The inspection took place on 30 January and 8 February 2018. It was unannounced on both days.

The Heathers 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 we looked at both during this inspection. The Heathers provides care and support to people who had past or present alcohol dependency problems. The home is an adapted property. At the time of our inspection there were 33 people using the service.

The last full inspection of the service was in July 2016. At that time we found the provider was in breach of two regulations, there were related to staffing and good governance. The provider sent us an action plan to show what they would do to make the required improvements. During this inspection, we found the provider had made the required improvements. We also carried out a shorter focussed inspection in June 2017. During that inspection, we looked at how the service supported people to manage their money and checked to see if the service was meeting the requirements of the Mental Capacity Act. We did not have any concerns during that inspection.

The service had a registered manager. 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 found the service was safe. Staff knew how to recognise and report any concerns about people’s safety and wellbeing. Staff knew about people’s individual needs and risks to people’s safety and welfare were identified and managed.

There were enough staff deployed, the provider had increased the number of staff on duty following the last inspection. Recruitment procedures were robust and were followed. This helped to protect people from the risk of being supported by staff unsuitable to work in a care setting. Staff received the training they needed to carry out their roles safely and effectively. Staff told us they felt well supported.

People’s medicines were managed safely.

The home was clean and safe. The provider was in the process of making improvements to the environment to make sure it met the needs of people who used the service.

People’s nutritional needs were identified and met. People were satisfied with the food and told us they were always offered choices.

Staff understood the Mental Capacity Act and Deprivation of Liberty Safeguards and how this affected their roles. This helped to make sure people’s rights were protected and promoted.

People’s needs were assessed before they moved into the home. This helped to ensure their needs could be met. People had person centred care plans, which detailed their individual needs and preferences. People made decisions about their care and treatment.

The service worked openly and cooperatively with other agencies to make sure people received the support they needed to maintain and improve their health.

The registered manager and staff team were kind and compassion. They treated people with respect and dignity.

Since the last inspection, we found improvements had been made to the range of activities offered to people in the home and in the community.

People knew how to raise concerns. All concerns were recorded and we saw the management acted to try to resolve any issues or concerns raised.

We found the culture in the home was positive and inclusive. The management team and staff had a person centred approach and were committed to continuously improving the experiences of people who used the service.

People who lived at the home, relatives and other stakeholders spoke positively about the service and the standards of care and support provided.

The provider had improved the systems

We carried out an unannounced comprehensive inspection of this service on 13 July 2017. At that time the service was given a quality rating of 'requires improvement' overall . After that inspection we received concerns in relation to safeguarding and compliance with the Mental Capacity Act and Deprivation of Liberty Safeguard legislation. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to those. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk. The quality rating has not changed following this visit.

The Heathers is privately owned by Yorkshire Regency Health Care Limited. The home provides care and support for up to 34 people who have past or present alcohol dependency problems. The home is a detached adapted property located close to Bradford City centre and within walking distances of Lister Park, local shops and other amenities. It is on a main bus route and there is a car park to the front of the property.

At the time of the focused inspection on 14 June 2017 there were 32 people using the service.

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 told us they felt safe living at The Heathers and we found staff understood how to keep people safe from harm. Good systems were in place to make sure people were protected from any financial abuse.

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 support this practice. The legal requirements relating to Deprivation of Liberty Safeguards (DoLS) were being met.

The inspection took place on 13 July 2016 and was unannounced. The last inspection was in June 2014 and at that time the service was compliant with the regulations we looked at.

The Heathers Residential Care Home provides care and support to people who have past or present alcohol dependency problems. The home is a detached adapted property located close to Bradford City centre and within walking distances of Lister Park, local shops and other amenities.

The home had a registered manager in post at the time 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 2008 and associated Regulations about how the service is run.

The home had a safeguarding policy in place which made staff aware of their roles and responsibilities. We found staff knew and understood how to protect people from abuse and harm and what might constitute abuse.

We found the service was meeting the requirements of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS).This legislation is used to protect people who might not be able to make informed decisions on their own. We asked the staff about the MCA and DoLS and found they had a good working knowledge of the legislation and how it affected their roles.

We saw staff were patient and caring toward the people they supported and received appropriate levels of training and supervision to carry out their roles effectively. People who used the service told us they were happy living at the home and were complimentary about the registered manager and staff team. However, we had concerns there were at times insufficient staff on duty to meet people’s needs particularly on night duty.

We saw arrangements were in place that made sure people's health needs were met. For example, people had access to the full range of NHS services. This included GPs, hospital consultants, community health nurses, opticians, chiropodists and dentists. We found staff responsible for administering medication received appropriate training and people received their medicines safely. However, the providers medication policy was out of date and based on regulations which were no longer in use.

We saw some areas of the home required refurbishment to ensure they provided people with a safe and comfortable environment.

We saw there was a complaints procedure available which enabled people to raise any concerns or complaints about the care, support or treatment they received. However, the policy referred to regulation which were no longer relevant.

We also saw the statement of purpose, which contains detailed information about the service, required updating as it referred to a policy which had not yet been developed and facilities which were no longer available.

We found the quality assurance monitoring systems in place were not robust as not all shortfalls in the service highlighted in the body of this report had not been identified through the internal audits system.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

During the visit we had the opportunity to speak with four people and a relative who used the service . Everyone told us they were "very happy" with the care and support provided at The Heathers. They said the staff were "great and friendly." People told us they could make choices and decisions about how they wanted to spend time at the home and staff encouraged them to be fully involved in making decisions about their care and treatment.

A relative told us they were involved in discussions and decisions about their relatives care needs and were kept informed about any changes. They said "my relative loves it here, he gets choices of food and drink. My relative had seen their care plan and signed it and staff respected their dignity and privacy and can go out when they want." Another person who used the service told us "I live here like a king, I have my own room it's my home. I live like I want to live."

People who lived in the home and a relative said the food was good and the home was nice and comfortable.

During our inspection we saw care and support being given by caring staff. We spoke with seven people using the service who all told us they liked living at The Heathers. One person told us they had been in a number of other homes but they had settled here. Another told us "the majority of the staff are excellent."

We also spoke with three visiting health professionals. One told us "the care is always very good, the staff do a good job with clients who can be very challenging to care for, I have seen them calmly deal with conflict between the residents which has diffused the situation and prevented possible harm " Another told us "this is my third visit here and I have found no issues with the care provided."

People told us that they were generally pleased with the standard of care and support provided and that staff encouraged them to participate in a range of social and leisure activities.

They also told us that if they had any concerns or complaints, they would have no hesitation in approaching the manager or a member of the senior staff team.

During our inspection we looked for the answers to five questions;

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, their relatives, staff supporting them and from looking at records.

Is the service caring?

We spoke with staff that told us they treated people with respect and dignity and could give us examples of how they do so. We observed staff supporting people according to their care plans. The people who used the service told us staff were positive and they felt they could talk to all staff.

Is the service responsive?

We saw signatures of people who used the service on reviewed documentation. Questionnaires were sent out to people who used the service, staff and external professionals. We saw concerns were looked into and adjustments were made. There was a complaints system in place. One complaint had been acknowledged, investigated and responded too.

Is the service safe?

Care plans identified risk and had supporting risk assessments to keep people safe. We saw sufficient levels of trained staff to support the people using the service. There was a safeguarding policy in place with adult protection literature in the entrance to the building.

Is the service effective?

Care plans showed people’s needs had been assessed and care plans were person centred with information about preferences, likes and dislikes taken into account. Daily notes showed external professional were involved at peoples request or if staff believed it would benefit someone's health. We saw end of life plans had been signed by people that used the service.

Is the service well-led?

The service worked well with other agencies to make sure people received care in a joined up way. Records seen by us showed that identified shortfalls were addressed and concerns and complaints were investigated. Staff told us they were clear about their roles and responsibilities. This helped to ensure that people received a good quality service at all times.