Heathcotes (Middleton) is registered to provide accommodation and personal care for up to seven people with a learning disability and/or mental health diagnosis. There were six people accommodated at the home on the day of the inspection.

At the last inspection of January 2018 the service was rated as good overall but there was a breach of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. This was because recruitment processes were not sufficiently robust to adequately protect people from the risk of unsuitable staff. The service sent us an action plan detailing what improvements they would make to improve recruitment. At this announced inspection we found the service had made the improvements and recruitment was robust.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. The manager was registered in February 2016.

Staff we spoke with were aware of how to protect vulnerable people and had safeguarding policies and procedures to guide them, which included the contact details of the local authority to report to.

Recruitment procedures were robust and ensured new staff should be safe to work with vulnerable adults. There were sufficient staff to meet people’s needs.

There was a medicines policy and guidance for staff around safe administration. Care givers had undertaken training and competency checks were regularly undertaken.

Staff were trained in infection control topics and issued with personal protective equipment to help prevent the spread of infection.

The service was working within the legal requirements of The Mental Capacity Act 2005 (MCA).

People received a nutritious diet and were encouraged to plan their diet, shop and where possible were supported to make their own meals.

Staff received an induction and were supported when they commenced employment to become competent to work with vulnerable people. Staff were well trained and supervised to feel confident within their roles. Staff were encouraged to take further training in health and social care topics such as a diploma.

People had a range of activities they could attend which was suitable to their age, gender, ethnicity and beliefs.

There was a relevant complaints procedure. There had not been any recent complaints.

There was a recognised management structure. Staff thought the service was well-led and the two people we talked to thought staff were approachable. We observed staff interacting with people who used the service in a friendly and appropriate manner.

There were systems to check the quality of service provision to help management maintain and improve standards.

The service liaised well with other organisations to help meet people’s health and social care needs.

This was an unannounced inspection which took place on 13 January 2017. We had previously inspected the service in August 2015 when we found four breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. These related to a lack of risk assessments for people who used the service, staff had not received training to help them understand people’s specific health conditions, a lack of care plans to advise staff how to support people with specific health conditions and a lack of regular supervision for staff.

Following the inspection in August 2015 the provider wrote to us to tell us the action they intended to take to ensure they met all the relevant regulations. During this inspection we found the required improvements had been made and the provider was now meeting these regulations.

Heathcotes (Middleton) is a registered to provide accommodation and personal care for up to six people with a learning disability and/or mental health diagnosis. There were six people living in the service on the day of our inspection.

The service had a registered manager in place as required by the conditions of their registration with the Care Quality Commission (CQC). 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. The registered manager had been appointed since the last inspection.

During this inspection we identified one breach of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. This was because recruitment processes were not sufficiently robust to adequately protect people from the risk of unsuitable staff. We did not see evidence that the identity of people sending references from personal e-mail accounts had been verified. The provider had not carried out the required additional checks when people had worked previously with vulnerable adults or children to ascertain why their employment in that service had ended. You can see what action we have told the provider to take at the back of the full version of the report.

People who used the service told us they felt safe with the staff who supported them. They told us staff were always available to support them in the activities they wished to do. People were enabled to make their own decisions and told us staff always promoted their independence. During the inspection we observed staff were caring and respectful in their interactions with people who used the service.

Staff had received training in the safe administration of medicines. The competence of staff to administer medicines safely was regularly assessed.

Systems were in place to help ensure the safety and cleanliness of the environment. People who used the service were encouraged to participate in cleaning the home.

Staff told us they received the training and support they needed to carry out their role effectively. We saw that staff received specialist training to enable them to provide positive support to people whose behaviour might challenge others. There were systems in place to track the training staff had completed and to plan the training required.

All the staff we spoke with told us they enjoyed working in the service and felt valued by the registered manager. Staff felt able to raise any issues of concern in supervision and staff meetings. We saw evidence that the registered manager had taken action in response to feedback received.

Staff we spoke with had a good understanding of the Mental Capacity Act 2005. We saw that appropriate arrangements were in place to assess whether people were able to consent to their care and support. The necessary DoLS applications had been made to authorise any restrictions in place.

People who used the service had health suppo

This was an unannounced inspection which took place on the 25 and 26 August 2015. The service registered with the Care Quality Commission on the 18 December 2014 and this was the first inspection undertaken at the service.

Heathcotes (Middleton) is a registered to provide accommodation for up to six people with a learning disability and/or mental health diagnosis. The service is registered to provide personal care. There were five people living in the service on the day of our inspection.

The service did not have a registered manager in place at the time of our inspection. 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. We were informed by the Head of Services the registered manager had left approximately two weeks previous to our inspection and another person had been identified to take on this role. We had received an application from the registered manager to cancel their registration prior to our inspection.

During this inspection we found breaches in the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014. You can see what action we have told the provider to take at the back of the full version of the report.

We found that risk assessments relating to the health conditions of people who used the service had not been completed. Risk assessment should be completed in order to keep people safe and to direct staff.

Records we looked at showed nine out of 20 staff members had fully completed their induction, which included mandatory training. We found diabetes training was available to staff, however records showed that no staff members had completed this, despite some people in the service being diagnosed with this condition.

We looked at five personnel files and found that supervisions were not undertaken within time frames described in the policy and procedure. Some staff members had received one supervision despite being employed for a number of months.

People who used the service who had health conditions such as diabetes and renal failure did not have sufficiently robust care plans in place in order to inform and direct staff on the condition, the impact of these conditions or how to support people. Health action plans in care records had not been completed.

Staff did not follow care plans and pathways in relation to risks. Records we looked at showed that one person should have been weighed on a weekly basis due to a high risk of weight loss. Records showed that this person had not been weighed for five weeks.

The dietary wishes and needs in relation to ethnicity, religion, culture and spirituality were not considered or documented in care records. Care plans we looked at did not make reference to a person’s cultural preferences or how there were to be supported with their religious needs.

We found a number of policies and procedures within the service had not been subjected to a review within timeframes identified by the company and some contained incorrect information.

We saw care staff interacted with people who used the service in a kind and sensitive manner and humour was used appropriately. Laughter was heard throughout the service on a regular basis throughout our inspection.

We observed that people’s privacy and dignity was respected at all times. We saw that people who preferred to spend time in their room were given the opportunity do to so without being disturbed.

We saw that people were offered activities on a daily basis that were suitable to their age, gender and abilities. People accessed the community on a regular basis and one person was planning a holiday.

We saw that bedrooms were large and provided ample space for people to personalise them. There was ample communal space for people, including a quiet room with a computer, lounge, dining room and large basement area with patio doors leading to a garden.