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Inspection carried out on 31 January 2018

During a routine inspection

We inspected the service on 31 January 2018. The inspection was unannounced.

Heathcotes (Basford) 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.

Heathcotes (Basford) accommodates six people living with mental health needs and or learning disabilities and or an autistic spectrum disorder. On the day of our inspection six people were living at the service.

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.

At the last inspection, in February 2016 the service was rated overall as ‘Good’. At this inspection we found that the service remained ‘Good’.

Since our last inspection there had been a change of registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 supported by a staff team who understood their role and responsibilities to protect them from abuse and avoidable harm. The registered provider had systems, policies and processes to support staff in safeguarding people. Staff had received appropriate safeguarding training.

Risks to people’s safety, including the environment had been assessed and were monitored and reviewed. Some concerns were identified with staffing levels and action was taken to improve this with immediate effect.

People’s medicines were managed safely. Not all night staff had received medicines training, whilst there was a plan to manage this action was taken to resolve this issue. Following our inspection the registered manager confirmed night staff that had not received medicines training, were enrolled to complete this as a matter of priority. The service was clean and hygienic and staff had received training in the prevention and control of infections and a policy and procedure was available to support staff.

People’s needs had been appropriately assessed and staff had information of the support people required to effectively manage their needs. Staff had received an appropriate induction and support. Some gaps were found in staff training, this had been already identified in some areas and training booked. Immediate action was taken to arrange for staff to receive refresher training where required.

People received a choice of meals and drinks and their dietary needs were known and understood by staff. People were supported to access primary and specialist health services to monitor their health needs. Staff worked with external healthcare professionals to secure good outcomes for people. The internal and external environment was appropriate for people’s individual needs.

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 were supported by a staff team that knew them well; staff were caring and provided a person centred approach. Independence was promoted, dignity and privacy respected and people were involved in their care and support. People had access to independent advocacy information should they have required this support.

Staff supported people with their interests and hobbies and people contributed to planning the care and support they received. People’s communication needs had been assessed and planned for. The provider’s complaints procedu

Inspection carried out on 10 February 2016

During a routine inspection

We carried out an unannounced inspection of the service on 10 February 2016.

Heathcotes (Basford) provides accommodation and personal care for up to 5 people living with a learning disability and/or autistic spectrum or mental health needs. Five people were living at the service at the time of the inspection.

Heathcotes (Basford) is required to have a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 the time of the inspection a registered manager was in place. However, a new acting manager was taking over and had started the process of registering with CQC.

Staff were aware of the safeguarding adult procedures to protect people from abuse and avoidable harm and had received appropriate training. Appropriate action had been taken to respond and investigate safeguarding concerns.

Risks to people had been assessed and risk plans were in place to manage and reduce known risks. Accidents and incidents were recorded and appropriate action had been taken to reduce further risks. These were monitored and analysed for themes, patterns and trends. People received their medicines as prescribed by the GP and these medicines were managed correctly.

Safe recruitment practices meant as far as possible only people suitable to work for the service were employed. Staff received an induction, training and appropriate support. There were sufficient staff available to meet people’s needs, staffing levels were flexible and responsive to people’s needs.

People received sufficient to eat and drink and their nutritional needs had been assessed and planned for. People’s healthcare needs had been assessed and were regularly monitored. Some concerns were identified about the recording of information that informed staff of the support people required with their needs and choices.

The manager applied the principles of the Mental Capacity Act 2005 (MCA) and Deprivations of Liberty Safeguards (Dolls). However, best interest decisions had not always been made in accordance with this legislation.

Staff were kind, caring and respectful towards the people they supported. They had a person centred approach and an understanding of people’s individual needs, preferences and routines. People were involved as fully as possible in decisions and choice about how they lived their life.

There was a complaint policy and procedure available for people, and complaints made had been investigated and appropriate action had been taken to resolve issues if required. People had access to information about an independent advocacy service. There were no restrictions on people visiting the service.

The provider had good systems and processes in place that checked and monitored the quality and safety of the service. These included daily, weekly and monthly audits completed by the manager and staff team, and regular audits completed by the regional manager. Where shortfalls were identified actions plans were developed and improvements were made.

Inspection carried out on 10 April 2014

During a routine inspection

Heathcotes (Basford) is a care home providing accommodation for up to five people. There were four people living there when we visited. The service provides care and support to adults who have a learning disability, a mental health illness or physical disability. Heathcotes (Basford) is a new service that had been registered seven months prior to our visit and so people had only been living in the home for a few months. There is a manager registered at the service, who is also the regional manager. There is also a manager who is responsible for the day to day running of the service. The registered manager told us the day to day manager planned to register with the CQC.

We saw there were systems and processes in place to protect people from the risk of harm. People were protected against the risk of unlawful or excessive control or restraint because the provider had made suitable arrangements for staff to respond appropriately to people whose behaviour may challenge others.

People were supported to take informed risks to ensure they were not restricted. Where people lacked capacity to make decisions, the Mental Capacity Act (MCA) 2005 was being adhered to, to ensure staff made decisions based on people’s best interests. The MCA was introduced to protect people who lacked capacity to make certain decisions because of illness or disability.

We found that there were systems in place to ensure people received their medicines as prescribed. There were enough staff to support people safely and meet their needs.

There were processes in place to gain the views of people in relation to their care and support. People’s preferences and needs were recorded in their care plans and staff were following the plans in practice. People were being supported to maintain good health. Records and observations showed that the risks around nutrition and hydration were monitored and managed by staff to ensure that everyone received adequate food and drink.

We observed that staff were kind and respectful to people when they supported them. There was a clear set of values in place to support staff to respect people’s privacy and dignity. People were supported to attend meetings where they could express their views about the home.

Staff were able to describe examples of where they had responded to what was important to individuals living in the home. People knew who to speak to if they wanted to raise a concern and there were processes in place for responding to their concerns. The manager told us there had not been any complaints made by people living in the home or their relatives or advocates.

There were effective systems in place to monitor and improve the quality of the service provided. Action plans, in response to audits and incidents, and the following up of these ensured continuous improvement. Staff were supported to raise issues when they felt there could be improvements and there was an open and transparent culture in the home.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS), and to report on what we find. The deprivation of liberty safeguards are a code of practice to supplement the main Mental Capacity Act 2005 Code of Practice.

We looked at whether the service was applying the DoLS appropriately. These safeguards protect the rights of adults using services by ensuring that if there are restrictions on their freedom and liberty these are assessed by professionals who are trained to assess whether the restriction is needed. The manager told us there was nobody who needed to be on an authorisation. We saw no evidence to suggest that anyone living in the home was being deprived of their liberty. We found the location to be meeting the requirements of the DoLS.