This inspection visit took place on the 27 and 28 June 2017 and was unannounced. At the last inspection on 24 August 2016, the service was rated as requires improvement. We made a recommendation that the provider should review their staffing levels against people’s individual needs to ensure there are sufficient staff at all times. Improvements were also needed to ensure the staff followed legislation when they supported people with decision making and to ensure the systems used to monitor the quality of the service were consistently effective. At this inspection visit we found the provider had made improvements however some further action was still needed.

Highfield Hall provides accommodation and personal care for up to 21 people with learning disabilities. The service is provided in three units which comprise Abbey, Kingston and the main Hall. One the day of our inspection visit, 20 people were living at the home.

There had not been a registered manager at the service since February 2016. However, the acting manager had recently applied to register with us. 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 received their medicines when they needed them. However, some improvements were required to ensure the systems used to monitor the recording of medicines were effective in identifying and correcting inaccuracies. People and their relatives were asked for their views on the service but there were no systems in place to demonstrate how this feedback was used to make improvements in the service.

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 acting manager. Risks to people’s health and wellbeing were assessed and managed and staff understood their responsibilities to protect people from the risk of abuse. The provider ensured 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 felt supported and valued by the acting manager.

Staff gained people’s consent before providing care and support and understood their responsibilities to support people to make their own decisions. Staff acted in accordance with the legal requirements where people were unable to make their own decisions.

Staff knew people well and encouraged them to have choice over how they spent their day. Staff had caring relationships with people and promoted people’s privacy and dignity and encouraged them to maintain their independence. People had sufficient amounts to eat and drink to maintain a healthy diet. People were supported to access the support of other health professionals to maintain their day to day health needs.

People received personalised care from staff who knew their preferences 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.

This inspection visit took place on the 24 August 2016 and was unannounced. At the last inspection on 19 October 2015, the service was rated as Requires Improvement. We asked the provider to make improvements to ensure that where people lacked capacity, any decisions made on their behalf were made in their best interest and in accordance with the legal requirements. Improvements were also needed to ensure the systems used to monitor the quality and safety of the service were effective in identifying shortfalls and driving improvements. The provider sent us an action plan which said that the legal requirements would be met by 31 January 2016. At this inspection visit we found that some progress had been made, but further improvements were still required. We also found improvements were needed in the systems used to calculate staffing levels and the management of medicines.

Highfield Hall provides accommodation and personal care for up to 21 people with learning disabilities. The service is provided in three units which comprise Abbey, Kingston and the main Hall. One the day of our inspection visit, 20 people were living at the home.

There had not been a registered manager at the service since February 2016. There was an acting manager who had been covering the registered manager’s absence but they had not yet registered with us. 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 provider had made some improvements to show that where people lacked the capacity to make certain decisions and where people were being restricted to keep them safe, this was in their best interests and followed the legal requirements. However, further work was needed to demonstrate that people’s rights were consistently being upheld.

The provider had made some improvements in the systems used to assess and monitor the quality and safety of the service, but further action was needed to ensure shortfalls were consistently identified to bring about the required changes.

At times, we saw that staff were busy with housekeeping tasks and did not always have time to interact with people. We have made a recommendation about the way staffing levels are calculated and deployed by the provider. Staff received training to gain the skills and knowledge to meet people’s needs but did not always feel supported in their role because the acting manager was not always accessible to them.

People received their medicines as needed but improvements were needed to ensure that the administration of topical creams was accurately recorded.

Staff had caring relationships with people, respected their individuality and promoted their privacy and dignity. People were encouraged to be as independent as they wanted to be and had opportunities to follow their hobbies and interests and engage in activities both inside and outside of the home. People were supported to have food and drink which met their individual needs and preferences. Staff supported people to access other health professionals to maintain good health.

People and their relatives were asked for their feedback on the service and the provider made improvements where needed. There was an accessible complaints procedure and people were supported to raise any concerns or complaints.

This inspection took place on 19 October 2015 and was unannounced. At the last inspection on 16 July 2014 we found that the provider was not meeting the standards of care we expect. We asked the provider to make improvements because we had concerns that people were not being supported and encouraged to be as independent as possible. The provider sent us an action plan and told us they would make the improvements by January 2015. At this inspection we found that some improvements had been made but further improvements were still required.

Highfield Hall provides accommodation and personal care for up to 21 people with learning disabilities, some of whom were living with dementia. The service is provided in three units which comprise, Abbey, Kingston and the main Hall. On the day of our inspection, 20 people were living at the home.

The provider had recruited an acting manager to cover the absence of the registered manager, who had not been working at the service since May 2015. 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 acting manager had worked at the home as a registered manager before. We refer to them as the acting manager in the report. 

At the last inspection, we found that people did not always have choice and their independence was not always promoted. At this inspection we saw that most people were able to have choice over how they spent their day and staff supported people to be as independent as possible.

At the last inspection, we found that people were not always offered choices of food and drink that met their preferences. At this inspection we saw that people were offered choice in a variety of ways to ensure they had food and drink that met their preferences. People told us they enjoyed the food at the home and we saw mealtimes were an enjoyable, sociable experience. People had enough to eat and drink to maintain good health and were referred to other healthcare professionals to maintain their health and wellbeing

We found that improvements were needed to ensure where people lacked capacity, decisions were made in their best interests.

Systems were in place to monitor the quality and safety of the service. However, these were not always effective because the acting manager did not always check to ensure that identified actions had been taken. Improvements were needed to ensure the home environment was safe for people. There were no suitable arrangements to ensure staff had the information they needed to keep people safe in the event of an emergency, such as a fire.

We saw there were enough staff on duty to support people and the provider had systems in place to monitor staffing levels to ensure they met people’s needs. Staff knew how to protect people against the risk of abuse and followed plans to manage identified risks to people’s health and wellbeing. Medicines were managed safely and in accordance with good practice.

The provider followed recruitment procedures that ensured staff were suitable to provide care to people. Staff received training and support to meet the needs of people living at the home.

Staff had caring relationships with people and encouraged them to keep in touch with people that mattered to them. Staff respected people’s privacy and dignity and promoted their independence. People felt able to raise any concerns with the staff and any complaints raised at the home were investigated and responded to appropriately. The provider sought feedback from people and their relatives and used this to make improvements to the service where necessary.

We found one breach 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 carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

This was an unannounced inspection. Highfield Hall provides accommodation and personal care for up to 21 people with learning disabilities. The service is separated into three units. On the day of our inspection 20 people were using the service.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

At our inspection in September 2013 we found that the care provider had breached regulations relating to respecting and involving people and care and welfare of people who used the service. People were not always encouraged to be as independent as they were able to be. Following the inspection the provider had implemented an action plan recording how the service planned to make the required improvements. During this inspection we looked to see if these improvements had been made and found that the provider had made some improvements but required further improvement to meet Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2010.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLs) and to report on what we find. We saw evidence that a best interest meeting had taken place for one person who lacked capacity to make a complex decision themselves. This meeting was to make sure the decision was made in the person’s best interest.

People who used the service told us they liked living at Highfield Hall and we observed that staff were kind and caring.

The provider was working towards promoting people’s independence and ensuring that care was delivered in a personalised way but further improvements were required.

People were protected from the risk of harm through risk assessments. Safeguarding referrals were made to the local authority when they suspected a person had been abused.

Staffing levels were sufficient to meet the needs of people who used the service. People did not have to wait to have their care needs met.

People received health and social care support when they needed it. When people’s needs changed or they became unwell the relevant professional advice was gained in a timely manner.

Care plans and risk assessments were followed which ensured that people received the care and support they required. We saw that these were regularly reviewed to ensure the care was current and relevant to people’s needs.

Hobbies and interests were on offer dependent on people’s individual preferences. People were able to access the community.

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. Where people were not able to express their views we observed interaction between people and the staff.

People had individual care records which informed staff of how people wanted to be supported and were written in a style that people could understand.

We saw that some people using the service were encouraged to be independent and helped with cooking, making drinks, and looking after their home. We saw other people were not given the same opportunities and their independence was not always promoted.

We saw people were comfortable in the presence of staff and people told us they were happy with the care and support. Some people were not asked how they would like to be supported and people were not always treated with dignity and their care did not reflect their diversity.

We found that people were able to choose how to spend their time and what activities to be involved with. People could choose to socialise with other people or spend time alone.

There were systems were in place to identify and report any concerns about people’s safety.

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

We saw that staff treated people with respect and choices were offered and people’s views had been taken into consideration. We saw personal care was not always addressed promptly to ensure people remained clean.

The routines and daily activities were flexible and staff responded to people’s needs. The staffing was provided to ensure people were able to carry out planned activities. We saw people chose what to do and where to go and were provided with support from staff to keep safe.

People said if they had any concerns they would discuss them with members of staff or the manager and they were happy with the support they received.

Recruitment processes ensured that staff employed were suitable to work with the people living at the home which protected them from harm.

We found that medication systems were safe and that medication had been given to people as it had been prescribed by their doctor.

The care records were being reviewed to ensure they contained all the information about how people wanted to be supported.

One person said, “I’ve lived here for along time and the staff know what I like doing and help me. I know who my key worker is and I talk to her about the things I want to do.”

We observed people in one of the bungalows interacting well together and with the support staff, they were engaging in table top activities.

We spoke to people in the on-site activity centre about the things they do and the things they are planning. They told us about holidays and having the opportunity to go out in to the local community.

We were invited to look in a bedroom in the Hall and one of the bedrooms in a bungalow, both were comfortably furnished, with evidence that the individuals had been supported and encouraged to personalise them.

We observed that staff engaged positively with people using the service and were sensitive to their needs.