You are here

Heathcotes (Hollyfield House) Requires improvement

The provider of this service changed - see old profile

Inspection Summary

Overall summary & rating

Requires improvement

Updated 22 August 2019

About the service

Heathcotes (Hollyfield House), is a residential care home providing 24-hour support for adults with a learning disability, autism, epilepsy and associated challenging behaviour. The service has nine en-suite bedrooms over three floors. It has two lounges, two kitchens and a well-maintained garden area. At the time of our inspection eight people were using the service.

People’s experience of using this service and what we found

Risk assessments in place were detailed and person centred. However, some people’s risk had not been identified and some equipment that was used to help manage people's risk was not checked or working as it should do. People received their medicines when they needed them but the room people’s medicines were kept in was too hot and no measures were in place to reduce the temperature. This meant some people’s medicines may not be safe or work very well.

There were enough staff to keep people safe. However, some staff did not always receive their induction training before they started to work at the service and some mandatory training for existing staff had not been completed or had not been refreshed. This meant some staff may not have the skills and knowledge they needed to support people.

The service applied the principles and values of Registering the Right Support. This meant people who used the service were able to live as full a life as possible and achieve good outcomes that include control, choice and independence. However, some best practice and legislation around how people were supported in the least restrictive way possible and in their best interests had not been followed.

Staff knew how to keep people safe and used many different ways to communicate with people to find out how they were feeling and what choices they wanted to make. Care records helped staff know what was important to people and how they wanted to be supported. Information was available for people in a way they could understand.

Staff supported people to follow their interests in the community and at the service. They helped people keep in contact with their family and friends. During our inspection people were very active getting ready with staff to go out or making plans for their day.

The manager had joined the service in the last six months and people and staff liked him. He was working hard to make the improvements needed. The provider was making regular checks on the service to make sure people had the care and support they needed. When issues were identified they were working with the manager to make things better for people.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.

For more details, please see the full report which is on the CQC website at

Rating at last inspection

The last rating for this service was good (report published 09 January 2018).

Why we inspected

The inspection was prompted in part by risks identified at other Heathcotes services, these included risks around poor restraint practices, risk management, staff training and governance. A decision was made for us to inspect and examine those risks as part of a comp

Inspection areas


Requires improvement

Updated 22 August 2019

The service was not always safe.

Details are in our safe findings below.


Requires improvement

Updated 22 August 2019

The service was not always effective.

Details are in our effective findings below.



Updated 22 August 2019

The service was caring.

Details are in our caring findings below.



Updated 22 August 2019

The service was responsive.

Details are in our responsive findings below.


Requires improvement

Updated 22 August 2019

The service was not always well-led.

Details are in our well-Led findings below.