We carried out an unannounced inspection of Healey House on 27 and 28 September 2017.

Healey House provides accommodation and personal care and support for up to ten people with a learning disability. The service does not provide nursing care. At the time of the inspection there were nine people accommodated in the home.

Healey House comprises of the main house which accommodates eight people and the bungalow accommodating two people. Healey House and bungalow are situated in landscaped gardens off the main road in Whitworth and is within easy reach of Rochdale and surrounding areas. The home is part of a wider service provision which includes a day care facility, respite care and supported living.

The service was managed by 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.

At our last inspection on 28 October 2014 we found the service was meeting all the standards assessed.

At this inspection we found the service provided an outstanding level of care and support that placed people at the heart of their care and promoted their right to be independent and to determine how they lived their lives. All the people we spoke with had nothing but praise for the service and the excellent quality of life people living in the service experienced. People’s rights to privacy, dignity, and freedom of choice were firmly embedded into the culture of the home. Staff embraced people's diversity and this was reflected in the support plans we saw.

The service was very much a family run service. The provider and the providers' family members were known by staff and people using the service and were a visible presence in the service. We observed excellent relationships between people and observed the senior management team and staff interacting with people in a caring, good humoured and friendly manner. Management and staff demonstrated exceptional insight and understanding of people’s personal values and needs. People were happy and relaxed with staff and we overheard much laughter and also meaningful conversations during our visit.

Everyone we spoke with was very complimentary about the service. People, their relatives, staff and professionals to the home described the management and leadership of the service as exceptional. The registered manager was referred to as ‘an excellent leader who placed people at the heart of everything they did’. There was an excellent standard of organisation within the service that fully supported continuous improvement and ensured people received a high quality service that met their needs and expectations.

People living in the home told us they felt safe and staff treated them well. Staff understood their responsibilities to safeguard people from abuse and had challenged other services when people were not being treated fairly. People using the service had undertaken safeguarding and health and safety training with staff; this had helped them recognise when they were at risk and the action they needed to take to keep themselves and others safe. We found examples of when people had raised their concerns with staff and the registered manager and they had been acted on appropriately. Staff were clear about their responsibilities for reporting incidents in line with local guidance.

People had been consulted about their needs and aspirations. Each person had been involved in the development of their own support plans and risk assessments which provided clear guidance for staff on how to meet their needs and preferences. Care and support was focused on people's wishes and preferences and people were supported to be as independent as possible in all aspects of their lives such as activities, outings and me

We carried out an unannounced inspection of Healey House on 28 and 29 October 2014. Healey House is a care home which is registered to provide care for up to 10 people. It specialises in the care of people with a learning disability and does not provide nursing care. At the time of the inspection there were seven people accommodated in the home.

Healey House provides accommodation within the main house which comprises of eight single bedrooms on two floors; there is a passenger lift available. There is also an additional bungalow located in the grounds of the home which has two en-suite bedrooms.

At the previous inspection on 9 December 2013 we found the service was meeting all standards assessed.

There is a registered manager in day to day charge of the home. 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 who we spoke with described the management of the home as ‘approachable’ and ‘open’. One relative told us, “The home is very well managed”.

People living in the home told us they felt safe. One person said, “I like living here; everyone is very nice to me”. A relative said, “When I leave I know he is being looked after properly by people that care about him”. People were given easy read guidance about how to recognise and report abuse; meetings were arranged with the local police to help raise their awareness of personal safety. Staff had a good understanding of what constituted abuse and were able to describe the action they would take if they witnessed or suspected any abusive or neglectful practice.

We found risks to people’s safety had been assessed, discussed with each person and recorded in their care plan. Staff were given clear instructions about how to safely manage any risks and to make sure people’s independence, rights and lifestyle choices were respected.

Proper checks had been completed before new staff started working in the home. People who lived in the home were involved in the recruitment process. They had been able to meet and greet new applicants or had participated in the interview to help make sure any new staff recruited were capable of supporting them. New staff were given training, support and supervision before they started work.

There were enough staff to look after people properly and the numbers of staff were changed to make sure people’s choices, routines and needs were met. People were happy with the staff team. Comments included, "They are lovely; they help me a lot” and “The staff are brilliant”. A relative said, “There are always enough staff to make sure he has a good social life” and “My relative gets fantastic support from the management and staff and so do we”.

All staff were given training and support they needed to help them look after people properly. We observed staff being kind, friendly and respectful of people's choices and opinions. The atmosphere in the home was relaxed; we heard a lot of laughter and conversations about different things. All the staff spoken with had a good knowledge of the people they supported.

People’s medicines were looked after properly by staff that had been given training to help them with this. Regular checks were done to make sure they were competent. We noticed some medicines were not always checked in or out of the home properly when people left the house. We talked to the registered manager about this; she looked into this at once.

The Mental Capacity Act 2005 (MCA) sets out what must be done to make sure the rights of people who may lack capacity to make safe decisions are protected. The Deprivation of Liberty Safeguards (DoLS) provides a legal framework to protect people who need to be deprived of their liberty to ensure they receive the care and treatment they need. Staff had received training about the MCA and DoLS and had a good understanding of the procedures to follow. There was clear evidence to support appropriate action had been taken to apply for authorisation by local authorities and that the provider was complying with any instructions applied to the authorisation.

We observed people being asked for their consent to any care and treatment and it was clear staff were aware of people’s capacity to make safe decisions. However, the information in care plans did not consistently clearly record people’s ability to make choices and decisions about their lives. We were told the care plans were being further developed to make sure people’s consent to care and treatment was always recorded clearly.

People told us they were involved in the planning of weekly menus and would go shopping for groceries, with staff, to local shops and supermarkets. People, who were able to, were given support by staff to prepare their own meals. During the lunch time meals we saw people were given support as needed; the atmosphere was relaxed with a lot of chatter and laughter between staff and people living in the home. We saw healthy eating plans had been discussed with people and considered as part of the menu planning and preparation of meals.

People were involved in discussions and decisions about their health and lifestyles and were supported to reach any goals they had set for themselves. Information from the recent satisfaction survey indicated people were supported to stay healthy; this included attendance at sports facilities. We found the service had good links with other health care professionals and specialists to help make sure people received prompt, co-ordinated and effective care.

People were involved in discussions and decisions about the activities they would prefer and were involved in many interesting activities both inside and outside the home. Activities were arranged for groups of people or on a one to one basis which would help make sure activities were tailored to each individual. During our visit people visited the local pubs and shops, the park and the café for a cup of tea; activities were flexible and suggested by people living in the home. People were also involved in household chores. People told us they were supported to maintain contact with their friends and family and were able to spend periods of time away from the home.

The complaints procedure was displayed around the home and was available in an easy to read format that could be understood by everyone. People who used the service and their relatives were encouraged to discuss any concerns during key worker meetings, in house meetings, in day to day discussions with staff and management, and also as part of the annual survey. Information from the recent satisfaction survey indicated people living in the home and their relatives knew who to complain to if they were unhappy about any aspect of their care.

There were effective systems in place to regularly assess and monitor the quality of the service. They included checks of the medication systems, care plans, money, activities, staff training, infection control and environment. We saw improvements had been made when any shortfalls had been found.

People were asked their views and opinions of the service during meetings, key worker reviews and day to day discussions with staff and management. People using the service, their relatives and staff had completed customer satisfaction surveys to determine their views on the service. A ‘Compass Group’ enabled people using the service to meet and discuss improvements and developments that were important to them; records showed people had been listened to. People using the service, their friends and family and people from the local community were able to attend training sessions, meetings and social events at ‘The Chill Mill’ (day centre).