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

Highfield House can accommodate up to 45 people across three floors, each of which have separate adapted facilities. People were able to interact across the floors. Highfield House specialises in providing care for people who are medically highly dependent due to their complex physical and/or neurological disorders. At the time of our inspection 37 people were using the service.

At the last inspection on 9 October 2015 the service was rated ‘Good’ overall and for each key question. At this inspection on 23 and 27 November 2017 the service had improved their rating for the key questions ‘Is the service effective’ ‘Is the service responsive’ and ‘Is the service well-led’ to ‘outstanding’. This meant the service was now rated ‘outstanding’ overall.

People, relatives, staff and healthcare professionals were very complimentary about the management team at Highfield House. They felt the management team were approachable and interested to hear from them their experiences and any suggestions to improve practice. Healthcare professionals felt there was a drive within the staff team to improve and develop their practice.

Since our last inspection the provider had developed their corporate values. The provider had updated their policies and procedures linking them to their values and adopting the five CQC key questions as their desired outcomes. The provider’s values and behaviours underpinned their governance framework and there were robust procedures in place to review and improve the quality of service delivery. Staff worked in partnership with other agencies, this included liaison with their local NHS trusts, Clinical Commissioning Groups (CCGs) and the local authority. The service followed public health England guidance and implemented NHS initiatives at the service. There were systems in place to enable staff to continuously learn, improve, innovate and ensure sustainability of service. The provider issued safety alerts in response to any incidents that occurred. They had also developed a staff newsletter which was themed on the 5 CQC key questions to further enhance staff’s understanding of the five questions about how the care they provided fitted into these and the provider’s values.

Staff were very passionate about their roles and working at Highfield House. Staff, people and relatives were keen to share with us their experiences of Highfield House and staff were very proud of the work they did. There was an obvious drive and commitment within the team to provide high quality personalised care. All of the healthcare professionals we received feedback from were very positive about the quality of service delivery and joint working arrangements.

Staff stayed up to date with and delivered care, support and treatment in line with best practice guidelines. This included guidance from the National Institute for Health and Care Excellence (NICE) and Royal College of Physicians (RCP). The management team organised for authors from recently published guidance to come to the service to speak to staff and families about the new guidance available. There was a comprehensive training programme in place and robust processes to ensure staff were competent to undertake their allocated tasks. Training drop in sessions were held daily for staff to update their knowledge on the provider’s mandatory training topics as well as ‘skills sessions’ held for staff to update their clinical knowledge.

The service provided healthcare support in line with the principles of the NHS England’s vanguard initiative for enhanced models of care which ensured proactive review of people’s healthcare needs and streamlining processes to ensure accurate and complete information was available in the e

On the day of our inspection we were able to speak with four people using the service, one relative and two visitors to the home, who shared with us their views and experiences. People spoke positively about the service and the care and support provided. Comments ranged from, “Staff are very respectful and kind”, “It’s very positive here in every way”, “The staff genuinely do care” and “I’ve got no complaints. I’m happy with everything”

We met with and spoke to senior staff during the inspection including the service’s manager, two deputy managers and the Director of Nursing from the provider’s organisation. The Director of Nursing confirmed the current manager of the service would shortly be submitting an application to the Commission to become the registered manager for the service. We also spoke with three members of staff from the care and nursing team.

We looked at people’s records and noted their care and support needs had been assessed and plans were in place to meet these needs. Risks to their health and wellbeing had been identified and plans were in place to manage these. We noted information about people was reviewed and updated regularly so staff had up to date information about people’s current care and support needs. Staff received appropriate training to keep their skills and knowledge up to date to meet these needs.

Medicines were administered appropriately and stored safely in the home.

People were provided with information about how to make a complaint if they were not happy with the service. Their views and experiences were sought and acted on by staff. The service had systems in place to monitor the quality of service that people received.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by an Expert by Experience (people who have experience of using services and who can provide that perspective) and a practising professional.

We spoke with seven people who use the service, three relatives of people who use the service and seven staff members during our unannounced visit to Highfield House.

People who use the service we spoke to were positive about the standard of care being delivered and said that they were treated with dignity and respect.

One relative told us that ‘the care staff are excellent’ and ‘you get the impression that they really do care’. Other comments included ‘my relative requires assistance with personal care and eating and staff do this with a great deal of skill’ and ‘I am very pleased with the care they are receiving, staff are very polite, never lose their temper and are very patient’.

This inspection took place on 9 and 12 October 2015. We last inspected the service in October 2013. At that inspection we found the service was meeting all the regulations that we assessed.

Highfield House is a purpose-built care home providing accommodation, personal and nursing care for up to 27 people who are medically highly dependent due to their complex needs. The service specialises in the care and management of people with a wide range of neurological problems including those in a minimally awareness state, and people needing mechanical ventilation.

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.

The manager and members of staff clearly understood their roles and responsibilities to protect people from harm. Risks were assessed, and appropriate provision was made for staff to manage these effectively. People consented to their care and treatment and staff had a good understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). DoLS exist to protect the rights of people who lack the mental capacity to make certain decisions about their own wellbeing. Services should only deprive someone of their liberty when it is in the best interests of the person and there is no other way to look after them safely.

People were cared for by a multi-disciplinary staff team who were qualified, supported and trained to meet their needs. The provider had a proactive approach to the personal and clinical development of staff, who were well trained and skilled. They were provided with specific training and development, and supported to carry out their role competently and had opportunities to develop further.

Management were proactive in following safeguarding procedures, the manager had made a safeguarding alert to a local safeguarding authority when the care provided by another service was unsafe.

Medicines were managed safely. The provider had policies and procedures in place for the storage and administration of medicines which reflected the guidelines recommended by the National Institute of Clinical Excellence (NICE) for managing medicines in care homes.

People had enough to eat and drink throughout and there were suitable arrangements in place to identify and support people who were nutritionally at risk.

The home had systems in place to ensure there was an appropriate number of staff on duty at all times, and there was a good balance of knowledge, skills and experience

People were supported with access to healthcare services and staff were involved in the regular monitoring of their health. The service worked effectively with a range of healthcare professionals and was pro-active in referring people for treatment.

The service had policies and practices to support people and their relatives around end of life care.

The home was well managed, and had effective quality monitoring process in place to drive continuous improvement and high quality care. Action plans were developed and discussed with the staff team for learning and making improvements.