated Regulations about how the service is run.

At the last inspection, on 2 May 2014, we asked the provider to take action because the standard of record keeping did not ensure people were protected from the risks of unsafe or inappropriate care. We found during this inspection that record keeping continued to put people at risk of unsafe or inappropriate care because the home did not have an effective system for records management.

People’s need’s were monitored but this did not always lead to a timely response to concerns, such as weight loss. The home relied on community services to act once problems had developed. Systems, such as risk assessment tools, were not used so the home could identify where risk was increased, and take steps to prevent problems from occurring.

The service had inadequate systems to ensure health and safety were promoted at all times. However, there were arrangements for listening to people’s views and there were reviews of how the home was run which had led to changes, such as the staff training arrangements.

Staff did not adequately understand the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and how they applied this in practice. They understood the importance of providing people with choices and listening and responding to their preferences, where expressed. They were clear they would not act against people’s wishes. No person was being deprived of their liberty and decisions were made in their best interest.

People felt safe but arrangements relating to reporting abuse were not robust, although they were under review.

People’s needs were generally met by sufficient numbers of staff who considered their training to be effective and who were encouraged to take qualifications in care. Staff received supervision and support for their work and felt able to take any concern or enquiry to the registered manager. The arrangements for recruitment of staff protected people from staff who might be unsuitable to care for them.

Medicines management protected people using the service. It was well organised and ensured people received the medicines they required at the time they required them. People had a nutritious diet available to them although some requested more variety and people did not have the choice of whether they received sugar supplements or not.

People felt valued and were cared for. Time was set aside for additional one to one time with staff, called “TLC”. There was a variety of activities and engagement with the local community, where people had friends and neighbours.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. Changes in care needs were not responded to in a timely manner to promote people’s health and welfare. The home lacked systems to ensure risk was reduced and managed.

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