We carried out an unannounced comprehensive inspection of this service on 21 September 2016.

The home is registered to provide accommodation and personal care for adults who require care and who had a learning disability. A maximum of 11 people can live at the home. There were eight people living at home on the day of the inspection. There was a registered manager in place. 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 were supported by staff who knew how to keep them safe and free from harm and to recognise and report any risks, problems or potential signs of abuse. People’s risks were assessed prior to activities taking place to promote their independent lives. Guidelines were developed to ensure that people were then supported by staff safely. Regular reviews ensured that risks were updated as people’s needs or activities changed.

People were helped to have their medicines by staff knew how to administer and record medicines given. Robust training was in place to enable staff to safely support people to take their medicines when required. People received individual support from staff who had the knowledge and skills to meet their needs effectively and responsively. Staff training had been developed around the individual needs of the people who used the service. Staff competency was regularly reviewed and their knowledge was updated to ensure it continued to reflect current best practices and legislation. Staff felt well supported by the registered manager and their colleagues.

Staff understood their roles and responsibilities and worked well as a team to ensure people’s needs were met. People’s rights were upheld and staff understood how to protect people’s human rights. People were offered choices in how they lived their lives. Staff recognised the importance of people having the right information and support to enable them to make their own decisions. People enjoyed a balanced and nutritious diet. Staff worked with healthcare professionals to ensure people’s continued good health and wellbeing.

People were supported by staff who were caring and understood, promoted and developed people’s independence. People’s privacy and dignity was respected as was their individuality,. People were supported to maintain and develop positive relationships with people who were important to them.

People enjoyed living the lives they chose and this involved having active social lives. Activities were developed around individual preferences, likes and hobbies. Staff recognised the importance of social engagement and contact and encouraged it in daily planning.

People who used the service were able to raise concerns and the provider had a system to deal with any complaints. People were regularly asked if they were happy with the service provided. There were systems in place to ensure that people’s views and opinions were heard and their wishes acted upon.

The registered manager provided leadership and promoted an open culture where the people who used the service were supported. The management team had kept their knowledge current and the provider ensured regular checks were completed to monitor the quality of the care that people received and looked at where improvements may be needed.

In this report the name Debra Fritzi appears, who was not in post and not managing the regulatory activities at this location at the time of this inspection. Their name appears because they were still identified as the registered manager on our register at the time.

We considered all the evidence we had gathered under the outcomes we inspected. This is a summary of what we found:-

Is the service safe?

The people who used the service lacked capacity due to their learning disability to tell us about their experiences of living at the home. We observed that people appeared comfortable and safe within their environment. The manager said that due to people’s complex care needs they were provided with one to one support and we observed that these staffing levels were provided. Care staff had access to detailed risk assessments that told them how to promote people’s independence and ensure their safety whilst doing so. The care records we looked at contained a mental capacity assessment. This assessment showed whether the person had capacity to consent to their care, treatment and to make decisions relating to their welfare. We found that where people lacked capacity a best interest meeting had been carried out. This ensured that decisions made for the person was relevant and in their best interest.

We found that a number of people who used the service displayed behaviours that were challenging. Care plans contained detailed information about how to safely manage these behaviours. The staff we spoke with demonstrated a good understanding about how to support people with these behaviours. This meant that people could be confident that staff had the appropriate skills to support them safely.

The manager confirmed that staff had received Mental Capacity Act (MCA) 2005 training and the staff we spoke with confirmed that they had received this training. Access to this training should give staff a better understanding of how to care for people who lacked capacity. The records we looked at and discussions with the manager confirmed that no application had been made for Deprivation of Liberty Safeguards (DoLS). The manager said this would be reviewed when necessary.

Is the service caring?

We found that care plans and risk assessments provided detailed information to promote staff’s understanding of people’s assessed needs. The staff we spoke with demonstrated a good understanding of people’s care needs and how to support them. We observed staff communicating with people in manner they could understand by using picture boards and Makaton.

The manager and staff said that people were encouraged to be involved in their care planning by using Makaton and picture books to assist them. This should ensure that people received their care and treatment the way they preferred.

The care plans we looked at and discussions with the manager confirmed that people had access to relevant healthcare services. We saw that appropriate referrals had been made to ensure people’s physical and mental health needs were met.

Care records showed a positive emphasis on choice and we heard staff asking people their preferences with regards to meals and social activities. We saw that some people were able to express their choice by facial expressions or by pointing and that staff respected their wishes. We observed that people were well cared for. They were clean and tidy and were provided with a choice of activities to reflect their interests.

Is the service responsive?

At our previous inspection on 3 December 2013, we found that the provider was non-compliant with the regulations relating to consent to care and treatment and the management of medicines. The provider completed a detailed action plan to show what measures had been taken to address the non-compliance and to improve services. We found at this inspection that the provider had taken the appropriate measures to address the shortfalls.

During this inspection we found that two windows located above ground floor level were not fitted with restrictors to ensure people’s safety. The manager took the appropriate action to ensure that this was addressed on the day of the inspection.

Discussions with the manager confirmed that due to people’s lack of capacity they would be unable to make a complaint. We found that care plans provided detailed information about how to recognise when a person was unhappy and the staff we spoke with were aware of this.

Is the service effective?

Although we observed that people's assessed needs were being met, we found that audits were not always carried out to ensure people received a safe and effective service. For example, there were no audits for complaints or to ensure that people had access to other healthcare professionals such as dentists and opticians in a timely manner and the manager acknowledged this.

Is the service well led?

The management team consisted of a manager and deputy who both demonstrated a sound understanding of the care needs of people who used the service. We saw that there were sufficient skilled staff provided to meet people’s needs. The manager and staff confirmed that they had received appropriate training to undertake their role. This meant people could be confident that staff would have the skills and competence to care for them.

In this report, the name of a registered manager appears who was not in post at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

Highbury House comprises three separate houses in a row. Two are used for permanent residents and one is used for respite care. There were eight people living in the two main homes at the time of our visit. The respite house was empty. Although we met several people, they were not able to express their views about the service in any detail. However, everyone we saw appeared to be happy and relaxed in the home.

We saw good evidence that people were supported to make day to day decisions for themselves. However, when people lacked the capacity to make important decisions, meetings were not held to make decisions for them that were in their best interests.

We found that care plans were person centred and contained lots of information about people’s choice and preferences. Staff told us that the care plans contained all the information they needed to provide consistent care.

We found that medicines were safely stored and handled. However, there was no guidance in place to help staff to know when to administer a drug to control people’s behaviour that had been prescribed on an ‘as required’ basis.

Staff we spoke with told us that they enjoyed their work. They told us that there was a good team spirit and that they were well supported by the manager. We saw evidence of regular supervision and appropriate training.

The provider had a suitable complaints procedure in place. It had been made available to people’s relatives and representatives.

Although we spoke with two people, they were not able to express their views about the service in any detail. However, everyone we saw appeared to be happy and relaxed in the home.

We found that people were consulted about the support they received and had the opportunity to contribute to their care plans as much as they were able.

Care plans were person centred and contained lots of information about people’s choice and preferences. Staff told us that the care plans contained all the information they needed to provide consistent care.

We found that there were policies and procedures to keep people safe in the home. Improved controls over the way staff dealt with people’s money had been introduced following a recent safeguarding investigation relating to people’s finances.

Staff told us that the recent financial safeguarding investigation and subsequent changes in the management of the home had been unsettling.

Most of the people who live in this home have difficulty in expressing their views verbally. However, those that could do told us that they were able to regularly take part in the activities that they needed to or enjoyed. During the visit we saw people going out with staff to take part in various activities.

We talked to one person who told us that every month she was able to sit down with staff to discuss any issues she might have about the service she was being provided with and she also said that she felt that staff listened and changed her support package if necessary.

One of the people that we spoke to told us about the wide range of activities that she takes part in one of which included going to college. While we talked she was taking part in a cooking session that she told us was a regular activity for her.

Some of the people who live in this home were able to tell us that they knew how to raise any issues that worried them with any member of staff and that they felt that their worries would be listened to. They also told us that they felt safe living in the home.