We inspected the service on 11 and 13 December 2018. The inspection was unannounced and was the provider’s first inspection since it was registered.

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.

Heathcotes Enright Lodge is a care home and accommodates up to six people with a learning disability and or autism and complex mental health needs. The service consisted of one bungalow for four people and two individual flats in another building. Within the same grounds the provider had a second registered location Heathcotes Enright view that provided the same service for seven people. The management and staff team managed and worked across both services. People received high levels of staff support. On the day of our inspection, two people were living at Heathcotes Enright Lodge.

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 present time 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 were not supported by sufficient numbers of staff, and skill mix and competency was a concern. Staff had not all completed an induction on commencement of their employment, due to how the three day induction was delivered. There was high use of agency staff, who did not all have relevant skills and experience in working with people with complex needs. Concerns were also identified in the induction agency staff received. Significant gaps were also identified in the training staff had received, which the provider required staff to complete. Staff did not consistently receive opportunities to discuss their work, training and development needs.

Risks associated with people’s needs were not consistently and effectively managed. Incidents were not sufficiently reviewed and robustly analysed, to consider themes and patterns and how lessons could be learnt and improvements made.

National best practice guidance in the management of medicines was not consistently met. This included how medicines were checked and recorded. Guidance and instruction for staff also lacked detail in places. Whilst some changes had been made to make improvements, these required further time to be fully embedded.

Staff found it difficult to keep the environment clean due to the time available whilst supporting people. Checks associated with legionella was not fully completed. This was in relation to water flushes in unoccupied bedrooms.

The provider recruited staff after completing checks. This ensured, as far as possible, staff were suitable to work with people. Staff could identify the potential signs of abuse and knew who to report any concerns to. Action had been taken to safeguard people when concerns had been identified.

The provider was not consistently working in accordance with the Mental Capacity Act 2005 (MCA). Consent to care was not always sought in accordance with legislation and guidance.

People’s health needs were not consistently met. People had experienced missed health appointments and or, their health needs were not monitored as required and this not been identified by staff. This could have impacted on people’s health and well