This unannounced comprehensive inspection started on 2 August 2018. We returned for a second day on the 16 August 2018 which was arranged with the registered manager during the first inspection day. Both inspection days were carried out by two inspectors, who were accompanied on the first day by an expert by experience.

Heatherside House Care Centre 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 care and support for up to 25 younger and older adults with a diagnosis of learning disability and/or autism. Some people also have sensory impairments and/or physical disabilities. There were 21 people living at the service at the time of the inspection. Three other people also used the service for respite care on a regular basis each week.

At a comprehensive inspection in March 2017, we found ongoing breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This included a breach of Regulation 12 (safe care and treatment). This was because risks to people had not been assessed and documented. Routine fire checks were not being carried out. Some medicines were out of date; medicines were not always recorded appropriately.

At that inspection we also found breaches of 17 (Good governance), 18 (Staffing) and 19 (Fit and proper persons employed). This was because recruitment processes did not always include all the checks necessary to ensure that fit and proper people were employed; staff were not up to date with all the training required and did not receive regular supervision; Quality and safety systems were not robust and had not identified areas where improvement was necessary, including medicine administration audits, building checks, staff training and changes to care records.

Following the March 2017 inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Is the service safe? Is the service effective, Is the service responsive and Is the service well-led? to at least good. Because of the concerns in respect of the governance of the home, CQC took enforcement action by serving a warning notice on the provider and on the registered manager. These warning notices gave the service six months to meet the requirements of Regulation 17, good governance.

We undertook a focussed inspection in December 2017 to check whether the service had addressed the concerns in the warning notices. At this inspection we only looked at the Well-led domain. We found that the requirements of the warning notice had not been met and there was an still a breach of Regulation 17. We identified significant ongoing concerns which included:

• A lack of robust quality assurance framework and systems

• Risks relating to health, safety and welfare of residents had not been considered or addressed

• Audits of care records had not resulted in updates and amendments where needed

• Audits of buildings and equipment had not identified or address issues

• Communication systems were not robust and did not ensure that staff would be made aware of changes to people’s care

• People and their families had not been involved in meaningful decisions about the ongoing refurbishment work in the home

• The registered manager had not been aware of current national policy including Registering the Right Support and other best practice guidance.

Following the focussed inspection, we met with the provider to discuss how they were going to meet the requirements of the warning notice and improve the service to ensure that they were good in all domains.

At the current inspection we found the quality assurance and governance arrangements for the home were still not sufficient to ensure that people received safe, effective care. Environme

This focussed inspection took place on 18 and 19 December 2017 and was carried out by one adult social care inspector. The inspection was unannounced on the first day. The inspection was undertaken to see whether the service was now meeting the requirements of Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The team inspected the service against one of the five questions we ask about services: Is the service well led? We found that the service was still not meeting this regulation.

Previously we had carried out a comprehensive inspection in March 2017, which had rated the home as requiring improvement overall. We identified the provider did not have effective systems to assess, monitor and improve the quality and safety of the services provided. After that inspection, we issued warning notices to the provider and to the registered manager as we found the service was not well governed and was therefore not meeting the requirements of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because audits and checks had not identified or addressed quality and safety issues. There was no overall quality assurance system which ensured that the provider monitored the quality and safety of the service. The warning notices specified that the home should address the concerns and be compliant with the Regulation by 30 September 2017.

Heatherside House Care Centre 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. Heatherside House accommodates people in two connected buildings.

The service provides care and support for up to 25 younger and older adults with a diagnosis of learning disability and/or autism. Some people also have sensory impairments and/or physical disabilities. There were 22 people living at the service at the time of the inspection.

The home had a manager who had registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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.

We found that people were still at potential risk because quality assurance and governance did not identify areas of risk or improvement required.

The home had been undergoing extensive renovations and refurbishment for since 2015, which had posed risks to people’s safety and well-being. Many of these risks had not been identified or addressed as part of the home’s quality assurance systems. During the inspection, we carried out a walk around the service with the registered manager and identified risks to people’s safety. After the inspection we wrote to the registered manager and provider asking them to provide assurances as to how these risks had been addressed. These included tools being left in a corridor and a fire exit being left open when used by workmen. The fire exit led to an area where there was a skip and building equipment which was accessible to people in the home. We also identified a laundry which was not suitable for use, a toilet with no running water at the hand wash basin and a ripped carpet in the main reception area. We received a response from the registered manager and the provider showing the steps they had or were taking to reduce the risks and keep people safe.

People and their families had not been involved in discussions about the ongoing building work or the impact this might have on stress levels and enjoyment of life.

Some audits and checks that were carried out within the home had not identified risks to people’s health and wellbeing. F

This comprehensive inspection took place on 9 and 15 March 2017 and was unannounced on the first day.

Heatherside is located in a village on the edge of Dartmoor about 7 miles northeast of Plymouth. The home provides accommodation and personal care for up to 25 adults and specialises in providing care to people with a learning disability.

The home had previously been inspected in December 2015 and January 2016. At that inspection we found breaches of two regulations. This was because people were not fully protected from the risks associated with unsafe premises; medicines were not always administered safely and clinical waste was not disposed of safely. We also found some areas of the home were not well maintained which meant people were exposed to the risks of infection.

People said they were happy and felt safe living at Heatherside. Comments included “Look after me proper, staff are nice” and “Staff are nice and friendly.” Relatives also made very positive comments about the care their family member received. For example they described staff as providing friendship and helping the person to have a laugh and a joke.

Since the last inspection, a major refurbishment programme had continued. This meant that there were significant improvements to bedrooms and communal areas. Some work was still being carried out which meant that one part of the home was not accessible to people or staff. Although some aspects of this had been better managed than when we last inspected, we found that people’s safety had been put at risk as routine fire safety checks were not being carried out. The home was clean and well-maintained.

Most aspects of medicines management were well managed. However some improvement was needed to ensure people received their medicines safely. Medicine audits had not identified that some medicines had been out of date when received. Some cream charts had not been fully completed.

The home was run by a registered manager who had been in post for a number of years. 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 very well known and liked by people, their families and staff. She and senior staff from the provider organisation encouraged a positive, homely and happy atmosphere. Staff reflected these values and behaviours. There were sufficient staff to meet people’s needs. The registered manager monitored staffing levels and took action when needed. Staff spent time with people both in groups and on their own, encouraging them to undertake activities they enjoyed. People were supported to go to clubs and groups in the community as well as on holiday.

The home’s recruitment processes did not fully ensure that people were protected. New staff were supported and trained when they first started working at Heatherside. Staff were supported to undertake a nationally recognised qualification to develop their skills. However staff had not completed or refreshed all the training needed to support people’s needs.

Supervision of staff was not carried out regularly, although staff said they were able to talk to the registered manager or a senior member of staff from the provider organisation if they needed to.

People were able to decorate and furnish their bedrooms to suit their tastes. Families were encouraged to visit and were able to have private space to meet their relative if they wanted to. People and their families said they had not had any reason to complain but felt able to raise concerns if they ever needed to.

Staff had an understanding of the Mental Capacity Act (2005). No applications for a Deprivation of Liberty Authorisation had been made.

People were su

We spoke with the manager two senior and two junior staff and people who lived at the home. The people who lived at Heatherside House told us that they enjoyed their lives at the home. One person told us "I feel happy and safe here" another told us "The carers are lovely and they listen to what I want". All people who lived at the home had clear assessments of their needs and plans and strategies were in place to meet them. Individuals care plans were reviewed regularly.

We saw written evidence of a robust staff selection process and training program for any new members of staff.

We saw that people received a good selection of nutritional meals and drinks and saw evidence that choices had been offered. We observed a mealtime where all clients appeared to be enjoying their meals, One person told us "The food here is lovely".

Sfaff worked at the pace of each individual and encouraged their independence within the range of people's disabilities. Individuals were given choices about their care and how they spent their day. People had made friendships within the home and had access to informal and organised social activities.

We examined the medication processes in place within the home. We observed that safe delivery, dispensing and recording of medications was performed by senior carers. We saw evidence that all carers had received up to date training on "medication management".

Staff were aware of safeguarding venerable adults and recognising signs of abuse and knew how to report any concerns. People told us they felt safe at the home.

Our inspection of 19 July 2012 found that there were hazards within the home and those hazards had not been risk assessed and steps taken to reduce any risk. The risks included a ladder propped against a wall and cleaning chemicals left unattended near vulnerable people. We also found that domestic staff were not receiving any form of training and we saw that this was putting people at risk. The provider wrote to us and told us how they intended to improve.

When we visited the home toward this inspection we met many of the people living there but we did not ask them specifically about safety in the home environment. However, we saw that there was good engagement between them and the staff providing care. We saw people helping with preparation for lunch, some went out in the home's minibus and others were occupied as was their choice. It was a relaxed atmosphere.

We walked around the home with the registered manager and looked at records pertaining to safety.

We found that the home environment was much safer as items, which could pose a danger, had been removed and cleaning chemicals were not left unattended where a person, who would be at risk, might access them.

Issues of health and safety had been addressed with staff through discussion, team meetings and individual supervision. They were now working in a safer way. Training arrangements had been improved and domestic staff had training planned for October 2012.

We conducted an unannounced visit to Heatherside House on 19 July 2012 as part of a programme of scheduled inspections. We spoke to nine of the 18 people who used the service. Some people living at the home were unable to communicate verbally in a meaningful way so we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We looked closely at the care of two people who used the service. This involved meeting them, talking to staff about their needs and reading records about their care. We also talked to two health care professionals, one before the visit and one after the visit, and two people's families. The registered manager was available and involved in the visit.

We received only positive comments about the home. One person told us, "I always talk to the boss" and people told us about the things they did. These included working in the office, helping lay the table for lunch and recent holidays. There were age and gender appropriate activities available for people.

District nurses spoke highly of the care provided saying how well people's complex needs were being met. People's families were full of praise for the home, with comments including: "Nothing but praise"; "Complete confidence" and "The staff are consistent and know people". We saw that staff knew how to communicate with people and understand their actions and body language where verbal communication was limited.

People's individuality was upheld. Their rooms were very individual and each person had a detailed plan of how their needs would be met. Information was provided in picture form and one person told us how they were involved in their care planning. People’s families told us that they were kept well informed.

We found that there were good arrangements in place to safeguard people from abuse.

We saw that there was much opportunity for people to comment on the service and that the registered manager took steps to check how the service was provided. This included looking at accident and incident forms and taking steps to address any issues. However, we found several hazards, in and outside of the building, due to the necessary building works. These had not been considered and managed.

Care staff received training and supervision and spoke highly of the 'team work' and supportive environment. However, non care staff were not receiving training and one had not been prepaired to undertake their role in a safe way.

The inspection took place on 30 December 2015 and 5 January 2016 and was unannounced. The service was last inspected in November 2013 and was found compliant. The inspection was carried out by one Adult Social Care inspector.

The home was located in a rural area and comprised of an original two storey house which had two single storey additions linked to it. The home was divided into three ‘units’ although all were connected by corridors and people were able to move freely between them. There were three large sitting/dining rooms. Externally there was a garden laid mainly to lawn, as well as large parking area.

The location was registered to provide care for up to 25 people with learning disability needs. Some people also had physical disabilities. However the registered manager said that the maximum number they could accommodate at the time of the inspection was 21. Work had commenced to increase the number of bedrooms at the service to accommodate the number of people the home was registered to provide care to. Everyone living at Heatherside had their own bedroom, some of which were en-suite. There were plans to make more rooms en-suite. At the time of the inspection 18 people were living at Heatherside, all of whom had been resident for a number of years.

There was a registered manager who had been in post for several years. They knew people living at the home well and were also familiar with family and friends. Everyone we spoke with, including people, families, staff and professionals said the registered manager was good at her job and knew people well.

The home was undergoing a major refurbishment programme which had started the previous summer and was due to continue for several months into 2016. The planning of this work as well as the risk assessments associated with carrying it out had not been effectively carried out, which meant that people were at risk from building work not being fenced off outside. There were also trip hazards internally and some building materials not safely stored which posed risks to people. A director of the company agreed to work with the registered manager to address the concerns. Some parts of the home had not been well maintained.

People said they were happy at the home and liked the staff who supported them. Some people said they were sometimes frightened by other people living at the home, but staff supported them so they felt safe.

People were supported to be as independent as possible and chose what activities they would like to do. This included following hobbies they were interested in, going out to activities including swimming and walking as well as joining in activities run in the home. These activities included weekly music sessions, bingo and art and craft sessions. People were also supported to maintain good health and have access to healthcare professionals when needed.

People got involved in the running of the home, including choosing what food was served. People were able to decorate and furnish their bedrooms to their own personal taste and were consulted about communal areas of the home.

Staff had been trained to support people and were able to describe their role. Staff knew people well and showed kindness, care and compassion when working with them. Risks to people’s safety had been assessed and documented. The registered manager and staff understood the requirements of the Mental Capacity Act 2005 and ensured that people were assessed in terms of their mental capacity to make certain decisions. Where a person was deemed not to have capacity, a best interest assessment had been carried out to ensure that any restrictions were kept to a minimum.

Medicines were stored safely and there were systems in place to audit medicines. However, we observed one member of staff who did not administer and accurately record medicine administration safely.

There were sufficient staff to support people, including care workers and catering staff. Staff had received supervision and support to ensure they were delivering care that met people’s needs.

Although there were some quality assurance systems in place, these did not cover all aspects of running the home.

We found two breaches of the regulations of the Health and Social Care Act 2008 (Regulated Activities), Regulations 2014