The inspection took place on 27 September 2017 and the visit was unannounced.

Heartwell House Residential Care Home is a care service providing accommodation and support for up to 13 people with learning disabilities or mental health conditions. Accommodation is on three floors with a staircase for access. There are 11 single bedrooms and one double bedroom situated on the first and second floors with stairs for access. There are two lounges and a dining room at the service.

At the time of our inspection there were 12 people using the service.

Heartwell House had 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.

At the last inspection on 7 January 2016 the service was rated Requires Improvement in Safe and Effective. At the follow up inspection in June 2016 we returned and saw these two areas had improved and were rated as Good.

At this inspection we found the service remained Good.

People had their support needs assessed and were involved in the development of their care plans. Staff had access to people’s care plans and received regular updates about people’s changing needs. Care plans were updated and included changes to people’s support needs. People attended routine and specialist health checks.

People felt staff were kind and caring. People felt their privacy and dignity was respected in the delivery of care and their choice of lifestyle. People were aware of their care plans and were involved in care plan reviews. Staff prompted people to make choices and respected their decisions.

People were provided with a choice of meals that matched their dietary and cultural needs and choices. Staff ensured people were able to maintain contact with their family and friends and visitors were made welcome at the service. There were sufficient personalised and culturally appropriate activities provided on a regular basis. People felt they could raise any issues or concerns with the registered manager or staff.

Staff were subject to a thorough recruitment procedure that ensured they were qualified and suitable to work with the people using the service. All the staff received an induction and then on-going training for their specific job roles. Staff were informed about, and were able to explain, how to keep people safe from abuse. Staff were aware of whistleblowing procedures and how to report suspected abuse to external bodies and follow up alleged incidents. Staff were available in adequate numbers to meet people’s support needs.

Staff told us they had access to information about people’s care and support needs and what was important to people. People and staff felt they could make comments or raise concerns with the management team about the way the service was run and were confident these would be acted on.

The service promoted equality and diversity and management followed the provider’s policy on delivering a culturally appropriate service. The staff team was made up of people with a range of skills including the ability to cook culturally appropriate food and speak a number of local languages.

There was a clear supportive management structure within the service and staff knew who to contact for advice out of hours. The provider undertook quality monitoring of the service and was supported by the registered manager and staff. Staff were aware of the reporting procedure for faults and repairs and had access to maintenance services to manage emergency and other repairs.

The provider had developed opportunities for people to express their views about the service. These included the views and suggestions from people using the service, their relatives and health and social care professionals. We receiv

We carried out an unannounced comprehensive inspection of this service on 7 January 2016. A breach of legal requirements was found. This was because the provider had not ensured the people using the service were protected from the risk of unsafe care or treatment.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach.

We undertook this focused inspection unannounced on 10 June 2016 to check that the provider had followed their plan and to confirm that they now met legal requirements.

This report covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting ‘all reports’ link for Heartwell House on our website at www.cqc.org.uk

Heartwell House Residential Care Home provides care and support for up to 13 people with learning disabilities or mental health conditions. It is situated in a detached house in Leicester City. The home has two lounges and a dining room. There are 11 single bedrooms and one double bedroom situated on the first and second floors with stairs for access.

On the day of our inspection visit there were 13 people using the service.

The service has a registered manager. This 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.

Since out last inspection visit many improvements had been made to this service. The people using it were enthusiastic about these changes and enjoying the benefits of receiving more personalised care and support.

Heartwell House had a calm atmosphere and people using the service told us they felt safe. They knew their rights and who to tell if they had any concerns. Staff had been trained in safeguarding and understood their responsibilities to protect people from harm.

People’s risk assessments had been re-written and improved. They identified areas where people might be at risk and what staff needed to do to minimise this. Staff followed risk assessment guidance in order to keep people safe.

The provider had made a number of improvements to the premises to make them safer. A paved garden area at the rear of the premises was in need of clearing and upgrading and the provider had agreed for this to be done.

There were enough staff on duty to meet people’s needs. Staffing levels at night had been increased to meet the needs of people who preferred later bedtimes. A new staff recruitment and retention policy had been introduced to help ensure the staff employed were suitable to work with people who use care services.

Improvements had been made to how people’s medicines were managed. These included the re-training of staff and new policies for staff to follow to help ensure these medicines were administered safely.

People told us they were happy with the staff team. The staff provided effective care and understood the importance of offering people choice. They followed the principles of the Mental Capacity Act when supporting people to make decisions.

People using the service and staff told us the choice of food served had improved. A new cook had been employed and they provided a varied menu in line with people’s dietary preferences.

The staff had a good understanding of people physical and mental healthcare needs. They supported people to see healthcare professionals to help ensure they got any treatment they needed.

This inspection took place on 7 January 2015 and was unannounced.

We previously carried out two unannounced inspection of this service. These took place on 21 May/11 June 2015 and on 21 September 2015. Over the course of these inspections six breaches of legal requirements were found and, following each inspection, the service was judged to be ‘Inadequate’ overall.

After these inspections the provider sent us an action plan stating what they would do to meet legal requirements in relation to the breaches.

Heartwell House Residential Care Home provides care and support for up to 13 people with learning disabilities or mental health conditions. It is situated in a detached house in Leicester City. The home has two lounges and a dining room. There are 11 single bedrooms and one double bedroom situated on the first and second floors with stairs for access.

Heartwell House is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. At the time of our inspection a registered manager was employed at the service.

We found the atmosphere in the home had improved and the people using the service were more involved in how it was run. Staff were caring and friendly towards the people using the service. We observed some good interactions when a staff member encouraged people to join in activities and conversations. Staff also consulted with people before they supported them and enabled them to make choices about their daily routines.

We acknowledged that staff had worked hard to improve this service, although some further improvements are needed.

Although most people we spoke with said they felt safe at Heartwell House one person’s risk assessments were in need of improvement to address a safety issue in the home.

Staff understood safeguarding (protecting people who use care services from abuse) and knew what to do if they were concerned about the well-being of any of the people who used the service. Some improvements were also needed to the way medicines were stored and administered.

There were enough staff on duty to meet people’s needs and do activities with them. Staff supported people effectively and were trained to meet most of their needs. We observed that staff were skilled in providing reassurance and support to people if they became distressed.

Staff had a better understanding of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). However some improvements were needed to mental capacity assessments so they took into account people’s fluctuating capacity due to their mental health needs.

People told us they liked the food served at the home and they could have a drink and a snack when they wanted. A staff member told us she cooked spicy and non-spicy versions of the meals to suit people’s different tastes. Some improvements were needed to one person’s nutritional care plans.

People told us they took part in activities including minibus trips, walks, playing snooker in the pub, and going to the park or the library. Records showed people were involved in choosing activities at residents’ meetings and the activities they requested were provided.

People using the service knew what to do if they had any concerns or complaints about the service. Records showed the home’s complaints procedure had been explained to them so they knew who to go to if a problem arose.

Improvements had been made to how the home was run. Policies and procedures had been reviewed and improved and new ways of working and records keeping introduced. People using the service and staff had been involved in discussions about the changes and improvements that were being made.

You can see what action we told the provider to take at the back of the full version of the report.

This inspection took place on 21 September 2015 and was unannounced.

We previously carried out an unannounced inspection of this service on 21 May and 11 June 2015. Six breaches of legal requirements were found, two of which led to warning notices being issued, and the service was judged to be ‘Inadequate’ overall.

The warning notices were issued because the registered person did not have effective systems and processes in place to ensure people using the service were protected from abuse. Nor did they have an established system or process in place to enable them to assess, monitor and improve the quality and safety of the service provided in the carrying on of the regulated activity.

After this inspection we asked the provider to produce an action plan stating what they would do to meet legal requirements in relation to the breaches. We did not receive one. The provider said this was because he thought he had to share this information with the local authority and not CQC. He then agreed to send one retrospectively.

We undertook this focused inspection on the 21 September 2015 to check that the provider had now met legal requirements with regard to the warning notices. This report only covers our findings in relation to the warning notices. We will check the other breaches at a future inspection.

You can read the report from our last comprehensive inspection, by selecting ‘all reports’ link for Heartwell House on our website at www.cqc.org.uk

Focused inspections evaluate the quality and safety of particular aspects of care. They take place when we are following up after a comprehensive inspection, or when we have received concerns and have decided to look into them without doing a comprehensive inspection of all aspects of the service. They only ask the relevant key questions, rather than all of them.

Heartwell House Residential Care Home provides care and support for up to 13 people with learning disabilities or mental health conditions. It is situated in a detached house in Leicester City. The home has two lounges and a dining room. There are 11 single bedrooms and one double bedroom situated on the first and second floors with stairs for access.

Heartwell House is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. At the time of our inspection a registered manager was employed at the service.

Some care plans and risk assessments had been improved and others put in place to provide staff with the information they needed to protect people from harm. There was now a stronger emphasis in records on managing risks to people. However other care plans and risk assessments were still in need of improvement.

The staff members we spoke with were clearer about their safeguarding responsibilities. Safeguarding had been discussed with the people using the service and they had been told what to do if they needed to report abuse, or if they had reported abuse to staff at the home and nothing had been done.

Improvements had been made to way staff were recruited to help ensure they were safe to work in a care environment. During the inspection we observed there were enough staff on duty to meet people’s needs.

The provider’s undated quality assurance policy had not been followed and a system of quality assurance was still not in place.

We found some evidence of people using the service and relatives being asked for their views on the service. People had been given the opportunity to speak out at meetings and had had the service’s complaints procedure explained to them. Quality assurance questionnaires had been sent to relatives and returned, although at the time of our inspection no analysis had been made of the results of this survey and no action taken in response.

We found that the warning notices had been partially met and as a result we have used requirements notices to address the outstanding breaches. You can see what action we told the provider to take at the back of the full version of the report.

We spoke with four people who used the service, two care workers who were on duty at the time of our inspection and the registered manager. We also observed people in the communal areas and during lunch.

People we spoke with told us they were satisfied with the care and support being provided and that their choices were respected. Staff had a good understanding of the needs of people who used the service and demonstrated a good rapport with people. Staff were able to communicate with people in their own language.

Our observations showed that people were comfortable and confident with staff. We saw that people had a choice about when to eat their lunchtime meal and people’s individual preferences, religious and cultural needs had been catered for. The meal had been freshly prepared and looked appetising.

We looked at the records of three people who used the service and found care plans were detailed and thorough and provided clear guidance to staff about how the persons’ care should be delivered.

Staff had been appropriately screened to ensure they were suitable to work with vulnerable people.

There were appropriate arrangements were in place for the obtaining, recording and administration of medicine.

Records were accurate and fit for purpose.

We found that the service was compliant with the essential standards of quality and safety that we inspected.

We did not speak to people using the service about this outcome. Please refer to previous reports for more information about what people told us about the service.

At out last visit of 2 July 2012 we found that people were not fully protected from the risk of abuse by staffs' lack of up to date knowledge and training around safeguarding vulnerable adults. We followed this up at this visit and found that the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We spoke with people using the service about a range of issues. People told us they were supported to make choices and maintain their independence. One person told us about trips out they had taken on the mini bus. Another person told us about residents meetings they had been involved in.

People we spoke with were all positive about their experiences. People said “it’s good”, “very nice food”, “nothing would make it better” and “staff are helpful”.

The results of satisfaction surveys were positive and feedback from people using the service was; “I felt warm and safe”, “very relaxed and comforting”.

This was an unannounced inspection that took place on 21 May and 11 June 2015.

Heartwell House Residential Care Home provides care and support for up to 13 people with learning disabilities or mental health conditions. It is situated in a detached house in Leicester City. The home has two lounges and a dining room. There are 11 single bedrooms and one double bedroom situated on the first and second floors with stairs for access.

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.

People’s safety was being compromised in a number of areas. The provider’s safeguarding and whistleblowing polices were not fit for purpose. Staff did not know how to report abuse internally or externally. People’s risk assessments were unsuitable and some safeguarding incidents had not been referred to CQC or the local authority. Staff had not always been safely recruited and improvements were needed to medication management.

Some people using the service had restrictions placed on their liberty. However the management and staff were not aware of their responsibilities under the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and had not followed this legislation. This meant that some people may have been unlawfully deprived of their liberty at the home.

There were no records of staff being trained in MCA/DOLs, personalised care, dignity, or moving and handling. This meant we could not be sure that staff had the skills and knowledge they needed to support people effectively. People’s health care needs had not always been appropriately identified, assessed, or met.

Care workers were well-meaning and kind but did not always use appropriate language to discuss their work. The home had CCTV in communal areas and it was not clear if the people using the service had given informed consent to this.

It was not clear from care plans how staff supported people using the service. There was little information in records about people’s daily routines or preferences. Staff were unclear about what was meant by personalised care. Staff were not seen to encourage people in take part in meaningful activities.

The provider’s complaints procedure contained misleading information about how people using the service and their representatives could make complaints. The provider had not followed their quality assurance policy and no internal audits of the service had been carried out.

Records showed that accidents and incidents had occurred in the home, but these had not been properly documented or referred CQC as ‘notifications’. Some records were contradictory or incomplete which made it difficult to check if certain aspects of the service met requirements.

All the people we spoke with, who were able to give their views, said they felt safe living at the home and liked the food served. There were enough staff on duty to meet people’s needs. People told us the staff were caring and kind. Relationships between staff and the people they supported appeared good.

The atmosphere in the home was relaxed and friendly and the staff we spoke with had a caring attitude towards the people they supported. People told us they enjoyed some of the activities provided and were encouraged to practice their religions if they wanted to.

Following this inspection we took enforcement action including issuing two warning notices demanding the provider makes improvements to meet national standards of care.

You can see what action we told the provider to take at the back of the full version of the report.