About the service: Heathers is a 'care home' providing residential care to people with learning disabilities, autism and mental health conditions. The service is registered to accommodate up to nine people, there were eight people living at the service at the time of the inspection. Each person lived in a self contained apartment with ensuite bathroom, kitchen and living area. People had access to communal outdoor space and an activity room.

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. Details regarding conformity are detailed in the body of the report.

People’s experience of using this service:

People living at Heathers participated in activities and were involved in the local community. Staff showed kindness and compassion. They placed value on their caring role and involvement in people’s lives. People were offered a choice of meals and staff closely monitored people assessed to be at risk of poor food and fluid intake.

The service was working with people and their families to complete end of life care planning to ensure people received high standards of care and support. People were involved in the planning of their care at that stage of their life. The service had good working relationships with the local GP practice and learning disability healthcare professionals.

The service worked in partnership with people and encouraged feedback on the care provided. We received positive feedback from people about the staff and service received. Staff told us they enjoyed working at Heathers and spoke highly of the support and encouragement provided by the registered manager.

People had their care and support needs met by sufficient numbers of suitably trained staff, with use of regular agency staff or members of the management team to meet staffing shortfalls as required. The care environment was clean and comfortable throughout, with risk management plans in place. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; policies and systems in the service supported this practice.

The service had good governance arrangements in place, and completed internal quality checks and audits. Findings from these were regularly reviewed by the registered manager and provider. The management team continued to drive improvement within the service to ensure people received consistent standards of care and support.

Rating at last inspection: Heathers was previously inspected 18 October 2018, rated as Requires Improvement overall, with Inadequate in well-led. The report was published 05 December 2018.

The service was in breach of regulations 11, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and regulation 18 of the Registration Regulations 2009. There were conditions that remained in place on the service’s registration, and the service sent us monthly improvement plans on how those conditions were being met. Improvement plans were reviewed as part of this inspection.

Why we inspected: Services placed in special measures are inspected within six months of the publication date of the report to determine if sufficient levels of improvement have been made.

Enforcement: At the last inspection, we identified four breaches of regulation, and continued to take enforcement action.

At this inspection, we identified significant levels of improvement, with no breaches of regulation identified. The service was meeting the conditions placed on their registration and therefore no longer placed in special measures.

Follow up: We will continue to monitor this service and will reinspect in line wi

This was an unannounced, comprehensive inspection visit completed on 18 October 2018. This was completed within six months of publication of the last inspection report as the service was previously placed in special measures, with an overall rating of inadequate.

Heathers is a ‘care home’ providing residential care to people with learning disabilities, autism and mental health conditions. 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 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. Details regarding non-conformity are detailed in the body of the report.

The service is registered to provide care to a maximum of nine people. There were eight people living at the service at the time of the inspection. Each person lived in a self-contained apartment, receiving care and support from staff within their apartments.

The service’s manager had registered with the CQC since the last 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.

At our last inspection on 1 and 2 May 2018 we identified breaches of regulation in relation to safe care and treatment. The condition and cleanliness of the service. Low staffing levels per shift with poor training completion to meet the requirements of their roles. Staff did not consistently source people’s consent or adhere to the principles of the Mental Capacity Act and Deprivation of Liberty Safeguards. Governance and managerial oversight was poor. We also identified examples of incidents that had not been notified to CQC.

As an outcome of the last inspection visit, we put conditions on the home’s registration to encourage improvement. The provider was responsible for submitting an improvement plan and monthly updates to CQC. This information was reviewed during this follow up inspection.

During this inspection on the 18 October 2018, we identified that there continued to be poor governance procedures in place, particularly in relation to the management of risks. The management team were not fulfilling the requirements of their improvement plan from the last inspection. There continued to be non-compliance in relation to submitting notifications to CQC. Not all care records had not been reviewed and updated, this was an area of concern identified during the last inspection. Care records did not contain completed mental capacity assessments, or details of people’s deprivation of liberty safeguards status where applicable.

We did identify area of improvements since the last inspection. Staff morale had improved, with better working relationships between staff and the management team. There were improvements in the level of staff training completed since the last inspection. The cleanliness of the environment had improved. The service now had up to date fire, electrical and water safety checks in place. The management team had introduced community meetings had been introduced offering people an opportunity to raise concerns or give feedback on the service.

From reviewing the outcomes of the inspection, we made the decision was made for the conditions placed on the home’s registration to remain in place. This was to ensure the management team had the maximum amount of time for improvements to be made and embedd

The inspection took place on 1 and 2 May 2018 and was unannounced.

Heathers provides accommodation and support to a maximum of nine people with a learning disability or autistic spectrum disorder. It does not provide nursing care. Accommodation is provided in nine self-contained apartments. Each apartment has a bedroom, living room, kitchen, and bathroom. On the day of our inspection there were nine people living at Heathers.

This type of care service should be 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. Our inspection findings identified a lack of conformity with the Building the Right Support and Registering the Right Support guidance. Details regarding non-conformity are detailed in the body of the report.

There was a manager in post who was completing the registration process with the Commission. 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 our last comprehensive inspection on 12 July 2016 we found that the service was meeting the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and rated the service as Good.

During this inspection we identified that the service was not meeting the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider was in breach of the regulations for safe care and treatment, consent linked to the Mental Capacity Act, safeguarding people from abuse including depriving people of their liberty, good governance, staffing levels and training.

Full information about CQC's regulatory response to any breaches of regulation found during inspections is added to reports after any representations and appeals by the provider have been concluded.

From this inspection, on 1 and 2 May 2018 we identified areas of concern in relation to staff training in safe management of medicines, cleanliness of the environment and infection prevention control impacting on the care people received.

The service did not have robust governance processes in place for monitoring standards and quality of care provided. Staff did not complete clinical audits in areas such as medicines management and environmental condition and this was reflected in our findings during the inspection.

Staff did not consistently recognise the need to report safeguarding concerns or submit notifications relating to incidents to CQC.

Staff were not up to date with the provider’s mandatory training or annual performance appraisals.

Staff approach and people’s records demonstrated a lack of adherence to the Mental Capacity Act and Deprivation of Liberty Safeguards.

Low staffing levels impacted on people’s access to meaningful activities, particularly in the community. Planned staffing levels recorded on rotas were not an accurate reflection of actual staffing levels on each shift.

People had choice of food and fluids, with support in place to shop and participate in food preparation. Staff treated people with care and compassion.

The overall rating for this service is 'Inadequate' and the service is therefore in '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 thi

This inspection took place on 12 July 2016 and was announced.

Heathers provides accommodation and support to a maximum of nine people with a learning disability or autistic spectrum disorder. It does not provide nursing care. Accommodation is provided in nine self-contained flats. Each flat has a bedroom, living room, kitchen, and bathroom. On the day of our inspection there were nine people living in the home

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.

People were safe living in the home. Medicines were managed safely and risks to people, including from the premises, were well managed. Staff had been successful in managing a number of risks that meant people’s quality of life improved. The registered manager encouraged staff to discuss and think about incidents that occurred in the home, so they could take action to reduce the likelihood of them reoccurring.

There had been some recent changes in the staffing team. This had been managed to ensure there were enough staff to meet people’s needs. Staff demonstrated an awareness of adult safeguarding and knew how to raise concerns.

Staff were supported to provide effective care through management support, good team work and effective training. New staff were provided with a detailed induction that gave them the skills and knowledge to undertake their new role.

The service worked within the requirements of the Mental Capacity Act (MCA). The registered manager understood the importance of providing the least restrictive care as possible and staff understood the importance of offering choice and supporting people to make decisions.

Staff understood people’s individual dietary needs and how to support them. They encouraged people to eat healthily and worked with health care professionals to ensure people’s nutritional needs were met. People were also supported to access other health care professionals when required.

People were supported by very caring and dedicated staff. Staff demonstrated they were committed to the people living in the home and their quality of life. They often went the extra mile to ensure people were happy and comfortable living in the home. Positive relationships had been developed between people living in the home and staff. This meant staff knew people well and were sensitive to people’s individual needs. Some people living in the home had complex communication needs. Staff had ensured they had learnt how to communicate with each person in their own individual way so the person could feel properly understood and were able to express themselves. Staff supported people to be involved in decisions regarding their care.

People were treated in a respectful manner and encouraged to be as independent as they could be. Support was provided to people in a way that met their individual needs, preferences, and routines. People’s care plans were written in a way that was individual to them and stressed their positive attributes and skills.

People were involved in writing and reviewing their care plans, so they reflected their needs and wishes. This included writing their activities plans. Activities were varied and tailored to people’s needs and preferences.

Leaflets on how to complain were written in an easy read format and kept in people’s flats, so people knew how to complain. Relatives told us they felt able and comfortable to raise concerns. The registered manager investigated concerns and took action to resolve issues raised.

Everyone we spoke with spoke highly of the home and the support provided. The service promoted a person centred and inclusive approach towards both people living in the home and staff. People and sta

Some of the people living in Heathers had complex needs and did not like their daily routines altered or interrupted. For this reason, we spent most of our time during this inspection observing and interacting with one person, in their own self-contained apartment. We also looked at some of the care records for all of the other people living in Heathers.

We saw that staff spoke respectfully with the person we observed and included them in conversations and friendly banter. We also saw that, when staff provided any personal support, this was carried out in a discreet and dignified manner.

The person we interacted with indicated that they were happy and appeared comfortable and relaxed with the staff supporting them during our visit.

This person also showed us around their home and indicated that they liked their apartment and enjoyed spending time in the kitchen.

We determined that there were enough qualified, skilled and experienced staff to meet people’s needs and the records we looked at were accurate, up to date and fit for purpose.

During our inspection we spoke with people living in the service. We also observed how people were being supported. Some people were unable to tell us about their experience but one person told us that they were happy living there and that had been involved in developing their support programmes. We saw that staff treated people with respect and that they supported them to be as independent as possible.

People told us that they liked the food that was provided and that they enjoyed going out to eat and helping to prepare their meals.

The home was a clean and welcoming environment that was maintained to a high standard. People were eager to show us their home and told us they were able to arrange their rooms as they wished.

We found that staffing levels in the service were sufficient to meet the needs of the people living there. Staff interacted well with them and clearly understood how individuals liked to be supported.

Complaints were managed appropriately and people using the service understood how to raise any concerns they may have.

We spoke with a person who uses the service and collected comments from the survey conducted by the service.

One person with whom we spoke stated that they were, “Very happy living here”. They explained that their flat had everything they needed. “The staff are good, they listen to us and help us as we want”, they added. They stated that they felt safe and that staff helped them feel protected.

People confirmed that they had choice and were listened to. Flats had been painted at the end of last year in colours which people had chosen themselves.

Relatives also commented on their satisfaction with the service. We were told that if all the tenants received the care as their relative does, all parents should be grateful. We were told that their relative appeared to be receiving a high level of care and that they were satisfied with the standards and quality shown.