We carried out an unannounced inspection of Healy House on 11 and 12 April 2018.

Healy House is a ‘care home’ which is registered to provide care and accommodation for up to eight adults with mental ill health. People in care homes receive accommodation and nursing 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. Nursing care is not provided. At the time of our inspection six people were using the service.

At the time of the inspection the registered manager had taken planned leave of absence from the service. 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. In the absence of the registered manager the provider had made interim arrangements for the management of the service.

At our last inspection the service was rated Good. At this inspection we found there were four breaches of the regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014. The breaches related to a lack of robust processes for recruiting staff, a lack of assessing and managing risks to individuals, a lack of effective processes for dealing with complaints and a lack of effective governance. As a result, the overall rating has deteriorated to ‘Requires improvement’. You can see what action we told the provider to take at the back of the full version of this report.

We found all the proper staff recruitment checks had not been carried out for the protection of people who used the service.

People were not adequately protected from the risks associated with hot water. The temperature of fridges and freezers indicated there were risks around the safe storage of food.

We found some improvements were need in medicines management and systems for checking the service. Therefore we have made recommendations on these matters. Staff responsible for supporting people with medicines had completed training. They had been assessed to make sure they were competent in this task.

The management and leadership arrangements needed some stability to support the day to day running of the service.

People were actively involved with recruiting new staff. However, we found a lack of evidence to show all the required checks had been completed.

There were enough staff on duty to provide care and support; however staffing arrangements need to be kept under review.

There were systems in place for staff to receive development and supervision. However, we found some supervisions were overdue and there was a lack of information to show training had been provided and arranged.

People told us they felt safe at the service. Staff were aware of the signs and indicators of abuse and they knew what to if they had any concerns. Staff said they had received training on safeguarding and protection matters.

Arrangements were in place to gather information on people’s backgrounds, their needs, abilities and preferences before they used the service. However the assessment records for one person were not available.

Each person had a care plan, describing their individual needs and choices. This provided clear guidance for staff on how to provide support. People had been involved with planning and reviewing their care.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Policies and processes at the service supported this practice.

We found people were supported with their healthcare needs and medical appointments. Changes in people’s health and well-being were monitored and responded to.

People were satisfied with the meals provided at Healy House. Their individual dietary

The inspection was carried out on 2 and 3 March 2016. The first day of the inspection was unannounced.

Healy House provides accommodation, care and support for up to eight people with mental ill health. The service aims to put the rights of people using the service at the forefront of its philosophy of care and support. Healy House is a large terraced house situated a short distance from Burnley town centre. There are two lounges, a dining kitchen and a games room. All the bedrooms are single; seven have en-suite facilities. There is an enclosed yard to the rear of the home and a garden forecourt to the front. There are limited parking spaces to the rear of the premises.

Healy House is registered to accommodate up to eight people. At the time of the inspection there were five people accommodated at the service. People using the service may be supported to access the provider’s neighbouring registered service, Adam House as a part of their individual care package and rehabilitation programme.

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 the last inspection on 19 September 2014 we found the service was meeting all the standards assessed.

Healy House had a management and leadership team to direct and support the day to day running of the service. We found there were systems to check and monitor the quality of the service. There were systems in place to consult with people about their experiences at Healy House.

The people we spoke with indicated they experienced good care and support. Their comments included, “I am happy, I am quite content” and “It’s okay.”

We found arrangements were in place to help keep people safe and secure. Risks to people’s well-being were being assessed and managed. People using the service had no concerns about the way they were supported. They told us they felt safe at the service, one person said, “They have never shouted at me or bossed me about.”

Staff were aware of the signs and indicators of abuse and they knew what to if they had any concerns. Proper character checks had been done before new staff started working at the service.

Arrangements were in place to maintain appropriate staffing levels. There were systems in place to ensure all staff received regular training and supervision. We found some training was overdue but action had been taken to address this.

People were receiving safe support with their medicines. Staff responsible for supporting people with medicines had completed training and further training was being arranged. This had included an assessment to make sure they were competent in this task.

The service was working within the principles of the MCA (Mental Capacity Act 2005). We found people were supported to make their own decisions and choices. They were effectively supported with their healthcare needs and medical appointments. Changes in people’s health and well-being were monitored and responded to.

People were mostly satisfied with the meals provided at Healy House. Their individual dietary needs, likes and dislikes were known and catered for. Arrangements were in place to help make sure people were offered a balanced diet. People were actively involved with shopping for provisions and devising menus, which meant they could make choices on the meals provided.

People made positive comments about the care and support they received from staff. They said, “The staff are friendly” and “They are very kind people.” We observed positive and respectful interactions between people using the service and staff.

People’s privacy, individuality and dignity was respected. There was a focus upon promoting independence and deve

During the inspection we spoke with three people who used the service, the manager and two members of staff. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

This is a summary of what we found:

Is the service safe?

People who used the service told us they were satisfied with the support they experienced at Healy House. One person said, “I am settled here”.

People spoken with during the inspection did not express any concerns about the support they received with their medicines. There were appropriate arrangements in place to manage people's medicines safely.

People said they were satisfied with the accommodation provided at Healy House. However, we found some improvements were needed for people’s well-being and comfort.

Staff recruitment practices were in place to protect people from unsuitable staff. We found the required clearance checks had been thoroughly carried out for the safety and well- being of people who used the service.

Is the service effective?

People were involved in discussions about support and regular reviews had been carried out. One person explained, “They always go through the care plan with me”.

Processes were in place for care workers to attain nationally recognised qualifications in health and social care. Staff spoken with, told us of the training they had received.

Is the service caring?

During the inspection we observed staff considerately supporting people with their chosen activities and individual needs. People said, “Things are fine” and “I am happy with things”.

People told us they liked the staff team they said, “All the staff are good” and “The staff are lovely in every way”.

Risks to peoples’ wellbeing and safety had been identified and managed. Staff told us they were aware of peoples’ individual needs and the information in their care plans.

CQC monitors the operation of the DoLS (Deprivation of Liberty Safeguards) which applies to care homes. Policies, procedures and a code of practice were available to support appropriate practice around DoLS and the Mental Capacity Act.

Is the service responsive?

Records and discussion showed peoples’ mental health, healthcare and general wellbeing was being monitored and responded to. People were getting appropriate attention from medical professionals.

We found people were supported to undertake planned activities both in the home and in the local community.

People were aware of the complaints processes and who to contact should they have any concerns about their support and care. However, we noted the complaints procedure needed updating to include details of other agencies that may provide support with complaints.

Is the service well-led?

The service had a registered manager responsible for the day to day management of the home. The owners were also involved with some aspects of management. Staff spoken with had no concerns about the management of the service. They felt they were appropriately supported.

We found people were involved with decisions which affected them informally on a daily basis. People were also invited to completed satisfaction surveys for their views of the service.

There were systems in place to assess and monitor how the home was managed and to monitor the quality of the service. However, we found the results of the quality monitoring could be better highlighted, with plans drawn up to show future improvements.

People using the service told us they were satisfied with the support they received at Healy House. They made the following comments: “It’s nice here”, “It’s not bad, I have been getting out and about more”, “I love it, the staff are great” and “Healy House has been good for me, I am now looking forward to moving to my own place”.

People were being involved as far as possible in planning and consenting to their support. They were also enabled to make decisions about matters which affected them.

We found people experienced some good care and support. They were supported to develop independence skills and to access resources and activities within the community.

People were getting support with healthcare needs. They had access to ongoing attention from healthcare professionals.

People told us they liked the staff. We found people using the service were supported by enough trained, capable staff.

People had no complaints or concerns about the services being provided at Healy House. They knew how to raise concerns and were confident any complaints would be dealt with.

We found improvements had been made to make sure people using the service were supported by well trained, capable staff.

People using the service told us they were satisfied with the support they received at Healy House. They told us, “Its not bad, staff treat me well, I’m doing okay” and “It’s lovely here, I like the peace and quiet, all the staff are nice”.

People were being involved as far as possible in planning their support and were enabled to make decisions about matters which affected them.

People were treated with respect and valued as individuals, they were able to make choices and develop independence skills. They were being supported to pursue some learning opportunities and try new experiences.

They were supported to access resources and activities within the community and keep in touch with relatives.

People were getting support with healthcare needs and they had ongoing attention from health care professionals. They were being supported sensitively with personal care needs.

Although we had no concerns about peoples’ care and support; we found some improvements were needed to make sure people using the service were supported by well trained, capable staff.

People were being consulted about their experience of service. We found that checks on practices and systems were being carried out and action was being to improve and develop the service.