We inspected the service on 2 October 2018. The inspection was unannounced. The Heathers 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 accommodates 12 people.

On the day of our inspection 10 people were using the service.

The care service had not originally 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. However, people were given choices and their independence and participation within the local community encouraged.

At our last inspection on 11 August 2016 we rated the service good. At this inspection we found the evidence continued to support the rating of 'good' overall but there had been a deterioration in well led which was rated as ‘requires improvement’. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People continued to receive a safe service where they were protected from avoidable harm, discrimination and abuse. Risks associated with people’s needs including the environment, had been assessed and planned for and these were monitored for any changes. People did not have any undue restrictions placed upon them. There were sufficient staff to meet people’s needs and safe staff recruitment procedures were in place and used. People received their prescribed medicines safely and these were managed in line with best practice guidance. Accidents and incidents were analysed for lessons learnt and these were shared with the staff team to reduce further reoccurrence.

People continued to receive an effective service. Staff received the training and support they required including specialist training to meet people’s individual needs. People were supported with their nutritional needs. Staff identified when people required further support with eating and drinking and took appropriate action. The staff worked well with external health care professionals, people were supported with their needs and accessed health services when required. 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. The principles of the Mental Capacity Act (MCA) were followed.

People continued to receive care from staff who were kind, compassionate and treated them with dignity and respected their privacy. Staff had developed positive relationships with the people they supported, they understood people’s needs, preferences, and what was important to them. Staff knew how to comfort people when they were distressed and made sure that emotional support was provided. People’s independence was promoted.

People continued to receive a responsive service. People’s needs were assessed and planned for with the involvement of the person and or their relative where required. Some care plans were not user friendly or up to date but staff knew and understood people’s needs well. People received opportunities to pursue their interests and hobbies, and social activities were offered. There was a complaint procedure and action had been taken to learn and improve where this was possible.

The service was rated ‘requires improvement for ‘well led’ at this inspection. The monitoring of service provision was not always effective because repeated shortfalls were not identified or resolved. There was an open and transparent and person-centred cult

This inspection took place on the 11 August and was unannounced.

The service is registered to provide accommodation and personal care for up to 12 people with mental health or learning difficulties. At the time of our inspection there were 10 people living there, some of whom had lived there for a number of years.

The service has a registered manager. 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 well supported and cared for and appeared relaxed and responded positively towards staff.

There were appropriate recruitment processes in place and people felt safe in the home. Staff understood their responsibilities to safeguard people and knew how to respond if they had any concerns.

People received care from staff who were kind and considerate and who were committed to respecting their individuality and promoting their independence. Their needs were assessed prior to coming to the home; individualised care plans were in place and were kept under review. Staff had taken time to understand peoples likes, dislikes and past lives and enabled people to pursue their interests and hobbies.

Staff were supported through regular supervisions and undertook training which focussed on helping them to understand the needs of the people they were supporting. People were involved in decisions about the way in which their care and support was provided. Staff understood the need to undertake specific assessments if people lacked capacity to consent to their care and / or their day to day routines. People’s health care and nutritional needs were carefully considered and relevant health care professionals were appropriately involved in people’s care.

People were cared for by staff who were respectful of their dignity and who demonstrated an understanding of each person’s needs. This was evident in the way staff spoke to people and engaged in conversations with them. Relatives commented positively about the care their relative was receiving and it was evident that people could approach management and staff to discuss any issues or concerns they had.

There were a variety of audits in place and action was taken to address any shortfalls. The registered manager was visible and open to feedback, actively looking at ways to improve and develop the service.

We were accompanied on this visit by someone called an expert by experience. This person had personal experience of using a social care service. We take an expert by experience to inspections to talk to people to help us understand the experience of people there.

The expert by experience said that she was only able to speak with two people. This was because other people had communication difficulties. The people she spoke with told her that staff were friendly and had been meeting their needs.

We also spoke with two people who lived in the home. They told us that staff were very friendly and tried to help them as much as they could.

We spoke with four relatives who confirmed that the service was very good. One relative said: ‘’The help staff give is impressive. There have been no problems‘’.

This was a largely a positive inspection. Everyone we spoke with said that care that staff supplied was good.

There were issues that needed to be dealt with. Medication systems need improvement to ensure people always received their prescribed medication. Premises issues needed improvement to ensure that anything affecting the decor and equipment are quickly attended to.

There were a small number of suggestions: more trips out to go shopping and to go to the cinema for example, for the home to have another vehicle with wheelchair facilities, for staff to be around lounge areas to make sure people were all right, and to have more in-house activities for people.

We briefly spoke with two people during the inspection. They said that they were not completely warm in the lounge they were sitting in. There was a portable heater in the lounge. The staff member then turned it on. The manager said he would remind staff to ask people about temperatures, so that they could quickly act to put heating on as needed.

We found that there had been progress in addressing the issues from the last inspection. Work had been carried out in replacing a heavily stained carpet. There was extra heating available if needed. There was evidence in place that work had been ordered to rectify the central heating system in the ground floor extension.

We spoke with four people who used the service.

People spoken with told us they liked the staff. One person said; '’They make sure I'm alright'’. Everyone confirmed that they were happy living in the home.

One person said that she was worried about the behaviour of another person, as this person had hit her. We spoke to the manager about this situation. We found that action had been taken to try to prevent this from happening again.

We spoke with four relatives. They were all satisfied with the support their relatives received. One relative told that staff were; "always friendly and professional. They know what they are doing’’.

One person was concerned about the lack of activities for her daughter. The manager said that this issue was regularly discussed and would be looked at again.

There was one comment about the lack of staffing when staff were sick. We followed this up with the manager who said that action was taken to fill the shortfall if possible. We looked at a staff rota which indicated the level of staffing able to meet people's needs.

Our main concern was about maintenance arrangements. We found that issues identified in the last inspection had been followed up. However, there were other maintenance issues found to be deficient on this inspection. Current procedures do not produce swift arrangements to ensure good maintenance. We have required more effective action to ensure that systems produce swift action.

We spoke with five people who use the service and with five relatives/representatives about their views of the care provided by the service. We also spoke with a consultant psychiatrist and community nurse who were visiting the home at the time of the inspection.

The people we spoke with were either satisfied or very satisfied with the care supplied by the service. One person said that two staff ‘got onto’ her, though she thought the other staff were friendly. Looking at the care plan for this person we saw that there was a history of making similar allegations. The manager said that these expressions of concern as a complaint and would be properly investigated.

Staff were generally seen as friendly and helpful. The only suggestions we received to improve the service were to have more activities during the day for the people who stay in the home, for the home to have its own transport which could properly accommodate wheelchair users, for some carpets to be replaced and some corridor decor to be repainted. The manager said that he would follow these suggestions up.

People largely praised the service: 'Staff are friendly and help you’. ‘We can do what we like. There are no rules here’. ‘This is one of the best homes we deal with. Staff are well trained and contact us when appropriate’. ‘My key worker helps me when I need her’. ‘I feel safe living here.’

This unannounced inspection took place on 29 and 30 October 2015. The service provides support for up to 12 people with mental health or learning difficulties. At the time of our inspection there were eleven people living at the home.

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.

Staffing levels had not always ensured that people received the support they required at the times they needed it. The recruitment practices were thorough and protected people from being cared for by staff that were unsuitable to work at the service.

Not all of the staff had benefitted from an annual appraisal of their performance.

People felt safe in the house and relatives said that they had no concerns. Staff understood the need to protect people from harm and abuse and knew what action they should take if they had any concerns.

Care records contained individual risk assessments to protect people from identified risks and help keep them safe. They provided information to staff about action to be taken to minimise any risks whilst allowing people to be as independent as possible.

Care plans were in place detailing how people wished to be supported and where possible people were involved in making decisions about their support. People participated in a range of planned activities both in the home and in the community and received the support they needed to help them to do this.

People were supported to take their medicines as prescribed. Records showed that medicines were obtained, stored, administered and disposed of safely. People were supported to maintain good health as staff had the knowledge and skills to support them and there was prompt and reliable access to healthcare services when needed.

People and their families were actively involved in decision about their care and support needs There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

Staff had good relationships with the people who lived at the house. Staff were aware of the importance of managing complaints promptly and in line with the provider’s policy. Staff and people living in the home were confident that issues would be addressed and that any concerns they had would be listened to.

The registered manager was visible and accessible and staff and people had confidence in the way the service was run.

We identified that the provider was in breach of one of the Regulation of the Health and Social Care Act 2008 (regulated activities) Regulations 2014 (Part 3) and you can see at the end of this report the action we have asked them to take.