This inspection took place on 10 and 11 September 2018, and was unannounced. At the last inspection completed on 6 April 2017, we rated the service as Requires Improvement.

At this inspection we found improvements had been made but more were needed and the provider was not meeting the regulations for governance arrangements. You can see what action we asked the provider to take at the end of this report.

Highfield Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Highfield Court accommodates up to 59 people in one adapted building. At the time of the inspection there were 53 people using the service. The location is currently registered; however, the location would no longer be registered under Registering the Right Support. Registering the Right Support has values which include choice, promotion of independence and inclusion. This is to ensure people with learning disabilities and autism using the service can live as ordinary a life as any citizen

There was a registered manager in post at the time of our 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.

Governance systems were not always effective in identifying concerns and driving improvements. There were insufficient staff and some staff did not have the skills to meet people’s needs safely. Risks to people were not always managed safely and documentation about people’s care was not consistently completed, including when people had an accident. People were not always protected from the risk of cross infection.

Staff had received training but further work was required to ensure staff competency was checked effectively. However, staff felt supported in their role. Improvements were needed to ensure the environment was suitable for people and that they received consistency with their care and support.

People were supported to have maximum choice and control of their lives and staff were aware of how to support them in the least restrictive way possible; the policies and systems in the service were supportive of this practice. However, documentation required some improvement.

People received support from staff that were caring. However, improvements were needed to make sure that this was consistent. People’s communication needs were planned but staff did not always follow these plans. People were respected but sometimes their right to privacy was not protected and they did not always receive care in a dignified manner.

People’s preferences were clearly documented and staff understood these. However, staff did not consistently follow the plans. People’s end of life wishes was documented. People were not always clear on how to make a complaint.

Staff were safely recruited. People were safeguarded from potential abuse. People were supported to meet their dietary needs. People were supported to take their prescribed medicines. People were supported to maintain their health and well-being.

Notifications were submitted as required and the registered manager understood their responsibilities. We found improvements were needed to how people were engaged in the service.

The location has previously been rated as Requires Improvement. At this inspection the provider had not made all the required improvements. We may consider enforcement action if there is a continued lack of improvement at our next inspection.

This inspection took place on 6 April 2017 and was unannounced. At the last inspection, the service was meeting the legal requirements and was rated as good.

Highfield Court provides accommodation and or personal care for up to 59 people in a complex of 23 bungalows. People living at the home have mental health needs and or a learning disability and receive varying levels of staff support dependent on their assessed needs. On the day of our inspection 54 people were living at the service.

There was a registered manager at the home. 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.’ The registered manager was absent from the service on the day of our inspection. We were assisted by the service manager who manages another of the provider’s homes, which is located on the same site.

We found improvements were needed to ensure the registered manager and staff always followed the legal requirements to ensure people’s rights were protected when they lacked the capacity to make their own decisions. Action was also required to ensure the registered manager’s quality monitoring checks were effective in identifying shortfalls and making improvements where needed People were supported and encouraged to eat and drink enough to maintain a healthy diet but improvements were needed to ensure people were always supported to enjoy their mealtime experience.

People felt safe living at the home and their relatives were confident they were well cared for. If they had any concerns, they felt able to raise them with the staff and management team. Risks to people’s health and wellbeing were assessed and managed and staff understood their responsibilities to protect people from the risk of abuse. People received their medicines when they needed them. There were sufficient, suitably recruited staff to keep people safe and promote their wellbeing. Staff received training so they had the skills and knowledge to provide the support people needed.

Staff gained people’s consent before providing care and support and encouraged them to have choice over how they spent their day. Where people were restricted of their liberty in their best interests, for example to keep them safe, the provider had applied for the appropriate approval. People were able to access the support of other health professionals to maintain their day to day health needs.

People received personalised care and were offered opportunities to join in social and leisure activities. People were supported to maintain important relationships with friends and family and staff kept them informed of any changes. People’s care was reviewed to ensure it remained relevant and relatives were invited to be involved.

There was a relaxed, informal atmosphere at the home. People and their relatives were asked for their views on the service and this was acted on where possible. Staff felt supported by the provider and management team and were encouraged to give their views on the service to improve people’s experience of care.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We inspected Highfield Court on 19 October 2015. The inspection was unannounced.

The provider is registered to provide accommodation and personal for up to 59 people. The service comprises of 25 separate homes. On the day of the inspection, 56 people used the service. People who use the service have mental health and or learning disability problems and receive varying levels of staff support.

There was 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 and associated Regulations about how the service is run.

At our last inspection of the service on 4 July 2013, the provider was compliant against the Regulations we inspected against.

People felt safe and protected from harm. Staff understood what constituted abuse and took action when people were at risk of harm. There were appropriate numbers of staff employed to meet people’s needs. People’s care needs were planned and reviewed regularly to meet their needs. Their care records reflected the care they received. People’s medicines were managed safely.

People were cared for by staff that had the knowledge and skills required to care and support them. Care staff demonstrated a good knowledge of the care needs of people and how high quality care could be provided. Staff had regular training, and were supported to have additional training which was specific to their roles and responsibilities.

Legal requirements of the Mental Capacity Act (MCA) 2005 were followed when people were unable to make certain decisions about their care. People liberties were not unlawfully restricted. The Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) set out the requirements that ensure where appropriate; decisions are made in people’s best interest.

People had sufficient amounts of food and drink. A variety of food was offered at meal times and people could choose what they wished to eat or drink.

People had access to other health care professionals and were supported to attend healthcare appointments when they needed it. Recommendations made by other professionals were followed.

The provider had devised various ways of ensuring that people’s individual needs were met in order for the environment to feel as homely as possible. People were supported to be independent.

People were treated with dignity and respect. People told us the staff were kind and treated them with dignity and respect.

The provider promoted people’s personal interests and hobbies. Social activities were organised to be in line with people’s personal interests and there was a lively atmosphere at the service. The service had strong links with the local community. A variety of activities took place at the service to minimise boredom.

People were encouraged to give feedback about the service. The provider had an effective system in place for dealing with concerns or complaints.

People who used the service the staff were very complimentary about the registered manager of the service. People told us that they were accessible and approachable. A positive and open culture was promoted at the service. The provider had effective systems in place to review the quality of the service provided.

We observed the routines and daily activities were flexible and responsive to people’s needs. Some people were supported on an individual basis to ensure they were safe and had access to activities in the home and the community. One person told us, “I have jobs to do each day like delivering the post. I like to be helpful and keep busy.”

We saw that people were dressed in individual styles of dress and people we spoke with told us they went shopping and chose their clothes. People told us they kept in close contact with family and friends and enjoyed spending time with people outside of the service. This meant people were supported to do the things they wanted to do.

Staff were compassionate to people’s needs and respected decisions that they made, including how they wanted to spend their time, who they were supported by and how they chose to dress. One person told us, “The staff are nice to work with. They are nice and polite.”

People received care and support from staff who received training for people’s assessed needs. This meant the provider demonstrated they were responsive to individual changes to ensure they could continue to meet people’s needs effectively.

We carried out this inspection to check on the care and welfare of people using this service. The inspection was unannounced which meant the provider and the staff did not know we were coming.

We used a number of different methods to help us understand the experiences of people using the service, because some people had complex needs. This meant they were unable to tell us their experiences about the care and support they received.

People using the service had choices in all aspects of their daily living. We observed staff interacting and supporting people in a respectful and positive manner. We observed that people were comfortable with staff and there was a relaxed atmosphere within the homes.

We saw that the homes were clean and well maintained. We saw that people’s bedrooms were personalised and had pictures and photos of them on the wall.

The registered provider carried out regular checks and maintenance work to ensure the properties were maintained and safe.

During our inspection we saw people using the service engaged in different activities and they were able to choose how they spent their time.

Some of the care records were not up to date and did not reflect the support and care that people wanted. This meant they were at risk of receiving care that did not meet their individual needs.

Some people using the service said they were happy to live there. One person said, “I have my own room and bathroom and I can do what I like.”

Another person confirmed that they knew who their key worker was and talked to them about her needs.

One person complained that staff would not respect his wishes regarding his care, personal hygiene and other matters. These issues were discussed at length with the operational manager, social worker and a referral to the local authority safeguarding team was made.

We observed people living in one bungalow interacting positively with staff and each other. In this bungalow, the kitchen and lounge had been redecorated and a new sofa and chairs had been purchased. We were invited to look in bedrooms and found that although comfortably furnished some of the furnishings were worn, stained and appeared to be old. But people appeared happy and confident in their surroundings and were observed to be actively involved in meal and drink preparation.

We visited two other bungalows, people told us, “My key support staff said I will be having new furniture and I’ll be able to pick it.”

We observed that staff engaged positively with people using the service and were sensitive to their needs. We saw people using the service participating in recreational and occupational activities of their choice.