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Support by Heart Ltd was rated Requires Improvement overall at its first inspection in December 2022, with breaches of Regulations 9, 12 and 17 identified relating to incomplete care plans (omitting sexuality and independent living goals), absent choking risk assessments, and ineffective quality assurance audits that failed to detect these shortfalls. Strengths included safe medicines management, adequate staffing, robust recruitment, a positive staff culture, and good support for people to access healthcare and community activities.