About the service: Heathcote (Arnold) Redhill Farm is a care home and accommodates up to 10 people with a learning disability and or autism and complex mental health needs. Nine people were using the service during the inspection.

The service consisted of one house with a self-contained flat within the house.

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.

There was no registered manager in post at the time of the inspection and an interim manager was managing the service with oversight by senior managers. 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 experience of using this service:

Risks associated with people's needs were not consistently and effectively managed. Assessments of people’s needs were not always undertaken using nationally recognised tools to ensure consistent care.

Safeguarding issues were not always managed effectively to protect people and staff from harm. Incidents were not sufficiently reviewed and robustly analysed, to consider themes and patterns and how lessons could be learnt, and improvements made.

People did not always have consistent support to access their medicines should they need them. They were not always supported by enough staff sufficiently trained to manage their needs.

People's nutritional and health needs were not consistently met, their health needs, such as long-term health issues were not monitored.

Recent changes to the way the environment could be safely used meant people who lived at the service could not safely access some areas of the service.

People did not always receive support that met their needs. There was a lack of consistent up to date information in care plans to provide staff with the guidance to safely meet people’s needs. Where there was guidance staff were not always following the information in people’s care plans to provide safe consistent care.

Complaints were not always recognised and as a result not responded to in a consistent way, in line with the provider’s complaints policy.

There was a failure by the management team to prioritise high risk work, and a lack of response to quality monitoring processes in place at the service. This impacted on several areas of people’s care and resulted in a lack of oversight that was required to improve the quality of care provided for people at the service.

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. They were supported to express their views and opinions about their care. People had formed positive relationships with staff. There were safe recruitment processes in place.

Rating at last inspection: the rating at our last inspection was Good. We last inspected the service on the 10 March 2016.

Why we inspected: This inspection was because of concerns raised prior to our inspection.

Enforcement: We found the provider was in breach of three of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up: The overall rating for this service is

We carried out an announced inspection of the service on 14 March 2016.

Heathcotes (Arnold) provides accommodation and personal care for up to 10 people living with mental health needs and or a learning disability. Nine people were living at the service at the time of the inspection.

Heathcotes (Arnold) is required to have 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 time of the inspection there were two registered managers in post and a house manager.

People received a safe service. Staff were aware of the safeguarding adult procedures to protect people from abuse and avoidable harm and had received appropriate training. Risks were known by staff and managed appropriately. Accidents and incidents were recorded and appropriate action had been taken to reduce further risks. People received their medicines as prescribed and these were managed correctly.

Risks to people’s needs had been assessed and plans were place to inform staff of the action required to reduce and manage known risks. These were reviewed on regular basis. The internal and external environment was monitored and improvements had been identified and planned for.

Safe recruitment practices meant as far as possible only people suitable to work for the service were employed. Staff received an induction, training and appropriate support. There were sufficient experienced, skilled and trained staff available to meet people’s needs.

People received sufficient to eat and drink and their nutritional needs had been assessed and planned for. People received a choice of meals and independence was promoted. People’s healthcare needs had been assessed and were regularly monitored. The service worked well with visiting healthcare professionals to ensure they provided effective care and support.

The manager applied the principles of the Mental Capacity Act 2005 (MCA) and Deprivations of Liberty Safeguards (DoLS), so that people’s rights were protected.

Staff were kind, caring and respectful towards the people they supported. They had a person centred approach and a clear understanding of people’s individual needs, preferences and routines. The provider asked relatives and visiting professionals to share their experience about the service provided. Communication between relatives, external professionals and the service was good.

People were involved as fully as possible in their care and support. There was a complaint policy and procedure available. People had information to inform them of independent advocacy services. There were no restrictions on people visiting the service.

People were supported to participate in activities, interests and hobbies of their choice. Staff supported people with their goals and aspirations and promoted independence.

The provider had checks in place that monitored the quality and safety of the service. These included daily, weekly and monthly audits.

Heathcotes (Arnold) is a care home providing accommodation for up to ten people. There were ten people living there when we visited. The service provides care and support to adults who have a learning disability, a mental health illness or a physical disability.

People told us they felt safe in the home and we saw there were systems and processes in place to protect people from the risk of harm. People were supported to take informed risks to ensure they were not restricted. Where people lacked capacity to make decisions, the Mental Capacity Act 2005 was being adhered to, to ensure staff made decisions based on people’s best interests. One relative told us, "I feel [my relative] is mentally and physically safe."

There were processes in place to gain the views of people in relation to their care and support. People’s preferences and needs were recorded in their care plans and staff were following the plans in practice. Records showed that the risks around nutrition and hydration were monitored by staff.

We observed staff supporting people living in the home and staff were kind and respectful to them. There were clear values in place for staff to respect people’s privacy and dignity. People were supported to attend meetings where they could express their views about their care. One person told us, "I go to the pub for a drink and go to the coast. I choose my activities, I go to the shop. I can do anything I want."

Staff were able to describe examples of where they had responded to what was important to individuals living in the home. People knew who to speak to if they wanted to raise a concern and there were processes in place for responding to concerns. There were plans in place for people to meet with an advocate so that people were aware of how they could use an advocacy service. People commented positively on the way staff supported them with one saying, "Very nice staff."

There were effective systems in place to monitor and improve the quality of the service provided. Action plans were put in place for the manager to action and these were then followed up by the regional manager to ensure continuous improvement. There was an open and transparent ethos in the home. One relative told us, "The manager is always very happy to help. I would have no concern raising any issues."

We looked at whether the service was applying the Deprivation of Liberty safeguards (DOLS) appropriately. These safeguards protect the rights of adults using services by ensuring that if there are restrictions on their freedom and liberty these are assessed by professionals who are trained to assess whether the restriction is needed. The manager told us there was no one living in the home currently who needed to be on an authorisation. We saw no evidence to suggest that anyone living in the home was being deprived of their liberty. We found the location to be meeting the requirements of the Deprivation of Liberty Safeguards.

We spoke with two people using the service. One person said, “Everything is alright.” Another person told us about the activities that they were involved in and were starting a college course soon.

One person showed us their bedroom and they had personalised their room and were happy with it. One person said, “There are enough staff on duty.” Another person told us they got on well with the staff.

We found that people received care that met their needs. We found that people using the service, visitors and staff were in safe surroundings that promoted their wellbeing. We also found that there were effective recruitment procedures in place.

We found that there were enough qualified, skilled and experienced staff to meet people’s needs at all times. We also found that people were cared for by staff who were fully supported to deliver care and treatment safely and to an appropriate standard.

We spoke with two people who use the service. One person told us they had visited the service before coming to live there. They told us they could choose what they wanted to do and they knew how to make a complaint. They also told us staff respected their privacy.

One person said, “It’s good here. It’s more caring here than the previous place.” They told us they received help when they needed it and they felt safe and got on with the other people living at the service. They also told us their room was big enough and comfortable but their shower wasn’t working and hadn’t worked since they started living at the service. They told us there were enough staff and they were well trained. Another person said, “The staff are all good here.”

Due to the complex needs of some people living at Heathcotes Arnold we were unable to talk with a number of them to gain their views. We therefore spent time observing how they spent their day and the support they received from staff.

One person using the service told us that they were supported by staff in attending college and looking for a job. They also went shopping with the staff which they said they enjoyed. They told us they were happy living at Heathcotes Arnold and staff were very nice, helped them when needed and always did as they were asked. They knew they had a plan of care in place and said they could look at this and add to it if they wanted to.