This inspection took place on 12 June 2018 and was unannounced.

Heathfield house 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. Heathfield House accommodates up to six people in one adapted building. At the time of the inspection there were six people living in the care home.

There was not a registered manager in post. The provider had a manager in post and it was their intention to register with us in the near future. 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 2 December 2015 we found the service was rated good overall. At this inspection we found the service continued to be rated good overall, but some improvements were needed in Well Led.

We found systems in place to check on the quality of the service people received were not always effective and improvements were needed. Whilst the manager had systems in place to monitor the delivery of people’s care, changes to risk assessments were not always documented and medicines stock checks were not always effective in identifying concerns.

People were protected from abuse and risks were assessed and planned for to keep people safe. Premises and equipment were maintained to minimise the risk of infection. People were supported by sufficient safely recruited staff. Medicines were administered safely. The manager had systems in place to learn when things went wrong.

People’s needs were assessed and they had effective care plans in place. Staff were trained and people received consistent support. People were supported to make choices and their needs and preferences for food and drinks were met. The environment was adapted to meet the needs of people. People were supported to maintain their health and wellbeing. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People received support from staff that were kind and caring and staff had good relationships with people and their relatives. People had their communication needs assessed and care plans were in place which supported people to make choices and retain their independence. People were treated with dignity and respect

We inspected this service on 2 December 2015. This was an unannounced inspection. Our last inspection took place in March 2014, we found the home was meeting the Regulations we looked at.

The service is registered to provide accommodation and personal care for up to six people with learning disabilities. At the time of our inspection four people were using the service.

The registered manager was present on the day of the 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 and associated Regulations about how the service is run.

People were cared for by staff who knew what safeguarding was, how to identify the different types of abuse and what actions to take if they suspected potential abuse. There was guidance on display for people who used the service and staff on how to raise safeguarding concerns. The provider took appropriate action when abuse was suspected. We observed that people were cared for safely and protected from harm.

People had risk assessments and management plans and these plans were reviewed regularly and updated when people’s needs changed. There were adequate numbers of staff to meet people’s needs. People’s medicines were managed safely.

Staff knew the people they cared for well and delivered care in in line with their specific needs. knew them well and understood their needs. They had completed training to enable them to provide safe and effective care.

People were supported to eat and drink suitable amounts of food and drink of their choice. Advice given by professionals was followed in respect of special diets. People were supported to attend health appointments as required. People had access to other health care professionals when they needed them.

People were cared for and supported by staff who were kind, friendly and compassion. Their dignity was respected at all times. Staff ensured that people were comfortable at all times and took appropriate action when people expressed signs of distress.

Care was provided to meet people’s individual needs and preferences. Care plans detailed how people wished to be cared for and supported. People were involved in assessments and planning of their care. People were supported to be as independent as possible. The views of their families were obtained about their preferences and likes and dislikes.

Information was provided in easy- to-read formats to enable them raise concerns. Their relatives were given opportunities and supported if the wished to raise concerns and make complaints about the service. The provider had systems in place to deal with and monitor complaints made about the service.

There were systems in place to monitor and assess the quality of the service provided.  The registered manager understood the requirements of their registration with us and they and the provider kept up to date with changes in health and social care regulation. There was a positive and open atmosphere within the service. Staff and relatives told us that the interim registered manager was approachable and supportive.

This was a follow-up inspection to see if improvements had been made since our last inspection which took place on 14 November 2013. During the previous inspection we had concerns about the safety of people who used the service, staff and other visitors to the home.

We were concerned that people's safety was compromised by the lack of maintenance to the building and grounds.

During this inspection we found that the issues had been addressed, people were able to enter and leave the buildings and move about the grounds in safety. The registered manager said, "It's much better now the work has been done".

Five people used the service at the time of our inspection. We were able to speak with each one of them. We spoke with three members of staff, and a visiting professional.

People were treated with respect by staff and there was a very friendly atmosphere in the home. A person who used the service told us, “It’s nice here. This is where I live”.

We saw that people were supported in a way which met their individual needs. Records were person centred and enabled staff to understand the support people needed and how this should be delivered.

At the time of our inspection the provider did not have a registered manager in post.

We saw that inside the home was clean and tidy. Staff used aprons and gloves when they served food or assisted people with their meals.

We found that maintenance of the exterior of the house and the grounds had been neglected. People who used the service or visited the home were put at risk. The deputy manager said, “We are supposed to be having the drive done in December”.

There were sufficient experienced staff available to meet the needs of people who used the service.

The provider had a complaints policy and procedure in place. We found that complaints and issues of concern were not recorded and dealt with appropriately.

Four people were in residence when we visited, the home can accommodate six people. We spoke with three people living at Heathfield House, the fourth person chose not to speak with us, we also spoke with three staff members. There weren't any visitors on the day we undertook this inspection.

We saw staff knocking on people's doors and waiting for an answer before entering. People told us they could spend time in any area of the home or alone in their bedroom when they wished to. This meant people's privacy and dignity were respected.

We were able to see that people received care and support that met their individual needs. The care records included pictures and photographs to support understanding.

We checked to ensure medication was stored and administered in a safe way and found suitable systems and procedures were in place.

We looked at the recruitment procedures for staff and found that systems were in place to protect people using the service.

We looked at ways in which the home assessed its own quality and safety. We saw systems were in place but there was little evidence to demonstrate how outcomes were improved for the people who lived there.