A registered manager was in place but not available at the time of our inspection. A manager was covering the registered manager until their return and was present at 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. The provider and registered manager had met their registration requirements had had notified CQC of any event they were required to do.

People told us they were happy with the service they received. Relatives were positive that the provider and staff, provided a service that met their family member’s individual needs. A relative said, “The manager is definitely approachable.” Another relative said, “Staff seem open and friendly, this indicates they get support. All the staff are very amenable. Pass messages on.”

The service had an open and transparent culture where the management team had clear expectations of staff to provide person centred care and support. People were supported to achieve good outcomes.

People’s diverse needs were discussed with them and the provider had clear values that promoted and empowered autonomy. This was backed up by the provider’s policies and procedures, these included equality and diversity and cross gender.

People who used the service, relatives, external professionals and staff received opportunities to share their experience about the service. This was by means of meetings, surveys and the management team having an open door policy where they made themselves available.

The provider was able to continually improve the service by completing regular audits and checks on quality and safety. The manager, area manager and the provider’s internal quality monitoring team completed this monitoring. Where shortfalls were identified an action plan was developed, to identify what was required by whom and when. This meant the provider had oversight of the service and there was accountability.

The service worked with external agencies and organisations as a method to improve outcomes for people. This involved attendance at local forum meetings where providers shared and exchanged information and good practice. Staff were supported by community health and social care professionals and engaged well with the support provided. A professional told us, “I found the manager of the service to be knowledgeable in relation to the service users and their needs. She formed a good working relationship with myself and others and attended all necessary meetings. The service was always clean and tidy and service users looked happy and were happy to talk about the activities / day trips they had been out on.”

We inspected the service on 26 November 2014. This was an unannounced inspection.

Heathcotes (Hucknall and Watnall) is registered to provide accommodation for up to 12 people with a learning disability, a mental health illness or physical disability. The registration consists of two separate houses. One house is named Hucknall and one named Watnall. There were 10 people using the service when we visited, six people living in one house and four living in the other.

We last inspected this service on 25 April 2014. During the inspection we found that the provider was not meeting 3 of the regulations that we assessed. These were in relation to ensuring that there were sufficient staff on duty, ensuring that people’s nutritional needs had been met and that staff were respecting and involving people. The provider sent us an action plan detailing the actions that they would take to meet these regulations. During this inspection we found that the provider had taken the necessary improvements.

The service had 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.

Everyone we spoke with told us that they felt safe. Staff told us that they followed plans to ensure people’s ongoing safety. However on one occasion we saw that staff had not followed guidance and as a result a person had been placed at risk of harm.

Staffing levels had been increased since the time of our last inspection and this had impacted positively on the people who used the service. People told us that they had opportunities to go out to pursue activities of their choice and staff told us that people did not have to wait for support. Increased staffing levels meant better opportunities for people to receive individualised support.

We saw there were systems and processes in place to protect people and keep them safe. People were protected against the risk of unlawful or excessive control or restraint because the provider had made suitable arrangements for staff to respond appropriately to people whose behaviour may challenge others. Staff told us that they had received training in order to do this safely and everyone we spoke with said they felt confident that they would know what to do in such a situation.

People were supported to take informed risks to ensure they were not restricted. Where people lacked capacity to make decisions, the Mental Capacity Act (MCA) 2005 was being considered, to ensure staff made decisions based on people’s best interests.

People’s medicines’ were managed safely and people received their medication when they should. Staff were recruited through safe recruitment practices.

People who used the service told us that they felt consulted in relation to how they lived their lives. There were processes in place to gain their views. People’s preferences and needs were recorded in their care plans and we saw that staff were following the plans in practice.

We saw that the monitoring of food and drink intake had improved and staff could show that people were receiving a varied and balanced diet. At least one person’s health had improved as a result.

Throughout the inspection we saw staff treat people with dignity and respect. We saw staff were kind and caring when supporting people.

People knew who to speak to if they wanted to raise a concern and there were processes in place for responding to complaints. This meant that people were enabled to make a complaint or share a concern about the care and support they received.

There were effective systems in place to monitor and improve the quality of the service provided. Action plans, in response to audits and incidents, documented continuous improvement. Staff had received training and support in relation to learning disability, autism and mental health awareness. to them a better understanding of people’s needs and behaviours.

Staff also told us how they had received support from the manager to raise their awareness of treating people with respect and recognising individuality.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS), and to report on what we find. The Deprivation of Liberty Safeguards are a code of practice to supplement the main Mental Capacity Act 2005 Code of Practice. We looked at whether the provider was applying the DoLS appropriately. These safeguards protect the rights of adults using services by ensuring that if there are restrictions on their freedom and liberty these were assessed by professionals who are appropriately trained to assess whether the restriction is needed. The registered manager told us there was one person who may be being deprived of their liberty. We saw that they had made an application to check this with the local authority and had notified the CQC. At the time of our inspection no one else living in the home was being deprived of their liberty. We found the provider and the registered manager to be meeting the requirements of the DoLS.

We carried out the inspection to check that the provider had met the compliance action that we set at our previous inspection on 30 April 2013.

We spoke with three people using the service. Two people were not happy with the amount of staff on duty. They raised concerns about the behaviour of other people using the service. We discussed this with the manager and other staff and they told us about the actions they were taking to address this issue. The other person we spoke with was happy with the amount of staff on duty.

We found that there were enough qualified, skilled and experienced staff to meet people’s needs at all times.

We spoke with two people using the service. One person said, “Staff are really nice here.”

One person told us they were very happy with their bedroom. The other person showed us where there was damp in the ceiling of their bedroom. They did not raise any other concerns with us.

We found that people using the service, visitors and staff were not fully protected against the risk of unsafe premises. We also found that there were not enough qualified, skilled and experienced staff to meet people’s needs at all times.

We found that people were cared for by staff who were fully supported to deliver care and treatment safely and to an appropriate standard. We also found that records were fit for purpose and kept securely.

We spoke with three people who use the service. One person said, “I like it here. Everything’s ok.” People told us they liked their room and one person told us they liked staff.