The inspection took place on 19 April 2018 and was announced.

Heather Lodge is a residential care home for up to three adults with a learning disability. There were three people living at the service at the time of inspection. The accommodation was in one building, arranged over two floors. One bedroom and an adapted shower room were on the ground floor and two bedrooms were on the first floor. There was a communal lounge, a kitchen/dining room and a garden.

Heather lodge is a ‘care home’. People in care homes receive accommodation and 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.

At the last inspection, on the 08 March 2016 the service had an overall rating of ‘Good.’ At this inspection we found the evidence continued to support the rating of good. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained ‘Good’.

The 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 using the service can live as ordinary a life as any citizen.

A registered manager continued to be employed at 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. The registered manager was also the provider.

There continued to be systems in place to keep people safe and to protect people from potential abuse. Staff had undertaken training in safeguarding and understood how to identify and report concerns. Medicines were managed safely and people received their medicines on time and when they needed them. The registered manager continued to assess and minimise risks. People understood these risks and how they were managed.

There was sufficient numbers of staff to meet people’s needs. Staff training had been consistently updated and staff had the skills and knowledge they needed to support people with learning disabilities. Staff had regular supervision meetings and annual appraisals. New staff had been recruited safely and pre-employment checks were carried out.

People’s needs were continually assessed and support plans remained up to date and accurately reflected people’s needs. People were continually involved in decisions about their support. People were supported to have choice and control of their lives and staff support them in the least restrictive way possible. Peoples support was individualised to them and met their needs. People made decisions about the activities they undertook. Staff were aware of peoples decisions and respected their choices.

People continued to be supported to maintain their health and wellbeing by eating a balanced diet. People were supported to maintain their health and had access to healthcare services. When people accessed other services such as going in to hospital they were supported by the service staff and there was continuity of care.

People were treated with respect, kindness and compassion. Staff took the time to listen to people and engage with them in a meaningful way. Staff knew people well and understood how people communicated. People were supported to communicate and build relationships with people in the community. People were well known in the community and were supported to maintain relationships with those who were important to them.

People were supported to express their views and had regular access to an advocate. People were supported to remain as inde

We carried out this inspection on the 8 March 2016 and it was unannounced.

Heather Lodge is a service that provides accommodation and personal care for up to three adults with learning disabilities. People had a variety of complex needs including mental and physical health needs. There were two people using the service at the time of our inspection.

People had a limited ability to verbally communicate with us or engage directly in the inspection process. People demonstrated that they were happy in their home by showing warmth to the staff that were supporting them. Staff were attentive and communicated with people in a warm and friendly manner. Staff were available throughout the day, and responded quickly to people’s requests for care and support. We observed staff supporting people with their daily activities.

A registered manager was employed at 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.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. Restrictions imposed on people were only considered after their ability to make individual decisions had been assessed as required under the Mental Capacity Act (2005) Code of Practice. The manager assisting the inspection understood when an application should be made. Decisions people made about their care or medical treatment were dealt with lawfully and fully recorded.

Staff had been trained to recognise and respond to the signs of abuse. Discussions with them confirmed that they knew the action to take in the event of any suspicion of abuse. Staff understood the whistle blowing policy and how to use it. They were confident they could raise any concerns with the registered provider or outside agencies if this was needed.

There were enough staff with the skills required to meet people’s needs. Staff were recruited using procedures designed to protect people from the employment of unsuitable staff. Staff were trained to meet people’s needs and were supported through regular supervision and an annual appraisal so they were supported to carry out their roles.

Staff respected people in the way they addressed them and helped them to move around the service. Staff respected people and we saw several instances of a kindly touch or a joke and conversation as drinks or the lunch was served and at other times during the day.

Staff were knowledgeable about the needs and requirements of people using the service. Staff involved people in planning their own care in formats that they were able to understand, for example pictorial formats. Staff supported them in making arrangements to meet their health needs.

Medicines were managed, stored, disposed of and administered safely. People received their medicines when they needed them and as prescribed.

People were provided with food and fluids that met their needs and preferences. Menus offered variety and choice.

There were risk assessments in place for the environment, and for each individual person who received care. Assessments identified people’s specific needs, and showed how risks could be minimised. People were involved in making decisions about their care and treatment.

There were systems in place to review accidents and incidents and make any relevant improvements as a result.

Management investigated and responded to people’s complaints and relatives/advocates said they felt able to raise any concerns with staff.

People were given individual support to take part in their preferred hobbies and interests.

There were systems in place to obtain people’s views about the quality of the service and the care they received. People were listened to and th

Our inspection team was made up of one inspector and followed up on areas of non compliance identified during our last inspection on the 7 April 2014. We spoke with two staff and two people who lived at the service. The registered manager of the service was not present during the inspection. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the following questions; is the service safe? Is the service effective? Is the service responsive? Is the service well led?

Below is a summary of what we found

Is the service safe?

People were cared for in an environment that was clean and well furnished. The devices in place to promote people’s safety in respect of windows and fire safety were now used effectively.

Records related to foreseeable emergencies were now accessible to staff for them to be able to reference and follow. This included information in respect of fire safety and a plan to follow in the event of foreseeable emergencies.

Following the inspection we were provided with a lone working policy and written risk assessment that documented how people were protected against the risks of unsafe care while staff worked alone.

Is the service effective?

One person’s mobility needs had recently been reviewed and documented.

Is the service responsive?

We saw that new flooring had been fitted to the shared lounge and kitchen and a staff member told us this was because the previous flooring had become worn. One person we spoke with told us that they liked the new flooring and they had been involved in choosing it.

Records showed that the guidance of a health professional had been sought to review how staff respond to one person’s behaviour.

Is the service well led?

There were systems in place to monitor the health and safety of the service. For example, we saw records that showed water temperature checks had been undertaken regularly to protect people from the risks associated with hot water.

We saw that the manager signed the incident records completed by staff that showed they had reviewed the information recorded.

People were cared for in an environment that was clean and well furnished. The devices in place to promote people’s safety in respect of windows and fire safety were not always used effectively. Records were not always easily accessible to staff for them to be able to reference and follow. This included information in respect of fire safety and a plan to follow in the event of a foreseeable emergency. Staff had an induction and received training to be able to undertake their role safely and effectively.

People we spoke with told us how much they liked living at the service and that the staff were nice. One person told us that if they were not feeling well they could talk to any of the staff and they would make sure they saw a doctor. They told us that the staff knew how to look after them. Another person told us that they talked to their key worker, the staff member responsible for overseeing their care, about their care and if they had any problems.

People were involved in making choices about their day to day lives and participated in activities that they enjoyed.

A relative we spoke with told us that their relative was “Doing really well” and “[Their relative] has come along leaps and bounds and that is due to the staff there.” They added that the staff treat their relative as a “person” and an “individual”, “They have shown [their relative] love”.

We found that the service was caring towards the people who lived there. We saw positive interaction between staff and people. Staff treated people with respect and promoted their privacy, dignity and independence.

We saw that people’s needs were assessed before they moved into the service and people’s ongoing needs were monitored and reviewed to ensure their welfare. Guidance was sought from health and social care professionals when needed in response to changes in people’s needs.

There were systems in place to monitor the quality of service delivery. These included providing a survey to relatives for them to feedback about the service. There was a complaints process in place. There were systems in place to support staff in their role and staff told us they felt supported and the manager was “Approachable”.