Heath Lodge 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.

Heath Lodge provides care and accommodation for up to eight adults with a learning disability and complex needs. At the time of the inspection there were seven people living there.

The inspection took place on 12, 13 and 18 September 2018 and was unannounced on day one. At the last inspection we identified significant breaches of the Health and Social Care Act Regulations regarding regulations 9,11,12,13,16,17 and 19 and the service was placed into special measures. During this inspection we found that improvements had been made and that the registered person was no longer in breach of regulations 9,11,12,13,16 and 19, although there was a continued breach of regulation 17 of the Health and Social Care Act Regulations. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures. At this inspection the overall rating for the service is 'Requires Improvement'.

The process for regular evaluation of care plans was not sufficiently robust and quality assurance systems in place had not identified all of the concerns noted within this report. A new comprehensive quality assurance audit had been introduced however, this had not highlighted that some care plans had not been regularly evaluated and that significant information about safe transportation had not been updated.

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.” Registering the Right Support CQC policy

At the time of this inspection there was no registered manager in post with day to day management provided by a manager from another of the registered provider’s services. 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. Following the last inspection, due to the seriousness of concerns identified, we used our enforcement powers and a decision was made to cancel the manager’s registration.

Registered persons are required by law to inform the Care Quality Commission (CQC) of certain events which occur within the service. During the last inspection we found that on several occasions they had failed to do so. This was an offence under Regulation 18 (1) (e) (f) of the Care Quality Commission (Registration) regulations 2009. Therefore, we used our enforcement powers to issue a Fixed Penalty Notice which resulted in the registered provider being fined £1,250. During this inspection we found that notifications had been submitted as required.

Improvements had been made regarding management and administration of medicines. The registered provider had liaised closely with a community pharmacist to raise standards and weekly audits were carried out.

Staff had received training and were knowledgeable about how to protect people from abuse and felt able to do so without fear of repercussion. They were also aware of whistleblowing procedures (reporting outside of the company). We saw that incidents had been reported to the local authority and notifications submitted appropriately.

There were procedures in place to record accidents and incidents and assess people’s associated risks. Although analysis of accidents

The inspection took place on 3, 4, 12 and 31 January 2018. The first day was unannounced, the remaining days were announced. Heath Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contract6ual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Heath Lodge accommodates eight adults who have a learning disability and/or complex needs. At the time of the inspection the home was fully occupied. Five bedrooms were located in the main house with three annex buildings in the garden. The home is located in a residential area of Warrington, close to shops, other local facilities and is on the bus route to Warrington town centre.

During this inspection we identified significant breaches of the Health and Social Care Act Regulations with regard to regulations 9, 11, 12, 13, 16, 17, and 19. These related to concerns regarding consent; safe care and treatment; safeguarding people from abuse; person centred care, complaints and governance. The provider had also failed to submit relevant statutory notifications to the Commission. A notification is information about important events which the provider is required to tell us about by law. Failure to submit notifications is an offence under the Care Quality Commission (Registration) regulations.

We identified several instances where the registered manager had not notified the CQC as required with regard to safeguarding concerns and incidents reported to or investigated by the police. This meant that the registered manager had not complied with the legal obligations attached to their role.

Heath Lodge adhered to the provider’s own internal quality assurance system. This included audits of areas such as care files, medication, finance and infection control. Although we could see that regular audits were being carried out, we had concerns about the effectiveness of them as they had failed to identify the issues and breaches of regulation noted during this inspection

We saw that the service had not always operated within the principles of the Mental Capacity Act 2005 particularly with regard to assessment of mental capacity and best interest decision making. Significant purchases had been made from service users’ monies and we found several references to restrictive practice. The provider was unable to demonstrate that these decisions had been made in peoples’ best interests. Records relating to management of service user finances were not sufficiently robust.

Although people told us that they felt safe at Heath Lodge, we found that safeguarding policies and procedures were not established and operated effectively to protect people from harm and abuse. Whistle-blowing concerns were received during the inspection. These included an allegation of aggressive and threatening behaviour by a member of staff towards a service user which had not been dealt with to ensure that the people living at Heath Lodge were protected from abuse and harm. We were also informed by the whistle-blower that the registered manager had instructed them not to inform the inspector of this incident. We reported the whistle-blowing concerns to the local authority safeguarding team.

People’s medicines were not managed or administered in a safe way. People did not always receive their medicines as prescribed, medical advice was not always sought when stocks were allowed to run out and we found that staff were instructed to sign Medicine Administration Records (MAR) retrospectively.

We asked people if they felt the staff were caring in attitude. Responses varied as some people said they were, however, one person felt they were spoken to with disrespect. We looked at daily living notes and found that the language used was at times disrespectful and inappropriate. During the inspection we observed staff speaking with people in a considera

This inspection took place on 19 March 2015 and was an unannounced inspection.

Heath Lodge is a care home for eight adults. with a learning disability and complex needs. The home is located in a residential area of Warrington, close to shops, other local facilities and is on the bus route to Warrington town centre. People living at the home are supported by staff on a twenty four hour basis. Each person has their own bedroom and share a kitchen, bathroom and lounge. There are gardens at the front and back of the house and parking outside.

There was a registered manager in place at the home. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

There were eight people living at the home on the day of our visit. We spoke with people living at Heath lodge and they said they were happy and felt supported.

From our observations and from speaking with staff we found that staff knew people well and were aware of people’ preferences and care and support needs. People were supported with their healthcare needs and medical appointments.

We found the home was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and staff followed the Mental Capacity Act 2005 for people who lacked capacity to make decisions for themselves.

We spoke with staff members who were aware of people’s risks and needs and how best they should be supported. The staff we spoke with said that they were effectively trained and supported to carry out their roles. All staff had received training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

We saw that people’s medicines were securely stored and safely managed. The provider had a policy to guide staff regarding the safe management of medicines. Staff were aware of the actions to take in the event of an error when giving medicines.

There were robust recruitment checks in place so that people were protected from being supported by unsuitable or unsafe staff.

The home was meeting people’s nutritional needs and people were supported to ensure they had a good choice and enough to eat and drink.

Staff involved people in choices about their daily living and treated them with compassion, kindness, and respect. People were supported by staff to maintain their privacy, dignity and independence.

We looked at the duty rotas and spoke to staff about the numbers of staff on duty. We found there were adequate numbers and skill mix of staff on duty to meet the needs of people living at Heath Lodge.

We saw records which showed that staff training had taken place and all staff were up to date with appropriate training so that people could be confident they were properly cared for.

The home had a complaints procedure in place and we saw that complaints were logged and actions taken following investigations were recorded so that the service could be improved.

We saw that the leadership and management of the home was good and there were systems in place to check that the quality of the service was effectively monitored.

We spoke with people living at Heath Lodge and they said “I think it is a lovely place. It has been a big improvement in my life.”

A record of the supervision sessions which staff received was seen on the staff files and all training was monitored and refreshed regularly. The staff said they found the management “very supportive”.

The staff told us that they encourage people to be as independent as possible and one person living at the home told us how everyone helps with choosing the meals and he helps with shopping and meal preparation.

We spoke with people living at Heath Lodge and they said that they were supported to "get on with their own life". One person said "I have improved since I have been here "

Another person who lived at the home showed me their new bedroom furniture and said he kept his room clean himself.

A record of staff interviews were present in the staff files and people who lived at the home were involved in the process. One person told us that he was on the interview panel for new staff and had interviewed the manager.

We spoke with people who lived at Heath Lodge and they said "the staff are really great" " they are always around if you need them"

The people using the service said the staff respect their privacy and dignity and they are very happy with the care and support they receive. They said they have never been treated badly and there are always staff available to talk to. The people using the service said they know what to do if they want to make a complaint. Comments from the people living at the home included:

“The staff are lovely, they are always polite.”

“The staff are very good”.

“The staff are great, they are very nice and help me with all sorts of things.”

“The staff come with me to the doctors which is ok with me.”

“The staff are always around when I need them, they are very good.”

“The staff are always there.”

“I’m happy living at Heath Lodge, the new manager is very good.”

“Things are going very well now the new manager has started working here.”

"I would speak to a senior member of the staff if I wanted to make a complaint."

"I’m happy with everything, I don’t have any complaints to make."

None of the healthcare professionals spoken to had any concerns to raise about Heath Lodge.