We carried out an unannounced comprehensive inspection of this service on 18, 19 and 25 August 2016. At this inspection we found that the provider and registered manager had not always ensured project workers were of good character before they started to work at Highfield House. This was a breach of regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook a focused inspection on the 13 January 2017 to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Highfield House’ on our website at www.cqc.org.uk’

Highfield House is a residential home for seven people living with learning disabilities or an autistic spectrum condition.

The home has a registered manager. 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 focused inspection on the 13 January 2017, we found that the provider had followed their plan and the legal requirements had been met.

People were supported by project workers who had been through a comprehensive recruitment process before they started working at Highfield House. Records relating to the recruitment of new project workers showed relevant checks had been completed before they worked unsupervised at the service.

This inspection took place on 18, 19 and 25 August 2016 and was unannounced. Highfield House is a residential home for seven people living with learning disabilities or an autistic spectrum condition. At the time of our inspection seven people were living at Highfield House. Highfield House is located near the centre of Stroud, close to a range of amenities which people can access.

Highfield House has a registered manager. 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.

We last inspected the service during July 2014. At the July 2014 inspection we found that the provider was meeting all of the requirements of the regulations at that time.

The provider and registered manager did not always ensure that new staff were of good character before they worked with people. People’s care records were detailed and refleced people’s needs.

People felt safe living in Highfield House. Project workers (service support staff at Highfield House are called project workers) knew their responsibilities to protect people from the risk of abuse. People’s legal rights were protected and project workers ensured people’s right to make decisions were respected.

People spoke positively about the staff. Project workers knew people, their needs, likes and dislikes and used this information to ensure people were kept comfortable and safe. There were enough project workers deployed to safely meet people’s needs. People enjoyed the time they spend with project workers, which included going for a coffee in the community.

Project workers were responsive to people’s needs and ensured people were safe and comfortable. Where people’s needs changed staff ensured their support changed to reflect their needs.

Project workers had access to supervisions and appraisals. They were supported and had access to training and professional development. Project workers felt involved in the day to day running of the service and were encouraged to make suggestions on how the service could improve.

The registered manager had systems in place to assess, monitor and improve the quality of the service. The registered manager promoted a caring ethos which all project believed in and accepted. People spoke positively about the registered manager.

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 this 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.

The inspection was unannounced. The previous inspection was completed in April 2013 and there had been no breaches of legal requirements at that time.

Highfield House is a care home, registered to provide accommodation for up to seven people. The service cares for people who have learning disabilities or mental health issues, or have both. There were seven people living in the home when we visited. Highfield House is a large semi-detached property, near the centre of Stroud and accommodation is spread over three floors. The staff team were led by 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.

People told us they were happy and enjoyed their life at Highfield House. Our observations, discussions with the staff team and the records we looked at supported the fact the seven people who lived at Highfield House were content, chose how they spent their time, and were supported to lead meaningful lives. People were supported to be as independent as possible but were supported with those tasks that they may not be able to achieve on their own. Each person took part in a range of meaningful activities, some to meet their individual needs and others as a group.

People were safe because staff knew how to recognise and respond to abuse correctly and had received safeguarding training. Staff recruitment procedures ensured that only suitable staff were employed to work in the home. The manager had completed Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) training and had arranged for all staff to complete on-line training. The MCA is legislation that provides a legal framework for acting and making decisions in a person’s best interests. DoLS is a lawful process whereby a person could be deprived of their liberty because it was in their best interests.Appropriate referrals had been made.

Staffing numbers were arranged around what activities people were undertaking which meant people were supported with their activities.

People were looked after and supported by staff who were well trained and supervised. The staff team provided a consistent approach to people as they shared ideas and suggestions. People enjoyed their meals and had a choice of food. People were supported to cook meals and decide what the weekly menus were to be. People were supported to access healthcare services and to receive on-going healthcare support. The staff team worked well to support people to have a healthy life.

People’s care and support needs were assessed, planned and then delivered in a way that took account of their individual choices and preferences. The plans were kept under continual review.

The staff team was led by the registered manager who was very much involved in the day to day running of the home. Clear leadership was provided and the staff team spoke about being well supported. There were good systems in place to monitor the quality and safety of the service and to take account of people’s views.

We were able to meet five of the six people who lived in the home when we visited. One person said “I am okay” and another said “they were going to go out later to the shops to buy something they wanted”.

We heard people being spoken to nicely and being treated with respect. All five people looked well cared, were nicely dressed and had a good rapport with the staff on duty.

People were supported to use community facilities and participated in daily living activities within their home.

People were made aware of the complaints procedure because a laminated copy of the procedure (summary version) was displayed in each person’s bedroom. The home had introduced a ‘Wishes, Wants and Requests’ book and everyone was encouraged to express their views and make suggestions.

We met the seven people who lived in the home and spoke with five of them about their experience. They told us that the staff asked them what they wanted to do each day. People said that they had a choice of activities during the week such as going to college, helping with cooking, going shopping and going out for meals.

People told us that the staff asked them what help and support they needed. They said that the staff understood the care and support that they needed and they received the right support. People said that they felt safe in the home.

They told us that the staff asked them their views about the care and support they received and about the quality of the service.

We met six of the seven people who live in Highfield House when we visited. They told us they were able to make decisions about their daily lives. We observed some people going out in to the community independently and others undertaking social activities that they had chosen to do. The staff who looked after them demonstrated that they had a good understanding of each person’s individual care needs and were able to interpret signs and behaviours to determine well being. We saw positive and friendly interactions between people and staff, and staff treated them with respect.

Staff talked about their responsibilities for safeguarding the seven people who live in the home however incidents that had occurred between people and staff in July and August had not been reported properly. This meant that people were not being safeguarded effectively and were therefore placed at risk of further harm. Improvements were needed.