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Inspection carried out on 22 January 2018

During a routine inspection

Heathcotes Balby is a 'care home'. People in care homes receive accommodation and nursing or personal care as a 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 home accommodates eight people. The home provides care and support to people with autism, learning disabilities and mental health conditions. Nursing care is not provided.

The unannounced inspection took place on 22 January 2018.

At our comprehensive inspection in December 2016 we found one breach of regulations and rated the service as 'Requires Improvement'. At this inspection we found the service had made improvements and we have rated the service as 'Good'.

People felt safe and were comfortable with the staff who supported them. Staff understood how to protect people from harm and abuse. Risks to people's safety were identified and clear support plans were followed. Incidents and accidents were monitored and action was taken to reduce risks to people. Environmental risks were assessed and managed appropriately. Improvements had been made to ‘as required’ medicines. People received their medicines safely and as prescribed.

Staff were only employed after they completed a thorough recruitment procedure. There were enough staff on shift to ensure that people had their needs met in a timely manner. Staff received the training they required to meet people's needs and were supported in their roles.

The CQC is required by law to monitor the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The provider had completed capacity assessments and DoLS applications where required. The provider could demonstrate how they supported people to make decisions about their care and the principles of the MCA were being followed.

Staff were kind and caring when working with people. They knew people well and were aware of their history, preferences, likes and dislikes. People's privacy and dignity was respected and maintained.

Staff monitored people's health and welfare needs. People had been referred to healthcare professionals when needed. People were provided with a choice of food and drink that they enjoyed. People were given appropriate support to enable them to eat and drink sufficiently.

People's privacy was respected and they were treated with dignity, kindness and compassion. People were supported to maintain relationships with others who were important to them. People could raise concerns about the service and have their complaints listened to.

People and staff were positive about the leadership of the service. There were systems in place to seek the views of people, their relatives, staff and visiting care professionals. Feedback was taken into account to improve and develop the service provided to people.

The registered provider had effective systems in place to monitor the quality of the service and ensure that areas for improvement were identified and addressed.

Inspection carried out on 22 December 2016

During a routine inspection

This comprehensive inspection took place on 22 December 2016 and was unannounced. The service was previously inspected on 9 July 2015 and was rated as good.

Heathcotes Balby is a care home registered to provide accommodation for up to eight people who have a learning disability or who are on the autistic spectrum. The home is located on two floors. Each person had their own individual room. The home had a communal lounge, kitchen and dining room where people could spend time together. The home had a garden that people had access to. At the time of inspection there were eight people using the service.

At the time of the inspection there was a registered manager in place. 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.

Staff were aware of their responsibilities to safeguard people and to keep people safe. Staff were trained in how to respond in the event of a fire and contingency plans were in place to keep people safe. Staff learned from accidents and incidents that had taken place.

There was a suitable number of staff to meet people's needs. Staff had been checked for their suitability before starting work with the provider. Staff received support through an induction and regular supervision. There was training available for staff to update them on safe ways of working and how to meet people's needs.

People were given their medicines when they needed them. There was a system in place to manage medicines in the home although this was not always effective. We found improvements were required in the recording of PRN (as required) medication.

Care plans described people's care and support needs. They were reviewed on a regular basis and also when changes to a person were identified. Health and social care professionals were involved to support people's care and health needs.

People were supported to have a healthy diet and stay hydrated. Staff prepared

meals which people enjoyed and which met their dietary needs.

The care plans were person centred and enabled staff to provide good quality care to people. They detailed people's routines, what they liked, what and who was important to them and how they communicated.

People were encouraged to take part in activities that suited their interests and hobbies. Activities were flexible and based on people's individual needs and preferences.

The complaints procedure was available in an accessible format for people and regular meetings were held to obtain their views.

Quality assurance systems were in place to monitor the quality of service being delivered and the running of the home.

Staff reported that the manager was supportive and responsive.

Inspection carried out on 14 & 15 April 2015

During a routine inspection

The inspection took place on 14 and 15 April 2015 and was unannounced on the first day. Our last inspection of this service took place in November 2013 when no breaches of legal requirements were identified.

Heathcotes (Balby) is registered to provide specialist residential accommodation for eight adults with learning disabilities, complex needs and associated challenging behaviour.

The service had a registered manager in post 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. The registered manager was not present every day and, as part of their personal development a senior staff member was acting as home manager on a day to day basis, in preparation to apply to take over the role of registered manager.

We spoke to four of people’s family members and they all said they felt that their relatives were safe. We spoke with staff, who had a clear understanding of safeguarding people from abuse and of what action they would take if they suspected abuse.

Care and support was planned and delivered in a way that ensured people were safe. The individual plans we looked at included risk assessments which identified any risk associated with people’s care. We saw risk assessments had been devised to help minimise and monitor the risk, while encouraging people to be as independent as possible.

We found there were enough staff with the right skills, knowledge and experience to meet people’s needs. We saw the staff training record for the service. This showed that staff were provided with appropriate training to help them meet people’s needs.

We found the service to be meeting the requirements of the mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). The staff we spoke with had a good knowledge of this and said they could speak to the managers for further advice.

People were supported to eat and drink sufficient to maintain a balanced diet and snacks were available in-between. We spoke with two people who used the service and they told us they liked the food. People were supported to maintain good health, have access to healthcare services and received on going healthcare support. We looked at people’s records and found they had received support from healthcare professionals when required.

People’s needs were assessed and care and support was planned and delivered in line with their individual support plan. We saw staff were aware of people’s needs and the best ways to support them, whilst maintaining their independence.

People’s individual plans included information about their family and friends and who was important to them. We saw that people took part in lots of activities and events on a weekly basis.

The service had a complaints procedure and people knew how to raise concerns. The procedure was also available in an ‘easy read’ version.

We saw various audits had taken place to make sure policies and procedures were being followed and the registered manager told us the company sent out satisfaction surveys to people for them to comment on their experience of the service provided.

Inspection carried out on 4 November 2013

During a routine inspection

During the SOFI we saw how staff members interacted with people who used the service. The staff appeared to know the people they were working with really well and were respectful of their wishes and feelings.

We found that where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

People experienced care, treatment and support that met their needs and protected their rights.

People were protected from the risks of inadequate nutrition and dehydration.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

There was an effective complaints system available.

Inspection carried out on 12 June 2012

During a routine inspection

There were seven people living in the home at the time of our inspection. Most people who used the service did not communicate in conventional ways. We were not able to talk with them to gain their views, because we were not familiar with the way they communicated. We therefore used a number of different methods to help us understand their experiences.

We used our Short Observational Framework for Inspection (SOFI) tool. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences. We used SOFI to observe the support offered to two people. This showed that there was very positive interaction between the staff and the people who used the service.

We spoke with three people�s relatives. They said they were happy with the care and support that people received and felt the home was a homely and safe place to live. Comments included:

�They (the staff) are lovely people.�

�I can�t praise them enough.�

�They (the staff) have been brilliant.�

People�s relatives told us that they felt confident taking any concerns to the manager or the care staff. They said they were involved in decisions and if they made comments or suggestions the manager and the staff were very responsive.

Inspection carried out on 20 December 2011

During an inspection looking at part of the service

We spoke with relatives and advocates, they told us the staff were very good they listened to you and acted on any issues.

They also told us they were kept informed of any changes and communication with the manager and staff was very good.

Inspection carried out on 11 August 2011

During an inspection in response to concerns

A person told us �he liked it here�. He could participate in activities that he chose in the home. Another person told us about making his breakfast in the kitchen, with support. Someone else using the service told us she made her own decisions on what to eat, what to wear and what to do. She told us �It�s lovely, I like it here�. �staff are fantastic�.