About the service:

Highcroft House is a residential care home that was providing personal and nursing care for up to nine people who had learning disabilities and physical disabilities or long-term conditions. At the time of the inspection there were seven people living in the home.

The care service had not originally been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. The home had been registered before such guidance was produced. The guidance focussed on values including choice, promotion of independence and inclusion so that people with learning disabilities and autism using a service can live as ordinary a life as any citizen. However, it was clear that people living in Highcroft House were given such choices. The home was located in a residential suburb where people’s independence and participation within the local community continued to be encouraged and enabled.

Rating at last inspection:

The service was rated Good at the last inspection; the report was published in July 2016

Why we inspected:

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

People’s experience of using this service:

People’s medicines were managed safely and in line with best practice guidelines. People received their medicines safely as they were prescribed. Improvements had been made since the last inspection to ensure that procedures to manage stocks of medication and return medicines that was not wanted were robust. Other detailed audits were also being carried out to check on the quality of the service and to maintain compliance with regulations.

Systems were in place to ensure that people were protected by the prevention and control of infection. Accidents, incidents and any near misses were analysed for lessons learnt and these were shared with the staff team to reduce further reoccurrence.

People continued to receive care that protected them to keep safe and staff understood how to protect people from abuse and harm. Risks to people were assessed and detailed guidance about how to manage these was available for staff to refer to and follow. All staff were clear about action they would take in the event of any emerging concerns about how people were being cared for. Recruitment of staff was carried out to ensure that adequate numbers of suitable staff were available to support people.

People continued to receive effective support from staff who had sufficient level of skills and knowledge to meet their specific needs. New staff received comprehensive induction training before they started to support people. People were supported in line with their abilities and known preferences. Staff involved people as much as possible to make decisions and utilised the shared information that was available to ensure that they fully explored what the person liked to do before commencing any activity.

People continued to be cared for by staff who displayed kindness and compassion in ways that upheld their privacy and dignity. People’s diverse needs were well known, always recognised and support and access to activities was supported and enabled by staff.

The care home continued to be well-led. Staff were positive about the leadership and skills of the registered manager. The registered manager had a good knowledge of the support needs and communication methods of people using the service. Required information was available in the home and made available when requested in line with the regulations.

Follow up:

We will continue to monitor the home through the information we receive.

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

This inspection took place on the 7 and 8 June 2016. The first day of the inspection visit was unannounced, the second day was announced. At our last inspection on 14 July 2015, the service was found to be requiring improvement. This included managing risk for people, medicine management and quality assurance systems that had not consistently identified where improvements were required to the service. We found there had been improvements made.

Highcroft House is a home providing residential and nursing care for up nine people. At the time of our inspection eight people were living at the home.

There was no registered manager in post at the time of the 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. However, the current manager had submitted their application to us to be considered as the registered manager. The application was being processed.

At the last inspection it was found systems were in place to monitor, audit and assess the quality and safety of the service but they had not always been effective. There had been an improvement, however there was still further improvement required.

At the last inspection it was found the provider’s systems for managing medicine required improvement. There had been an improvement. People were safely supported to take their medicine as prescribed.

People at Highcroft House were kept safe from the risk of harm. Staff understood their responsibility to take action to protect people because the provider had systems in place to minimise the risk of abuse.

There were sufficient numbers of staff available to support people. Suitable staff had been recruited and had received training to enable them to support people with their individual needs.

Staff recognised the care being offered had put some restrictions on people. The provider had taken the appropriate measures to ensure they were meeting the legal requirements to protect people’s human rights.

People were given choices what they ate and drank and given the opportunity to join in different activities if they wished.

People were supported to receive care and treatment from a variety of healthcare professionals and received treatment if they were unwell.

Staff demonstrated a positive regard for the people they were supporting. People were supported by staff that was kind and caring. Staff understood how to seek consent from people and how to involve people in their care and support.

There was a complaints process in place and concerns raised were investigated thoroughly. Feedback on the service provided at Highcroft House was sought from people living at the home, their relatives, staff and healthcare professionals.

The inspection took place on 14 July 2015 and was unannounced. At the last inspection on 3 July 2014, we found that the provider was meeting the requirements of the Regulations we inspected.

Highcroft House is a residential care home providing accommodation and nursing care for up to nine people. The home specialises in the care of people with a learning disability and physical disability. At the time of our inspection eight people were living at the home.

There was a registered manager in post at the time of the visit. 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 who lived at the home had different ways of expressing their feelings and were not able to tell us about their experiences. Relatives and staff were able to tell us they felt that people were kept safe. The provider had procedures in place to reduce the risk of harm to people because they supported staff to recognise unsafe practices. However, safety concerns regarding equipment were not acted upon in a timely manner, despite the registered manager bringing them to the attention of the maintenance team.

People were generally supported with their medicines as prescribed but medicine administrative records were not always consistently completed.

There had been difficulties in retaining staff. There was sufficient staff employed to keep people safe. People received a service from staff that were trained and supervised, which supported them to meet people’s needs.

The provider protected people’s rights in line with legislation.

People were supported to make some choices with food. Drinks were offered at times during the day. Staff provided healthy options and involved dieticians to ensure people’s nutritional needs were met.

People were supported to access other health care professionals to ensure their health care needs were met.

Relatives felt staff was caring and they had good relationships with the people they supported. People received care from staff that was respectful and maintained people’s privacy and dignity.

People were supported to participate in various social activities. People received appropriate care and support that was individual to their needs. Relatives told us they were confident their concerns or complaints would be listened to and matters addressed quickly.

The high turnover of staff had led to people’s care records not been updated in accordance with the provider’s policy. The provider had systems in place to monitor and improve the quality of the service, although these were not always effective, in ensuring the home was consistently well led and some improvements were needed.

Highcroft House is home to eight people with multiple disabilities and learning difficulties. Only one person used speech to communicate. We observed people during the day as six people were at home. We talked with the manager and a nurse. We looked in detail at the care records of three people. We visited on a weekday and we spoke with one visiting professional and one relative. We spoke with the area manager and two members of staff.

Below is a summary of what we found. The summary describes the records we looked at and what the records of people using the service and staff told us.

If you want to see the evidence that supports our summary, please read the full report.

Is the service safe?

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We saw that proper policies and procedures were in place. The manager had an understanding of these safeguards which ensure people’s rights and choices are protected.

A visiting professional told us, “Their understanding of capacity is very good, the staff know they need to get best interest decisions.”

Staff understood their role in safeguarding the people they supported. This meant people were kept safe. We saw people were cared for in an environment that was safe and clean. There were enough staff on duty to meet the needs of people who lived at the home. There were procedures in place to safeguard people from abuse. The staff and manager had a good understanding of whistle blowing policies.

Is the service effective?

Staff had a good understanding of people’s care and support needs and knew them well. The service worked well with other agencies and services to make sure people received their care safely and effectively. We saw that people were treated with dignity and care. During our inspection people were taken out to various activities including shopping trips to prepare for a holiday. Care plans specified people’s individual needs, for example, a person’s mobility, or food requirements. One member of staff told us, “The managers are very approachable, I have my supervisions, and I’ve got the skills to do my job.”

Is the service caring?

All the staff we spoke with expressed compassion and kindness towards the people they supported. We saw the staff and manager were patient and gave encouragement when supporting people. All staff were aware of peoples choices, preferences and support needs. We found the care and support was delivered with dignity and respect, and was very person centred. A member of staff told us, “I think the care here is good, all the staff are caring and loving. If we go out somewhere, we just work over to make sure people get the best from their day out.”

Is the service responsive?

Staff were aware that people’s needs varied throughout the day and responded accordingly. We saw clear and detailed recording that ensured the manager could make timely and informed decisions about any changes to a person’s care and support. A visiting social worker told us, “The records are always there for me, the managers are really responsive.”

Is the service well-led?

We looked at quality assurance systems. The systems in place to ensure the quality of the service was regularly assessed and monitored were robust. There was a clear structure of supervision responsibilities within the staff team. Staff we spoke with told us they thought the manager was approachable and provided good support. There were clear staff and nurse responsibilities for each person in the home. The manager was aware of her responsibilities in meeting the essential standards of quality and safety. A visiting professional told us, “I’ve visited many times and the quality of care is very good. They are passionate about what they do. There is always lots of staff.”

Our inspection was unannounced, which meant that no one knew that we would be visiting. There were seven people living at the home on the day of our inspection. We were unable to speak with people living in the home as they had limited verbal communication skills. The manager of the home was on leave at the time of our visit and we spoke with the nurse in charge and the operations director. We also spoke to two physiotherapists that were visiting the home at the time of our inspection. After our inspection visit we spoke with a relative of a person living at the home on the telephone.

Staff knew how to support people to meet their health needs. People were referred to health professionals for advice as to how to meet their needs.

People were supported during meal time and there was a choice of suitable and nutritious food and hydration, in sufficient quantities to meet people’s needs.

Staff knew how to safeguard people from harm and felt confident that if they had to report any abuse, action would be taken to protect people.

The home had a system to manage the training and professional development of the staff. However, there were some gaps in their training because the home had recruited a number of new staff.

The home had a quality assurance system in place to ensure risks to people’s health and welfare were minimised.

Some of the records we looked at were not accurate, which could have meant that people's health and welfare needs were not identified to ensure their safety and wellbeing.

On the day of our inspection there were seven people living at the home. All seven people had various levels of verbal communication skills due to their learning disability.We used a Short Observational Framework for Inspection (SOFI) on one person living at the home.This is a specific way of observing care to help us understand the experience of people who could not talk with us.

We were also able to look at other areas for evidence to support people's experience such as speaking with staff,observing care and looking at care records. We spoke with three members of staff, the manager and a relative. We also sampled two sets of care records for people identified as having complex needs.

We saw evidence that people were respected and their privacy and dignity was maintained. We saw that staff spoke with people in a caring and considerate manner. People were encouraged to be independent and staff provided assistance when necessary.

People had a range of activities available to them and choice at meal times. Care was delivered in a person centred way and people appeared relaxed and comfortable with staff.

Care plans and risk assessments were in place to maintain people's care and welfare needs.

Staff understood what constituted abuse and said that they would be able to recognise and report poor practice.

Staffing levels were appropriate to meet the needs of people. Arrangements were in place to deal with changes in staffing levels and the dependency needs of people.

Staff were supported and supervised to provide good care but gaps in areas of mandatory training was evident. Inconsistencies in training could mean people do not always receive the care they need.

We saw evidence that regular audits were undertaken in areas such as medication.The home was monitoring the quality of service and improving as a result of findings. Systems were in place to record and monitor accidents and incidences.

People living in this home had restricted communication that made it difficult to get their views. We asked the service to contact relatives so we could speak to them and to let us have details of health and social care professionals. As a result we spoke to a relative, an advocate and four health and social care professionals. They told us:-

People were assisted to have activities and were treated as individuals. People are referred to health specialists where needed. Some professionals did not get as much information and feedback as they wanted. They thought that records could be improved. People with very complex health conditions were kept stable.