We undertook an unannounced focused inspection of this home on 16 August 2018. This inspection was completed in response to some whistle blowing concerns we had received in relation to; safe care and treatment, skills and knowledge of the staff team and availability of food. The team inspected the service against two of the five questions we ask about services: is the service safe and is the service effective?

No concerns had been identified in the remaining Key Questions and none became apparent during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection'

Heathcotes Salford 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 a maximum of seven people. When we inspected there were six people living in the home. Accommodation is provided in a large detached property, over three floors, in single en-suite rooms. There were two communal lounges, a large dining kitchen, utility areas and a garden.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

We found people had been protected from the risk of harm and abuse. Where a person had experienced harm or abuse the home had responded appropriately by raising a safeguarding alert and reviewing practice to minimise reoccurrence. The home had ensured risks had been fully assessed and plans developed to manage them. Incidents had been fully recorded and the home had reviewed them regularly to learn and improve. Some staff had not felt safe working in the home and had left, one member of staff we spoke with said they had felt unsafe before but felt safer since there had been an increase in the staffing. The other staff we spoke with all said they felt they were safe and were able to maintain people's safety in the home.

We had received concerns that medicines had been given inappropriately and caused a person to be drowsy. We reviewed the medicines including medicines given when required, for example, to support a person to manage their feelings, and found these had not been used excessively. All as required medicines had been accurately recorded and given according to the agreed protocol. We checked the stocks against the records and found them to be correct.

We had received concerns that there had not been enough food in the home and people had not been able to eat breakfast or lunch. We looked at the food stocks and found these to be sufficient. We reviewed the food and drink records for three people in their daily records and saw a variety of food and drink had been provided at all times. At our previous inspection the home was found to be in breach of the regulations in relation to maintaining nutrition. At this inspection we found the home was no longer in breach of the regulations.

We had received concerns about the skills and knowledge of the staff team and the support and supervision available. We reviewed the training records and found all staff had received an induction and a broad range of training which included supporting people whose behaviours might challenge. We spoke with staff who told us they felt they had the skills and knowledge they needed to provide care and support effectively.

We reviewed the supervision records and found staff received regular supervision which addressed key areas of practice and staff welfare. Staff we spoke with told us they also received additional supervision following an incident or change of

This comprehensive inspection took place on 21 and 22 March 2018. Due to the nature of the service provided at Heathcotes, we gave the provider 24 hours' notice. This enabled the provider to prepare people at the service for our visit. This was the first inspection since this home was registered on 14 September 2017. We brought this inspection forward in response to whistleblowing concerns.

The whistleblowing concerns we had received related to unsafe staffing levels, unmanaged risks and the lack of up to date information in care plans. There had been safeguarding alerts raised in relation to administration of medication and restrictive practices. In addition, the police had attended the property in response to behavioural support needs. We looked specifically at events detailed in the whistleblowing and found there was no evidence to support the concerns raised.

The Rookery 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 a maximum of seven people. When we inspected there were six people living in the home. Accommodation is provided in a large detached property, over three floors, in single en-suite rooms. There were two communal lounges, a large dining kitchen, utility areas and a garden.

At this inspection we found three breaches of the Health and Social Care Act (2008) in relation to Regulation 14 Meeting nutritional and hydration needs and Regulation 17 Good governance. You can see what action we told the provider to take at the back of the full version of this report. We also found the provider had failed to notify us of specific incidents and we are considering our options in relation to this matter.

We discussed with the local police force their attendance at the property and found the police had attended more regularly than we were aware of. We discussed this with the registered manager who informed us the number of visits by the police had reduced significantly in response to risks being more effectively managed. We will continue to monitor this.

Nutritional and hydration support needs were not evidenced to have been met for one person who had been found to be nutritionally at risk. The home had not kept a contemporaneous record of the support offered.

Records in relation to medical appointments had not contained enough detail to determine the purpose and outcome of the appointment for one person and it was not possible to identify what action or treatment had been recommended.

Records in relation to a specific incident for one person were contradictory. The registered manager gave a different account to what had been recorded in the person’s notes. This meant it was difficult to be certain what may have caused the person to experience distress.

Auditing systems did not identify concerns we had found at the inspection.

Relatives we spoke with expressed a lack of confidence in the service’s understanding of their relative’s needs.

Staff we spoke with were knowledgeable about protecting people from the risk of harm and abuse and were able to explain how they raised a safeguarding concern. Staff also said they felt there were enough of them on duty to ensure people were safe.

Staff had received training appropriate to their roles and had regular supervision and support from the management team.

People’s needs had been assessed in consultation with families, commissioners and specialist learning disability services. Care plans were detailed and contained sufficient detail for staff to know how to provide care and support.

The home was compliant with the requirements of Deprivation of Liberty Safeguards (DoLS) contained in the Mental Capacity Act 2005. Mental capacity assessments and best interest decisions were well documented. Staff were aware of the need to gain consent from pe