The inspection took place on 30 and 31 January 2017 and the first day was unannounced.

The last inspection took place 12 and 13 April 2016 when we found breaches of four Regulations relating to notifying the Care Quality Commission (CQC) of significant events, having a process and system in place to report any safeguarding concerns, ensuring the service was safe and good governance. At this inspection we found improvements had been made in all these areas.

Heathfield House provides support and accommodation for up to ten people who have mental health needs and/or learning disabilities. There were ten people using the service at the time of this inspection.

There was a registered manager in post. 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 had been in post for approximately two years and regularly worked alongside staff on shift so that they could see how the service met people's needs.

There were now more detailed and regular checks and systems in place to check the fire procedures and that equipment protected people in the event of a fire. Fire doors were checked each week to ensure they automatically closed.

Staff received training on safeguarding adults from abuse and there were policies and procedures in place. There had been no safeguarding incidents since the last inspection. We saw evidence in the policies and in people’s care records that staff were reminded to report any concerns to the registered manager and to the local authority and to CQC.

People’s care records included people's needs and preferences and were individualised. We saw information had been reviewed on a regular basis.

There were checks on a range of areas in the service to ensure people received safe good care.

Feedback from people using the service, staff we spoke with and professionals was positive about the service.

Staff continued to receive support through one to one and group meetings. They also received an annual appraisal of their work. Training on various topics and refresher training had been arranged in different topics that were relevant to staff member's roles and responsibilities.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the systems in the service supported this practice.

There were sufficient numbers of staff working to meet people’s needs. Recruitment checks were carried out to make sure staff were suitable to work with people using the service.

People received the medicines they needed safely.

People had access to the health care services they needed and their nutritional needs were being met.

There was a complaints procedure available, which was also in a pictorial version for people who responded to pictures more than words.

The inspection took place on 30 and 31 January 2017 and the first day was unannounced.

The last inspection took place 12 and 13 April 2016 when we found breaches of four Regulations relating to notifying the Care Quality Commission (CQC) of significant events, having a process and system in place to report any safeguarding concerns, ensuring the service was safe and good governance. At this inspection we found improvements had been made in all these areas.

Heathfield House provides support and accommodation for up to ten people who have mental health needs and/or learning disabilities. There were ten people using the service at the time of this inspection.

There was a registered manager in post. 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 had been in post for approximately two years and regularly worked alongside staff on shift so that they could see how the service met people's needs.

There were now more detailed and regular checks and systems in place to check the fire procedures and that equipment protected people in the event of a fire. Fire doors were checked each week to ensure they automatically closed.

Staff received training on safeguarding adults from abuse and there were policies and procedures in place. There had been no safeguarding incidents since the last inspection. We saw evidence in the policies and in people’s care records that staff were reminded to report any concerns to the registered manager and to the local authority and to CQC.

People’s care records included people's needs and preferences and were individualised. We saw information had been reviewed on a regular basis.

There were checks on a range of areas in the service to ensure people received safe good care.

Feedback from people using the service, staff we spoke with and professionals was positive about the service.

Staff continued to receive support through one to one and group meetings. They also received an annual appraisal of their work. Training on various topics and refresher training had been arranged in different topics that were relevant to staff member's roles and responsibilities.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the systems in the service supported this practice.

There were sufficient numbers of staff working to meet people’s needs. Recruitment checks were carried out to make sure staff were suitable to work with people using the service.

People received the medicines they needed safely.

People had access to the health care services they needed and their nutritional needs were being met.

There was a complaints procedure available, which was also in a pictorial version for people who responded to pictures more than words.

At the time of our inspection there were nine people living at the service, six of whom were away on holiday at a holiday camp. We spoke with the provider, one other member of staff and two people who were using the service.

People told us that they were asked for their consent before any decisions were made about their care. We observed positive interactions between staff and the people using the service. We saw that people were routinely involved in decision making about daily routines such as meal preparation and offered choices about what they wanted to eat and what they wanted to do.

People's needs were assessed and a suitable plan of care developed. People's care plans had been reviewed at regular intervals and updated to reflect their changing needs. People were supported to access healthcare professionals for routine check-ups and specialist support where required. One person told us, "the dentist comes to visit us here and the chiropodist comes every few weeks."

The home was clean and well maintained. We saw that bedrooms were personalised to reflect people's preferences with pictures and personal effects. We looked at certificates relating to health and safety. We saw that gas, electrical and fire safety certificates were in place and renewed as required to ensure the premises remained safe for staff and people using the service. However, there had not been a fire drill recorded for the home for some time.

Quality assurance systems were in place to monitor the service people received and address any issues identified.

Staff recruitment processes were not effective and did not ensure that staff were suitable to work with vulnerable people.

We spoke with the manager of the service, one other member of staff and five people who used the service. There were seven people living at the home at the time of the inspection. People told us they were given choices and we saw evidence that staff listened to people and made changes in response to their views.

We observed positive interactions between staff and the people using the service. People told us staff treated them well and respected their privacy. Care records were clearly written and contained sufficient information about people's needs and the action staff should take to meet them. People's likes, dislikes and preferences had been considered throughout. People were supported to attend health appointments and encouraged to take part in leisure activities.

People were protected from the risk of abuse as staff were appropriately trained and aware of their responsibilities. Staff received training in appropriate topics to equip them with the appropriate knowledge and skills to effectively meet people's needs. Staff told us that they received regular formal and informal supervision and support. However, the records did not evidence that formal supervision was taking place at sufficiently regular intervals to ensure staff were supported in their roles.

There was an effective complaints management system in place. The complaints procedure was accessible and clearly displayed in the home and people told us they felt able to raise any concerns that they had.

People told us that they are happy living at the home. They said that staff help them and they can talk to staff if they are worried about anything. People enjoy going shopping and going out to places of interest. People said that they are able to make choices about their lives, to include the activities they do and the food they want to eat. Comments included:

‘It’s very good here’. ‘The staff are all very good to me’. ‘It’s a nice place, lovely place’.

At our inspection visit on 26 September 2013 we found that systems in place for recruiting staff were not robust and did not ensure that only staff suitable to work with vulnerable people were employed to work at the service. For example, prospective staff were not expected to provide a detailed employment history, some references had not been verified and there was not always sufficient evidence on staff records about their right to stay and work in the UK.

Following our inspection the provider submitted information telling us what action would be taken to ensure these issues were addressed.

During this inspection we found that systems had improved to ensure that only suitable staff were employed. For example, a new application form had been developed and implemented that requested more detailed information about each staff member’s employment history. We also saw that references had been verified to ensure they were authentic and there were details of each staff member’s right to work in the UK. However, the provider had not always documented discussions with staff about some remaining gaps in their employment history that had not been explained.