Heightlea provides care and accommodation for up to five people who have autistic spectrum disorders. At the time of the inspection five people were living at the service. The service is part of the Spectrum group who run several similar services throughout Cornwall, for people living on the autistic spectrum.

This unannounced comprehensive inspection took place on 10 April 2018. The last comprehensive inspection took place in January 2016 when the service was rated Good overall. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. At this inspection we found the service remained Good.

People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

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.

The service requires a registered manager and there was one 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.

People were comfortable and at ease with staff. Some people chose to spend time in their rooms and others were in shared areas of the service. People were in and out of the office at various points, asking staff for support or to check what was happening during the day. Staff were considerate and respectful when speaking with people. Relatives told us they were confident their family members were safe and well supported by staff who knew them well and understood their needs.

People were supported to have their medicines as prescribed. Systems for recording when people had received their medicine were not robust and we have made a recommendation about this in the report. Some people had specific health needs and not all staff training was up to date in this area. Following the inspection the registered manager contacted us to confirm this training had now been booked for all staff.

Staff told us they were well supported and confident in their abilities to fulfil their roles and responsibilities. Staff, relatives and external healthcare professionals all commented on how well the team worked together. Staff told us roles and responsibilities were clearly defined and understood by all. Systems for communicating about changes in people’s needs were effective.

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. DoLS applications or authorisations were in place for everyone living at Heightlea. Where relevant, best interest processes had been followed to help ensure any restrictive practices were necessary and proportionate.

People had access to a range of activities on a day to day basis both in and outside of the service. The activities provided were varied and met people’s individual preferences and interests. In addition, people were supported to have holidays and short breaks away from the service. Family contact was valued and encouraged. Relatives told us they were kept informed of any changes and were invited to take part in care plan reviews.

Care plans were detailed and informative. Staff recorded information about how people spent their time and their health and emotional well-be

We carried out an unannounced comprehensive inspection at Heightlea on 15 January 2016 when we identified a breach of the legal requirements in relation to the safety of the environment. After the comprehensive inspection the provider wrote to us to say what they would do to meet legal requirements.

We undertook this unannounced focused inspection on 12 July 2017 to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Heightlea on our website at www.cqc.org.uk.

Heightlea provides care and accommodation for up to five people who have autistic spectrum disorders. At the time of the inspection five people were living at the service. The service is part of the Spectrum group who run several similar services throughout Cornwall, for people living on the autistic spectrum.

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.

All potentially hazardous products were stored safely. Action had been taken to treat decking to ensure it was not slippery underfoot. Weekly temperature checks on hot and cold water taps were carried out to monitor the safety of the hot water.

There were sufficient staff to help ensure people’s needs were met. People were supported to take part in a range of activities which were in line with their interests and preferences.

Staff had received safeguarding training and information on reporting procedures were available in the service. Risk assessments were in place and new ones developed as people tried new activities. People were supported to go out on a daily basis to take part in activities they enjoyed.

Systems in place for the management and administration of medicines were robust.

We found the breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 identified at our comprehensive inspection in January 2017 was now being met.

We inspected Heightlea on 15 January 201, the inspection was unannounced. The service was last inspected in November 2013, we had no concerns at that time.

Heightlea provides care and accommodation for up to five people who have autistic spectrum disorders. At the time of the inspection five people were living at the service. 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.

Heightlea is part of the Spectrum group who provide services to people living with autism in Cornwall. The service is a modern property located on the outskirts of Truro. Three people who had lived in another Spectrum home had recently moved into Heightlea, effectively merging the two services. Staff from both services had worked with people to help ensure a smooth transition

The premises were well maintained, pleasant and roomy. People had large bedrooms which had been decorated and furnished in line with their personal preferences. Everyone had access to their own bathroom. We identified several risks associated with the environment. There were a large number of COSHH (Control of Substances Hazardous to Health), items being kept in an unlocked utility room. Hot water temperatures were not effectively regulated and staff had identified that one person had been running their bath independently but not always at an appropriate temperature. Outdoor decking was slippery underfoot but there were no risk assessments in place to help ensure the area was used safely.

The atmosphere at Heightlea was relaxed and welcoming. Interactions between staff and people were friendly and supportive. One person’s accommodation was separated from the main building which gave them a degree of independence and privacy that was important to them. Staff described to us how they worked to support them according to their preferences while protecting them from any risk of becoming socially isolated. They were able to tell us about activities the person enjoyed doing with others and who they liked to spend occasional time with.

People were able to access the local community and amenities easily as the city centre was within walking distance. People took part in a range of activities such as keep fit sessions, attending local social clubs and playing snooker. Relatives told us their family members had full and active lives.

Recruitment practices helped ensure staff working in the home were fit and appropriate to work in the care sector. Staff had received training in how to recognise and report abuse, and all were confident any concerns would be taken seriously by the registered manager.

People were assessed in line with the Deprivation of Liberty Safeguards (DoLS) as set out in the

Mental Capacity Act 2005 (MCA). DoLS provide legal protection for vulnerable people who are, or may become deprived of their liberty. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals when appropriate.

The registered manager and staff spoke of the importance of providing continuity of care for people. This had been identified as a priority for the service following the recent changes. More frequent staff meetings were being arranged to help ensure consistency. Staff told us they communicated well with each other and observed how people were supported by staff who knew them well.

There were effective quality assurance systems in place to monitor the standards of the care provided. Learning from incidents, feedback and complaints had been used to h

We spoke with three people who lived at Heightlea and one person who attended Heightlea for respite care. People told us they were “happy” at Heightlea and were pleased with the appearance of their bedrooms, the food and how they occupied their time. We observed how people interacted with staff and saw they appeared to be satisfied with the care they received and approached staff freely without hesitation.

We observed staff interacted with people who used the service in a kind and calm manner. We saw staff showed, through their actions, conversations and during discussions with us empathy and understanding towards the people they cared for. We saw that people's privacy and dignity was respected by the way that staff assisted people with their personal care.

We examined people’s care records and found the records were up to date and reviewed as the person's needs/wishes changed.

We found that people who used the service were involved in making day to day decisions and participated in tasks at home, such as cleaning and doing their laundry. During the visit we noted that people attended a variety of activities so that they had opportunities to pursue their interests.

People were protected from the risks of inadequate nutrition and dehydration.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

Staff, and people who used the service told us they felt there was sufficient staff on duty.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

We spoke to three people who used the service. They told us they liked living at Heightlea and the staff provided “good care” and “help me”. We saw people approach staff in a relaxed manner and staff responded to their approach.

We observed staff interacting with people who used the service in a kind and calm manner. We saw that staff showed, through their actions, conversations and during discussions with us empathy and understanding towards the people they cared for.

We saw that people's privacy and dignity was respected by the way that staff assisted people with their personal care.

We examined people’s care file and found the records were up to date and reviewed as the person's needs/wishes changed.

We found that people who used the service were involved in making day to day decisions and participated in tasks at home, such as cooking, cleaning and doing their laundry. The records showed that they went out frequently and saw healthcare professionals when they needed to.

Staff said they had received sufficient training and support to enable them to carry out their roles competently. The provider may like to review the staffing levels to ensure there was sufficient staff on duty.

Systems for safeguarding people from abuse were robust. Legal safeguards, which protect people unable to make decisions about their own welfare, were understood by staff and used to protect people’s rights