This inspection was unannounced and took place on 7 and 8 February 2017. This was a comprehensive inspection. The last inspection in August 2016 was a focussed inspection to look at what improvements the home had made with regard to medicines administration since their previous inspection. They had not made the required improvements and were in breach of regulation 12 of the Health and Social Care Act 2008. The previous comprehensive inspection of the home was carried out in January 2016 and the home was rated as requires improvement. Three breaches of regulations 12, 11and 17 of the Health and Social Care Act 2008 were identified. The provider wrote to us with an action plan of improvements that would be made. They told us they would make the necessary improvements by October 2016. During this inspection we saw the improvements identified had been made.

Highbridge Court is a care home providing accommodation for up to nine people with mental health needs. At the time of the inspection, four people were living there. Each person had a self-contained flat with their own cooking facilities, table and comfortable seating. Each flat has an en-suite shower room. There is a small communal area with a dining table and a sofa, and a communal kitchen area where staff prepare meals at the weekend.

The registered manager left in December 2016 and a temporary manager was in post. The service was actively seeking to recruit a new registered manager. 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.

People told us they were safe. There were appropriate numbers of staff employed to meet people’s needs and provide a flexible service. Staffing levels were planned, implemented and reviewed to keep people safe at all times. Any staff shortages were responded to quickly and appropriately.

Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

There were suitable recruitment procedures and required employment checks were undertaken before staff began to work at the home. People were involved in the recruitment process.

The staff understood their role in relation to the Mental Capacity Act 2005 (MCA) and how the Deprivation of Liberty Safeguards (DoLS) should be put into practice. People’s legal rights were protected because the correct procedures were followed where people lacked the capacity to make specific decisions for themselves.

Systems, processes and standard operating procedures around medicines were reliable and appropriate to keep people safe.

Assessments were undertaken to assess any risks to the person using the service and to the staff supporting them. The risk assessments included information about action to be taken to minimise the chance of harm occurring.

Staff knew the people they supported and provided a personalised service. Care plans were in place detailing how people wished to be supported and people were involved in making decisions about their care.

People were supported to make healthy choices around their meals. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs.

Staff told us the manager was accessible and approachable. People told us they were able to speak with the manager and provided feedback on the service.

People told us staff were caring and supported them with the activities they wanted to do. The manager and provider undertook checks to review the quality of the service provided and made the necessary improvements to the service.

This inspection was unannounced and took place on 01 August 2016. This was a focussed inspection to look at what improvements the home had made with regard to medicines administration since their last inspection. The last inspection of the home was carried out in January 2016 and the home was rated as requires improvement. Three breaches of regulations 12, 11and 17 of the Health and Social Care Act 2008 were identified.

Highbridge Court is a care home providing accommodation for up to nine people with mental health needs. At the time of the inspection, four people were living there. Each person had a self-contained flat with their own cooking facilities, table and comfortable seating. Each flat has an en-suite shower room. There is a small communal area with a dining table and a sofa, and a communal kitchen area where staff prepare meals at the weekend.

There is a registered manager in post. 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.

Staff promoted people’s privacy and dignity by asking people if they wanted to return to their rooms to have their medicines in private. We observed staff giving medicines to people and saw people consented to this.

Medicines were stored in a secure, locked room which was protected from heat and damp to ensure the medicines did not lose their effectiveness. Medicines waiting to be returned to the pharmacy were kept separately. Staff sent unused or wasted medicines back at the end of the month, so there were no excess stocks of medicines.

Staff did not record accurately when one person had received the correct number of medicines they should have, in one day. Although staff were counting medicines every day, the audits had not picked this up.

Staff did not record dates when creams were opened and when creams expired on the box, which meant there was a risk creams could be applied after they had expired. There was no written guidance for staff where to apply creams, or how much to apply.

Not all staff had undergone checks to ensure they were competent to give people their medicines as stated in the provider’s policy. Of the five staff files we looked at, two staff did not have the required checks in place.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

This inspection was unannounced and took place on 29 January 2016, 1 February and 4 February 2016.

Highbridge Court is a care home providing accommodation for up to nine people with mental health needs. At the time of our inspection, four people were living in the home.

There wasn’t a registered manager; however there was a manager in post who was going through the registration process with CQC. 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.

At the last inspection on 16 and 17 July 2015 Highbridge Court was breaching five regulations of the Health and Social Care Act 2008.

1. Safe care and treatment (Regulation 12). We saw partial improvements had been made.
2. Safeguarding service users from abuse and improper treatments (Regulation 13). The required improvements had been made.
3. Staffing (Regulation 18). The required improvements had been made.
4. Need for consent (Regulation 11). We saw partial improvements had been made.
5. Good governance (Regulation 17). We saw partial improvements had been made.

Although there were systems to assess the quality of the service provided in the home, we found some of these were not effective. The systems had not ensured that people were protected against some key risks, such as unsafe practices around medicines. The amounts of medicines that were recorded as being in stock were not always the same as the actual medicine in stock.

Staff were not consistently recording information about people’s food and fluid intake where food and fluid charts were used. People’s mental health needs may not be fully supported because care plans had gaps in records for mental health relapse monitoring.

Staff had been provided with a range of specialist mental health training such as autism and schizophrenia. Staff felt the training they received gave them the skills they needed to be able to provide the necessary support for people.

Although a senior clinical lead had identified some people may lack capacity at certain times, care plans had not been updated with this information. There was no guidance for staff how to recognise when people may have reduced capacity. There were no records of best interest meetings being held where people lacked capacity to make decisions.

People were protected from the risks of abuse because staff knew how to recognise abuse and how to respond appropriately. Staff were aware of procedures to escalate concerns to the local authority if necessary.

People were supported to access a range of activities in the community. Activities were arranged on an individual basis according to people’s needs and wishes.

We found repeat breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are taking further action in relation to this provider and will report on this when it is completed.