Our unannounced inspection began on 5 April 2018. We told the provider we would return on 9 April 2018 to conclude the inspection. At our last inspection in July 2016 we rated the service as ‘good’ in all key questions. At this inspection we found the provider was still rated ‘good’.

Heathcotes (Wakefield) is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service provides residential care for up to 20 adults with learning disabilities and complex needs, and is located in a quiet area close to the centre of Wakefield. The service is split into two houses and a building containing three flats. These buildings are within shared grounds. There were 19 people using the service when we inspected.

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.

There were two registered managers in post when we inspected. 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.

There was an excellent, person-centred culture in the service, driven by a committed management team that led by example and supported their staff at all times. Staff were passionate about providing excellent care and support that was tailored to and respected each person’s individual needs and preferences. People’s care plans were detailed, person-centred and the provider ensured key information was available for people in formats accessible to them.

Staff were recruited safely, well trained and told us they were proud of the work they did. Staff were deployed in sufficient numbers to provide safe support when people needed it, and we saw staff managed challenging behaviours confidently and effectively. There was a low level of use of ‘as and when’ medicines in the management of behaviours that challenge. Staff training and practice meant people were safeguarded from potential abuse.

There were good controls in place to ensure the safe ordering, checking, storage and recording of people’s medicines. We saw records were fully completed with no gaps, and saw staff had a detailed handover of medicines at each shift change to ensure any issues were identified in a timely way.

People lived in a well maintained home and were encouraged to help in keeping it clean. The home had a very relaxed atmosphere, which we observed people were comfortable in. Staff and people who used the service clearly knew each other well and we observed appropriate banter which people enjoyed.

People were able to maintain and develop activities they enjoyed and encouraged to increase their independence whenever they were able. This included accessing local amenities and experiences of working in environments meaningful to the individual. People were supported to have maximum choice and control of their lives, and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

There were clear processes in place to ensure concerns and complaints from people or their relatives were investigated and actioned as necessary, with people being updated as to the outcome. Some concerns which people expressed indirectly were addressed through changes to care plans and other routines, meaning the service was responsive to feedback received in a number of ways.

The provider had mechanisms in plac

People who used the service told us “The managers are all brilliant, they always chat to me and ask me what I have been doing.”

A family member of a person who used the service told us “I can’t praise the managers and the staff team here enough. They have been outstanding with (relative); they made more progress with them in a short time than anyone else ever has.”

Health professionals who worked with people who use the service told us “The registered manager is really good. They always make time to have a meeting with me when I come into the service, so they know what is happening with people who use the service.” “The service is really pro-active; they are always suggesting and trying new ways to help people. The thing I like most about the service though is that they don’t give up at the first hurdle like a lot of places do, they persevere and make a real difference to the lives of the people they support.”

Staff told us, “The manager is brilliant, they get involved and their door is always open. I feel safe working here as I am supported by the manager and the rest of the staff team.”

The atmosphere in the homes was warm and welcoming from the people who used the service and the staff team. The staff team worked well as a team and communicated effectively to pass on information they needed to keep everyone safe without people who used the service feeling they were being talked about, or hearing information about others which would have been inappropriate.

Staff told us that the registered manager was very visible and accessible; we saw this to be the case during the inspection. Staff understood their roles and responsibilities which meant people were able to work cohesively as they were clear about what was expected from whilst they were on duty.

Communication throughout the staff team was open and staff demonstrated their understanding of the responsibility they had to make sure that people were safe and were supported to make positive changes to their lives and achieve their potential. The staff team were passionate about their roles and were proud of the service they provided.

The registered manager and the regional manager were committed to the continuous improvement of the service Heathcotes was providing. They understood the importance of accountability and were able to evidence that there were processes in place which assured where necessary people were held accountable for their actions. We found the home was meeting the registration requirements as a registered service provider, as they were sending in notifications to tell us when a notifiable event had occurred.

Heathcotes employed a behavioural psychologist, who had previously worked with people in the service as a community based health professional. The purpose of their appointment was to work with people who had personality disorders which caused them to display suicidal behaviour or to harm themselves. There was a group starting which was based outside of Heathcotes in a community setting to work with an identified group to improve their self-image, allow them to understand their emotions and to prepare them for more traditional forms of counselling in the future if this was required. As part of this project there were opportunities being offered to existing staff to become involved in the group and to undertake specialist training to become skills trainers to share this valuable knowledge to other staff in the home. This showed that the registered provider was looking for ways to work in partnership with others and to offer opportunities for staff to develop and progress within the organisation.

We asked staff about the organisations visions and values, staff told us, “The vision is for us to support people to have a better quality of life.” Another member of staff told us “We take people when they are at a low point, sometimes because their previous placement has broken down, and we support them to make a difference to how they live their lif

We spoke with five people about their experience of living at Heathcotes. People were involved in planning the support they received and were able to make choices about all aspects of their lives. People were aware of their rights and felt that they were respected. People had access to advocates and one person spoke of working well with their advocate.

People’s comments included:

“I like it here. Staff are good.”

“The staff are great they are there when you need them.’’

We saw staff being kind and respectful towards people. We observed that staff and service users had positive relationships and people appeared comfortable with their surroundings; with staff and the activities they were engaged in.

We saw that people's rooms were personalised to reflect their individual tastes and interests, which made their rooms more personal and homely.

We saw written risk assessments had been completed which showed potential risks, and how they could be minimised. We found risk reduction plans were put in to place for different activities with different people. Specific activities and support had been risk assessed and showed what action should be taken to ensure that people were safe without restricting their independence.

We spoke with a relative of people who receive support within their own homes. They spoke very highly of the service and said they could not praise the staff highly enough for the way they relate and support their relative.

The valuing of people's diversity and human rights was evident within care planning and in how support was offered.