About the service:

Highfield House is a care home registered to provide accommodation for up to 20 people. The service provides specialist care to people living with varying degrees of cognitive impairment. Some of the people at Highfield House had complex and sometimes challenging needs. The home also provides day care for people living in the community. Care was provided in a safe and dementia friendly environment. At the time of our inspection there were 20 people living in the home and six people being supported for day care.

People’s experience of using this service:

People at Highfield House received outstanding care and were supported by a staff team that were committed, passionate and knowledgeable. People were treated with exceptional kindness and had positive outcomes.

The service was especially responsive to the needs of people at the home, with a wide range of person-centred activities. Arrangements for social activities were innovative, met people's individual needs, and followed best practice guidance so people could live as full a life as possible. There were good community links and people accessed the community regularly.

The service went the extra mile to provide a family orientated and homely environment for people. Staff had developed strong relationships with people and knew them exceptionally well. People, their relatives and external health and social care professionals overwhelmingly told us that the staff made them feel included and part of a large family. One relative said, “It’s like a big family. They [staff] support us and make us laugh.”

Staff knew people exceptionally well and delivered care and support in a way that met those needs and promoted equality. People and their families were involved in planning their lives, and the service ensured that care was always personalised to meet the needs of each individual living there.

People received their medicines safely and as prescribed. Appropriate arrangements were in place for obtaining, recording, administering and disposing of prescribed medicines.

Staff used positive communication techniques with people so that they felt listened to and valued according to their individual needs. People’s unique communication styles were understood and respected by staff.

Staff were motivated by and proud of the home. Continuous learning was embedded in the home's culture.

People were supported by staff who were highly skilled, and knowledgeable in caring for people with complex needs. There were enough staff to meet people's needs and they supported people with a calm approach, that demonstrated their skills and confidence.

Appropriate recruitment procedures were in place to help ensure only suitable staff were employed.

The service ensured that care delivery was safe, with risks to people continually assessed to ensure both their home environment, and outings in the community were safe. Premises were well maintained.

Rating at last inspection:

The service was rated as Outstanding at the last full comprehensive inspection, the report for which was published on 01 December 2016. The service continues to be Outstanding.

Why we inspected:

This was a planned inspection based on the previous inspection rating.

Follow up:

There is no required follow up to this inspection. However, we will continue to monitor the service and will inspect the service again based on the information we receive.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We carried out an unannounced comprehensive inspection of Highfield House on 8 September 2016.

Highfield House is a care home registered to provide accommodation for up to 20 people. At the time of our inspection there were 20 people living in the home. The service provides specialist care to people living with varying degrees of cognitive impairment. Some of the people at Highfield House had complex and sometimes challenging needs. Care was provided in a safe and dementia friendly environment.

There was a registered manager in place at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

People received exceptionally person centred care from staff who knew each person well, about their life and what mattered to them. The people living at the home experienced a level of care and support that promoted their health and wellbeing and enhanced their quality of life. The service focussed on the individual needs of the people and their families. People, families and professionals all described Highfield House as a “Home from home” and praised the high quality person-centred approach to care provided by the staff.

People were supported by enough staff who were highly skilled and knowledgeable in caring for people with cognitive impairments. People and their relatives said or expressed that they felt safe in the service. Staff were clear about their safeguarding responsibilities and knew how to recognise signs of potential abuse and how to report it.

Staff carried out their roles and responsibilities effectively. Staff had an excellent understanding of managing risks and supported people to reach their full potential through inventiveness and personalised care. The attitude of the staff and their knowledge of the people clearly had a positive impact on the people and their families. Staff were skilled in helping people to express their views and communicated with them in ways they could understand.

People were treated with dignity and the greatest of respect at all times. Staff demonstrated caring and positive relationships with people and was sensitive to their individual choices. Staff focused on people's wishes and preferences and people were supported to remain active and independent.

The registered manager, provider and staff were highly responsive to the needs of the people and their families. Staff thought creatively about how people’s needs could be met and demonstrated a commitment to ensuring the service was tailor made and flexible to each individual. People and relatives and visiting professionals described the staff as ‘going out of their way’ to meet the needs of the people.

Staff worked tirelessly to meet the social, emotional and physical needs of the people they cared for. People’s lives were enhanced by being encouraged and aided to take part in activities they enjoyed and that were meaningful to them. Staff continually encouraged and supported people to remain active and independent.

People benefitted from an exceptionally well-managed and organised service and the provider and registered manager led by example. People were placed at the heart of the service though the providers clear vision and values that underpinned practice. The staff all recognised the on going importance of ensuring the vision and values were understood and implemented, without exception.

The registered manager was very approachable and well supported by the provider. There were comprehensive quality assurance processes in place using formal audits and regular contact with people, relatives, professionals and staff. Family members told us they were given the opportunity to provide feedback about the culture and development of the home and all

At the time of the inspection 20 people were living at Highfield House. One room was used by people staying for respite care and on that day one person was going home and one had arrived.

We spoke with three people using the service. One person told us “they make me feel like it’s my home.” Another said “They look after me well”. A relative who was visiting that day said “It’s a lovely, lovely home. We are very lucky.”

We spoke with the manager, three senior carers, three carers, the administrator who also maintained the accounts and the chef. One senior carer told us “The clients always come first. Cost doesn’t matter, time doesn’t matter.”

We reviewed care records for two people using the service. We found that people who lived at the home experienced safe and effective care because their needs were assessed and reviewed, and care plans updated to reflect a person’s current needs.

People had a varied diet and were given the support and encouragement they needed to eat and drink.

People were protected from the risk of the unsafe management of medication because staff were trained and followed clear procedures.

There were effective systems in place to ensure people were safe because staff were subject to rigorous recruitment procedures and a thorough induction.

We spoke with 6 of the 18 people who were living at the home. We met other people and three visitors. People told us that they could make decisions and that the staff were very nice “more like family than staff”. People said that they had no concerns about how their care needs were met. People commented that they could make choices and these were respected. We were told that staff were available when people needed them and knew what care they required. People told us that they felt safe and happy at the home. They told us that their privacy was respected and that staff always knocked on their doors before entering.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk to us. This helped us observe particular people and activities over a set period of time. This showed that there was a high level of staff initiated interactions with people and that these interactions were positive. Staff had a good knowledge of people.

We spoke with four health professionals involved in the care of people. They were complimentary about the way the service met people's needs. We were told that the home contacted them appropriately and followed guidance and suggestions. We observed that staff were courteous and respectful of people's views and opinions and that dignity was respected.