This inspection took place on 9 and 12 June 2015. It was unannounced. There were 57 people living at Heather View when we inspected. People cared for were all older people. They were living with a range of complex needs, including diabetes, stroke and heart conditions. Some people were also living with dementia. Some of the people living with dementia could show behaviour which may challenge others. Many people needed support with their personal care, eating and drinking and mobility needs. The registered manager reported they provided end of life care when required. No one was receiving end of life care at the time of our inspection.
Heather View was purpose-built as a care home. It provided accommodation, treatment and care for up to 74 people, over four floors. Accommodation for people was provided on three floors. The top floor provided accommodation to people who had residential care needs. The second floor provided nursing and care to people who had nursing care needs. The first floor provided care to people who were living with dementia, who had residential care needs. Each floor had its own sitting and dining areas. The ground floor provided further communal areas for people, the offices and support facilities like the laundry. A passenger lift was provided between floors. There was an enclosed garden area, which was wheelchair accessible. Heather View was situated close to the centre of Crowborough. The provider was Care UK Community Partnerships Ltd, a national provider of care.
Heather View had 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.’
People told us they felt there were not enough activities provided. We observed some activities taking place but most of the people, particularly people who did not go out of their rooms, had little to occupy them. People’s care plans relating to activities did not focus on activities which benefited them. Management had identified that action was needed and a new activities worker was in the process of being appointed.
People’s care and treatment plans were mixed. We saw occasions where people’s care needs were not documented and where people’s care plans did not clearly document what their needs were. This meant staff who were unfamiliar with the person would not know about all of people’s needs. Such matters had not all been identified during audit. Other care plans were clear and documented care that staff told us about and we observed being provided.
Many people’s clothes were unmarked so were not returned to them. Domestic workers did not have evidence of regular supervision, so areas for action had not been identified and addressed. Other staff felt supported in their roles by their line manager but said they did not always receive supervision. Each head of department had their own ways of recording supervision so there was not a consistent system, to ensure all staff were received supervision.
All of the staff we spoke with showed a clear understanding of their responsibilities for safeguarding people from risk of harm. Staff also showed a clear understanding of their responsibilities under the Mental Capacity Act 2015 and the Deprivation of Liberties Safeguards.
People said there were enough staff on duty to meet their needs and staff responded quickly when they needed them. The provider had standard systems to ensure prospective staff were fully assessed for their suitability to work with people, prior to employment. Recently employed staff described their induction as “Very effective.” Staff were positive about the training. Staff supported people in an effective, safe way, including people who were living with dementia.
People said Heather View was a caring place. Staff supported people in a caring way, seeking their permission before they supported them and involving them in decisions about how they wanted to be cared for. Staff were always polite to people and clearly knew them as individuals. People’s relatives said they were involved in supporting staff to care for their loved ones and people’s independence was encouraged. Staff practice ensured people’s privacy and dignity.
Heather View had relevant environmental risk assessments. All people also had individual risk assessments to ensure their safety. There were regularly reviewed. Heather View complied with national guidelines when ensuring people’s safety. The registered manager had clear systems for auditing accidents and incidents. They took action where matters were identified.
Heather View had safe systems for administration of medicines. These systems were regularly reviewed and audited, to ensure staff followed the provider’s policies. People said their medical needs were met. A GP said staff worked effectively with them to ensure people’s medical needs were promptly reported to relevant external professionals.
All of the people we spoke with made positive comments about the meals. Meals were attractively presented. People were able to make choices about what they wanted to eat and drink. Staff were readily available to support people with eating and drinking if needed.
The registered manager followed the provider’s complaints policy. Records of complaints were clearly documented, together with actions taken. People and their relatives were regularly consulted about quality of care provision.
People told us they thought Heather View was well managed. The registered manager and provider had established systems for auditing the quality of the service. Where matters were identified, action was taken. For example action had been taken to replace old furniture.
Staff said they were consulted and informed. Regular meetings took place. These were minuted so staff could review matters raised. Staff were aware of Heather View’s managerial structure and aims and values. One member of staff summed Heather View’s values up by saying their role was to “Make sure the care to everyone is person-centred.”