We inspected the service on 26 November 2014. This was an unannounced inspection.
Heathcotes (Hucknall and Watnall) is registered to provide accommodation for up to 12 people with a learning disability, a mental health illness or physical disability. The registration consists of two separate houses. One house is named Hucknall and one named Watnall. There were 10 people using the service when we visited, six people living in one house and four living in the other.
We last inspected this service on 25 April 2014. During the inspection we found that the provider was not meeting 3 of the regulations that we assessed. These were in relation to ensuring that there were sufficient staff on duty, ensuring that people’s nutritional needs had been met and that staff were respecting and involving people. The provider sent us an action plan detailing the actions that they would take to meet these regulations. During this inspection we found that the provider had taken the necessary improvements.
The service had a registered manager in place 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.
Everyone we spoke with told us that they felt safe. Staff told us that they followed plans to ensure people’s ongoing safety. However on one occasion we saw that staff had not followed guidance and as a result a person had been placed at risk of harm.
Staffing levels had been increased since the time of our last inspection and this had impacted positively on the people who used the service. People told us that they had opportunities to go out to pursue activities of their choice and staff told us that people did not have to wait for support. Increased staffing levels meant better opportunities for people to receive individualised support.
We saw there were systems and processes in place to protect people and keep them safe. 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. Staff told us that they had received training in order to do this safely and everyone we spoke with said they felt confident that they would know what to do in such a situation.
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 considered, to ensure staff made decisions based on people’s best interests.
People’s medicines’ were managed safely and people received their medication when they should. Staff were recruited through safe recruitment practices.
People who used the service told us that they felt consulted in relation to how they lived their lives. There were processes in place to gain their views. People’s preferences and needs were recorded in their care plans and we saw that staff were following the plans in practice.
We saw that the monitoring of food and drink intake had improved and staff could show that people were receiving a varied and balanced diet. At least one person’s health had improved as a result.
Throughout the inspection we saw staff treat people with dignity and respect. We saw staff were kind and caring when supporting people.
People knew who to speak to if they wanted to raise a concern and there were processes in place for responding to complaints. This meant that people were enabled to make a complaint or share a concern about the care and support they received.
There were effective systems in place to monitor and improve the quality of the service provided. Action plans, in response to audits and incidents, documented continuous improvement. Staff had received training and support in relation to learning disability, autism and mental health awareness. to them a better understanding of people’s needs and behaviours.
Staff also told us how they had received support from the manager to raise their awareness of treating people with respect and recognising individuality.
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 provider 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 were assessed by professionals who are appropriately trained to assess whether the restriction is needed. The registered manager told us there was one person who may be being deprived of their liberty. We saw that they had made an application to check this with the local authority and had notified the CQC. At the time of our inspection no one else living in the home was being deprived of their liberty. We found the provider and the registered manager to be meeting the requirements of the DoLS.