The inspection of Heathcotes (Whitley) took place on 1 August 2017 and was unannounced.

Heathcotes (Whitley) is a residential home for people with autism, learning disabilities, mental health needs, physical disability or sensory impairment. The service can accommodate up to nine people, but at the time we inspected there were seven people using the service. The building is a converted farmhouse in a rural location on the outskirts of the village of Whitley. Bedrooms are on the ground and upper floor, each with en-suite facilities. The service has communal areas and a secure garden for people to use. At the front of the service there is a courtyard, which people access and which is secured by a locked gate. A driveway, also secured by a locked gate, runs from the courtyard to the main road. Up to four cars can be parked on this driveway.

At the last inspection on 23 and 24 May 2016 the provider did not meet all of the regulations we assessed. This was with regard to safe care and treatment, staffing numbers, person-centred care and good governance. The provider had not ensured that people’s risk assessments were followed, sufficient support workers were on duty to meet people’s needs for one-to-one care, support was delivered in line with support plans and record keeping was accurately maintained. At that inspection the service was rated ‘Requires Improvement’.

At this inspection we also found the overall rating for the service to be ‘Good’. The rating is based on an aggregation of the ratings awarded for all five key questions. Improvements were made in the provision of safe care and treatment, as risks were managed, reduced and followed on an individual and group basis so that people avoided injury or harm wherever possible. Improvements in staffing numbers meant there were sufficient support workers to meet people’s needs and we saw that rosters accurately cross referenced with the support workers that were on duty. People’s support plans were followed more closely and so they were provided with person-centred care. However, although support workers maintained certain records more accurately than at the last inspection, some were still not detailed enough. This meant that while the requirements made against breaches in regulations at the last inspection, were now met, there were still some recommendations made with regard to best interest and physical intervention records.

The provider was required to have a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. On the day of the inspection there was no registered manager in post as they had left their position unexpectedly three days before we inspected. The provider was required to inform us of this via a formal notification. The acting area manager explained how the service was being managed in the interim period between having no registered manager and recruiting a new manager. They told us who would be managing the service from 7 August 2017 and that a new registered manager application would be made as quickly as possible. However, a service that does not have a registered manager in place cannot receive a higher rating than 'Requires Improvement' in the well-led domain as the registered provider is in breach of the conditions of their registration.

People were protected from the risk of harm because the provider had systems in place to detect, monitor and report potential or actual safeguarding concerns. Staff were appropriately trained in safeguarding adults from abuse and understood their responsibilities in respect of managing potential and actual safeguarding concerns.

The premises were safely maintained and there wa

This inspection took place on 23 and 24 May 2016.

The service is a residential home for people with autism and learning disabilities. The service can accommodate up to nine people. The building is a converted farmhouse in a rural location on the outskirts of the village of Whitley. Bedrooms are on the ground floor or upstairs, and each bedroom has ensuite facilities. The service has communal areas and a secure garden for people to use. At the front of the service there is a courtyard which people access, it had a locked gate then a driveway with another locked gate.

At the last inspection in August 2015 the service was rated good overall and was found to be meeting the regulations.

The service had a registered manager however, they had applied to deregister. Another manager within the organisation, who had been registered at another service, had applied to register at Heathcotes (Whitley). They had been working at the service for the last four weeks. 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.

The service did not always have sufficient staff to meet people’s needs. There were times when people who required specific support were not provided with this due to staff shortages. As the service did not employ ancillary staff this meant care staff were not always available to provide one to one care. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Risks to people who used the service were not always adequately managed. For example, one person who used the service had managed to run out of the service and onto a busy road. The service had implemented stricter security since the incidents. However, these should have been in place to prevent the incidents occurring. Environmental risks were identified during the inspection, for example, a broken trampoline and a chair at the top of a set of stairs which was a trip hazard. Not all areas of the service were clean. Some door handles were sticky and paintwork was dusty and stained. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People’s care did not always meet their needs. For example, one person’s care plan referred to a specialist communication method which should be used to enable them to express their needs and preferences. We did not see staff using this to communicate with the person. In addition another person was not supported to have a nutritious diet. This was a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Record keeping was not adequate. There were gaps in key documents which meant we could not be certain people received the care they required. Gaps in the handover book meant, on some days, there was no record of staff on duty or who they were providing support to. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the registered provider to take in relation to these breaches of regulation at the back of the full version of the report.

Staff demonstrated a good understanding of how to safeguard people who used the service. They told us they would raise concerns with the manager and they were confident these would be investigated appropriately.

We saw evidence of detailed risk assessments and risk management plans. Where restraint or medicines were used to alleviate people’s distress, staff told us this was always a last resort and risk management plans contained detailed guidance to ensure staff used the least restrictive intervention to keep the person safe. Medicines were safely managed.

The ser

The inspection took place on 11 August 2015. We announced the inspection 24 hours beforehand. This was because people who used the service may have needed reassurance from staff about our role to reduce their anxiety.

The last inspection took place on 9 July 2014 and the service met the regulations we looked at.

The service is a residential home for people with learning disabilities and autism. The service has nine people living there. The building is a converted farmhouse in a rural location on the outskirts of the village of Whitley. Bedrooms are on the ground floor or upstairs, and each bedroom has en suite facilities. The service has communal areas and a secure garden for people to use. At the front of the service there is a courtyard and people accessed this, it had a locked gate.

The service had a registered manager. However, for the last 12 months they had been in the role of regional manager. The registered manager told us they retained responsibility for the service and visited at least twice a week. They told us they had been supporting the manager to develop their skills within this role. The new manager told us they intend to apply to CQC to be the registered manager of 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.

There were sufficient staff to support people who used the service. We saw that people were provided with the support required to meet their assessed needs. Staff were recruited safely.

Staff were aware of how to safeguard people from avoidable harm. The service had developed risk assessments and risk management plans to reduce the risk of harm to people who used the service. There was clear guidance in people’s files about Non-abusive Psychological and Physical Intervention (NAPPI) and the use of different forms of restraint to use if needed. Physical restraint was used only as a last resort and when needed to keep people safe.

Medicines were safely managed and we safe the service had protocols in place for people who needed medication as required.

Staff were supported to develop the skills required to carry out their roles. Staff spoke positively about the induction programme, and we saw there was an ongoing assessment of their skills throughout the probationary period. Staff were supported to attend specialist training based on the needs of people they supported. There was effective supervision in place.

Staff followed the principles of the Mental Capacity Act (2005) and we saw evidence of mental capacity assessments and best interest decisions for people who were unable to give their consent. Staff understood Deprivation of Liberty Safeguards and all of the people who used the service were subject to these restrictions. The manager had completed the required referrals to ensure they followed the legislation.

People had access to appropriate health care support based on their individual needs. The service had access to clinical psychology services and they provided specific support to staff in relation to individual people.

People had access to regular snacks and drinks and the menu plans we looked at showed food provided was varied and nutritious.

Communal areas were busy, particularly in the morning when people were waiting to go out for the day. Some health professionals raised concerns this busy environment could have a detrimental impact on people with autism. The leadership team agreed to look at how this could be improved for people. They were also planning to look at how the available communal space could be used more effectively.

There were supportive relationships between staff and people who used the service. Staff respected people’s privacy and the service promoted people’s dignity.

There were some inconsistencies between what we saw recorded in people’s support plans and how we observed staff interact and respond to people’s behaviour and mood. We recommended the provider review this.

People’s support was reviewed on a regular basis however, we did not see records of the achievements people had made. Staff could tell us about these but we did not see how this information had been used to develop people’s support plans.

People were supported to access community transport to increase their independence and had access to a range of varied activities.

The service had an up to date complaints policy which had been sent to people’s families or advocates.

There were effective systems in place to monitor the quality of support provided to people. The manager completed audits, the regional manager visited on a regular basis and the service had an independent quality assurance team who completed their own audits. This meant if concerns were identified immediate action could be taken to resolve them.

People were asked to give feedback on the service via their reviews, and the organisation sent an annual questionnaire. Unfortunately this was done across the organisation as a whole and could not be broken down to this specific service.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions: is the service safe, effective, caring, responsive and well-led?

The summary describes what people using the service told us or their relatives, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

Risks to people’s health and wellbeing were known by the staff. These risks were kept under review to help to maintain people’s safety.

The service had policies and procedures in place in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). Staff had been trained in this area to help to protect people’s rights.

Systems were in place to make sure that the manager and staff learnt from accidents and incidents, complaints and concerns. This helped to reduce the risk to people and ensured that the service continually improved.

Staffing levels were monitored and adjusted to provide people with one to one or two to one support where this was needed. This helped to keep people safe and ensure that people were supported to live the life they chose.

Is the service effective?

People’s health and care needs were assessed with them or with their chosen representative. People were encouraged to live their life and be as independent as possible, even if there were risks attached to this. Relatives we spoke with said “The staff understand X’s needs very well. They (the staff) get the doctor if X is not well.” and “I look at X’s care records. I am invited for reviews and asked about X’s care.”

Help and advice was gained from relevant health care professionals. This helped to ensure that people received the help and support they needed to maintain their health and wellbeing.

People were provided with a choice of nutritious food. Snacks and drinks were available to people at any time. People’s dietary likes and dislikes were known by the staff. Health care professionals were involved in monitoring people’s dietary needs. This ensured people nutritional needs were met.

Is the service caring?

We asked people if they felt cared for, they nodded or said "Yes". We saw that people looked well cared for. People were supported by staff who appeared to be patient and kind. Staff appeared to understand people’s need well. Staff offered assistance and support to people in a timely way.

We saw staff spent time with people. For example we saw two members of staff taking a person to the park, we observed them at the park. We saw that the staff were happy to spend as much time at the park as the person wished to, which allowed the person to enjoy this. People living at the home were supported by staff who told us that the resident’s needs were their top priority.

People looked relaxed and comfortable in the presence of the manager and staff. A relative we spoke with said “Staff have a positive attitude. They don’t just say they are going to do things. When I came and looked round and met the manager I felt happy.”

Staff understood how people used sounds and body language to communicate their needs. We saw staff understood people’s individual communication methods well.

People using the service and their relatives were asked on a two yearly basis to complete a satisfaction survey. Where shortfall or concerns were raised these were addressed.

Is the service responsive?

Enough staff were on duty to be able to support people in a timely way. The manager told us that the staffing rota was completed to make sure people had the support they needed at all times. Extra staff were provided for hospital appointments, outings and to take people on holiday. A relative we spoke with said “There are plenty of staff, there are no problems.”

Information was provided to people and their relatives about how to make a complaint. Staff spent time observing people and asked people for their views. We saw that staff acted upon comments made. This helped people to remain happy with the service provided.

Is the service well led?

The manager and staff worked well with other health care professionals to ensure that people received the care they required.

Quality assurance systems were in place. The quality of the service provided was constantly being monitored by the manager and senior management team. Improvements were made where necessary to make sure that people living at the home received the help and support they required.

Staff we spoke with understood their roles and responsibilities. They told us they were happy working at the home. The ethos of the service was to make sure that people lived their life to the full. We saw that the manager provided staffing levels which promoted and encouraged people’s independence. For example people were able to go on holiday, go shopping and go horse riding. A relative we spoke with said “We met the manager and staff. We feel X is in safe hands."

People's needs were assessed and their rights were respected by the staff. People told us they were able to make decisions about how they wanted to spend their time. We saw staff treating people with dignity and respect. People said they were well cared for and said that they liked living at the home.

People had support plans and risk assessments in place which helped staff to understand and meet people's needs. We observed staff helping people to maintain their independence and make choices for themselves.

The home had policies and procedures and systems in place which helped to protect people.

We observed good interactions between those living and working at the home. Staff received sufficient training to enable them to meet the needs of people living at the home and they told us that they received good support.

People's views were being sought about the quality of the service provided. We saw that the management team acted upon any issues to make sure that people remained happy with the service they received.