This inspection took place on 18 September 2018 and was unannounced.

Heathcotes (Blythe Bridge) 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 up to eight people in one adapted building and at the time of this inspection, there were eight people living at Heathcotes (Blythe Bridge). 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.

There was 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.

At the last inspection, the service was rated as inadequate. This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. 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.

This is the first time the service has been rated Requires Improvement.

At the last inspection we found a number of breaches of regulations. At this inspection, sufficient improvements had been made to show the provider was no longer in breach of regulations, however further improvements and monitoring were required to ensure that improvements were sustained and built upon.

Improvements had been made to staffing levels to ensure there were enough staff to safely meet people’s needs. However, further work was required to ensure a consistent staffing level and to ensure staff were all suitably trained to provide safe and effective care.

People received their medicines as required, though more detail was required to ensure staff knew when, where and how to apply people’s prescribed creams.

People were treated with kindness and compassion, however there were some examples of staff using undignified language. We have made a recommendation about this.

People were safeguarding from abuse and the risk of harm. Their risks were assessed and managed to help keep them safe whilst protecting their freedom. People were protected from the spread of infection and the provider had learned lessons and made improvements when things had gone wrong.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. People’s needs were holistically assessed and met, including healthcare needs and they had access to healthcare professionals. The design and adaptation of the service met people’s needs.

Staff worked together and with other agencies and professionals to provide effective support. Staff had access to training and support to equip them with the skills and knowledge to care for people. People had access to a well-balanced diet, had choices and their independence was promoted.

People received personalised care as staff knew them well and supported them to access activities that interested them. People and relatives were involved in developing and reviewing their care and support plans. People had been supported to consider their wishes for end of life care.

People felt confident to complain if they needed to and felt th

This inspection took place on 26 and 29 January 2018. At our previous inspection we had no concerns about the quality of care and had rated this service as good. At this inspection we had serious concerns about the safety of people who used the service and found six breaches 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. The service is rated as inadequate and will be placed into special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

Heathcotes (Blythe Bridge) provides accommodation and personal care for eight people who have learning disabilities and associated complex needs. 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 the inspection eight people were using 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.

There were insufficient numbers of staff to meet people's assessed needs and people were not being safeguarded from the risk of abuse due to a lack of staff to keep them safe. People's risk assessments were not always followed to minimise the risk of harm. This had resulted in people being harmed in the home and continuing to be exposed to the risk of harm. People's medicines were not always being administered safely.

The systems the provider had in place to monitor the quality of the service had not been effective. Prompt action had not been taken to improve the service for people. The provider had not taken action following incidents to protect people. The provider had not considered people’s experience of living in the home.

People's needs were not always identified and assessed effectively to ensure they would be met safely.

The provider was not effectively following the principles of the Mental Capacity Act 2005 and ensuring that when people lacked the mental capacity to agree to their care they were supported to do so in their best interests.

People who used the service were not always treated with dignity and respect. Staff did not always refer to people respectfully or understand their specific needs.

When people became

This inspection took place on 22 October 2015 and was unannounced. Our last inspection took place on 9 November 2013 and at that time we found that the provider was meeting the regulations that we inspected against.

Heathcotes (Blythe Bridge) is registered to provide care and accommodation for up to eight people. People who use the service have a learning disability. At the time of our inspection, eight people were using the service.

The person named on our register as the manager of the service was not the manager. The current manager of the service was not registered with us. 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 felt safe and staff knew how to recognise and report abuse. Concerns were reported and investigated when required. People’s risks were assessed and managed individually to promote their safety and wellbeing.

There were enough staff to safely meet people’s needs. The manager and provider were in the process of recruiting more suitable staff to increase the level of personalised support provided.

People received their medicines when they needed them and there were systems in place to ensure that medicines were stored, managed and administered safely.

People were supported and encouraged to make decisions about their care. When they were unable to do this, staff had the knowledge to ensure that decisions were made in line with current legislation and guidance.

Staff were trained and supported to give them the skills to support people effectively. People had enough to eat and drink and were offered choice and flexibility about their food and drinks. They were encouraged to stay healthy and had access to health professionals when they needed them.

People were treated with kindness and compassion by staff who knew them well. People’s privacy was respected and they were encouraged to be independent and participate in the running of the home and the local community.

People received care that met their preferences and they were enabled to follow their interests. People’s strengths and goals were recorded in their care plans and staff were aware of these and supported them to achieve what was set out.

People were encouraged to give their feedback about the service and action was taken when needed. There was an accessible easy read complaints procedure available and we saw that complaints were managed in line with the provider’s procedures.

There was a friendly and supportive atmosphere at the home and staff enjoyed working there. Staff felt supported by the manager and were involved in developing the service.

The manager and provider completed quality checks and acted upon any issues identified. We saw that an improvements plan was being worked upon.

The name ‘Gary Tideswell’ appears on our report as being one of the registered managers at the home. At the time of our inspection this person was not a registered manager at the service. We have requested that the provider addresses this to ensure the correct details are held on our register.

During our inspection we spoke with four people who used the service and five members of staff. The registered manager ‘Ann Plant’ was not on shift at the time of our inspection. People told us they were happy with their care. One person said, "I like being with the staff". Another person said, "I am happy now and I like my room".

We saw that people were involved in making decisions about their care and support. Effective systems were in place to enable staff to support people who found some decision making difficult.

The home was well led. We observed people being treated with care and compassion, by staff who had received training and support to enable them to meet people’s individual needs. There was an effective system in place to ensure that people’s care records contained accurate and up to date information to ensure people were kept safe.

People were supported to access food and drink, and staff were responsive to people’s feedback about the food that they ate.

The home was suitably designed to meet the needs of the people who used the service. Effective systems were in place to check that the building was safe and in good condition.

We carried out this inspection to check on the care and welfare of people using the service. The inspection was unannounced which meant the provider and the staff did not know we were coming.

On the day of our inspection we met four people using the service and observed how staff supported and cared for people. Three other people were engaging in activities in the community and were not present during our inspection.

We reviewed information about two people’s care and found that their care needs were planned. We found that the staff understood people’s care needs and how to protect them from risk and harm.

We saw staff respected people’s privacy and dignity, and took account of what people had to say in relation to the way their care was provided. For example, we saw staff encouraged people to make informed choices about the food they ate and the social activities they participated in each day. We also saw people were actively encouraged and given support to maintain their independence and so far as possible to learn new skills.

The staff told us they enjoyed working at the home. We saw that all the checks were made to ensure they were fit to do their job.

There were systems in place to ensure people could raise concerns and improve the quality of the care received. We saw information which confirmed complaints were responded to and people were able to voice their opinions.

People were involved in making decisions about their care. Staff listened to their views and supported them to undertake activities they liked to do. People attended meetings where their care was talked about. People had their privacy and dignity promoted. Staff supported people to be as independent as possible. People went shopping, helped to make meals and helped to keep their bedrooms tidy.

People had their health and personal care needs met. People said that the staff supported them to go to the doctor, the dentist and to have eye checks. They said that the staff helped them to have a shower, shave and wash their hair.

Some people needed support to manage their behaviour and staff understood how to provide this support whilst keeping people safe. One person told us that if they were angry the staff would talk to them.

People said they liked the staff and we saw that people were treated with respect. Staff knew about people's needs and had been trained to provide people with the support they needed.

The provider completed checks on the premises and on the care people received to make sure that people got the support they needed in a safe way.