About the service:

• Highfield House residential care home provides personal care for up to seven people with a range of needs including learning disabilities and behaviours that may challenge. There were seven people at the home at the time of inspection.

• The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

People’s experience of using this service:

• People were safe and staff knew how to keep them safe from harm. The provider had a recruitment process to ensure they had enough staff to support people safely. People received their medicines as prescribed. Staff followed infection control guidance and had access to personal protective equipment.

• Staff had the skills and knowledge to meet people's needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People's nutritional needs were met and they received enough to eat and drink to ensure they had a healthy diet. People accessed health care when needed.

• People received care from staff who were kind and caring and knew them well. Staff were patient and empathetic and had built good relationships with people. People's privacy, dignity and independence were respected by staff.

• People's support needs were assessed regularly and planned to ensure they received the assistance they needed. People's support was individualised. People were supported to take part in activities of interest and their preferences, likes and dislikes were known to staff. The provider had a complaint process which people were aware of to share any concerns.

• The provider had systems in place to investigate and monitor accidents and incidents. The registered manager understood their legal requirements within the law to notify us of all incidents of concern, deaths and safeguarding alerts. The registered manager was open and honest and had a development plan in place to drive forward improvements.

Rating at last inspection:

• Rated Good overall (last report published 28/01/2016)

Why we inspected:

• This was a planned inspection based on the rating at the last inspection. The service continued to be rated good.

Follow up:

• We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This unannounced inspection took place on 2 December 2015. At our last inspection on 25 November 2014 we asked the provider to take action to ensure that accurate and appropriate records were maintained to protect people against the risk of unsafe or inappropriate care and treatment. This action has been completed.

Highfield House is a residential home providing accommodation for up to seven younger adults with learning disabilities or autistic spectrum disorder. At the time of the inspection five people were living there. The home did not have a registered manager in post. The deputy manager was acting up into the manager role until the new manager commenced working 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.

People’s relatives told us they felt staff kept their family member safe from the risk of harm or abuse. The provider had appropriate systems in place to protect people from potential harm. Staff understood their responsibilities in protecting people from harm and knew how to report issues of concern. There were sufficient numbers of staff on duty to meet people’s individual needs. The provider had effective recruitment processes in place and appropriate checks had been undertaken before staff began working at the home. People were kept safe by staff that had the skills and knowledge to support their needs.

Risks to people’s health and care needs had been assessed and were managed in a way that supported people to remain independent. People received their medicines at the correct times and as prescribed. Medicines were managed, stored and administered safely. Assessments of people’s capacity to consent had been completed and where necessary records and decisions had been completed in people’s best interest. The manager and staff understood their responsibility to protect people’s rights.

People were supported to eat and drink a variety of different foods and drinks. People had access to different healthcare professionals to ensure that their health needs were met. Staff were kind and caring. Staff understood people’s choices and preferences and respected their dignity when providing care. People were supported to take part in a variety of different activities and hobbies during the day. Relatives told us they felt comfortable raising concerns with the manager or staff members. The provider had a system in place to respond to people’s complaints or concerns.

There were audit systems in place to monitor the quality of care people received. This included gathering feedback from people, relatives and staff. Checks took place of people’s care plans, medicines and incidents and accidents. There was evidence that learning and improvement took place to improve the quality of the service provided to people. People’s relatives and staff spoke positively about the leadership and approachable nature of the manager.

We carried out an unannounced inspection of this home on 25 November 2014. We last inspected Highfield House in November 2013 and they were meeting the regulations we inspected against.

Highfield House is a care home providing personal care for up to seven younger adults with learning disabilities or autistic spectrum disorder. The home has a registered manager. ‘A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

We found a breach of Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2010. You can see what action we told the provider to take at the back of the full version of this report.

People and their relatives told us they felt safe at the home. Staff had knowledge of safeguarding procedures and how to report concerns they may have. The home had sufficient staff numbers with skills and experience to meet the needs of the people who lived at the home. Medicines were administered correctly to people and disposed of in a safe way.

Staff had good understanding on how the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) affected their practice. The manager had made an appropriate application to the local authority in accordance with DoLS and was following legal requirements.

People had a good choice of meals, drinks and snacks and were encouraged to make their own decision about the food they wanted to eat. Staff had good knowledge of people’s care needs and how to respond to them. People had access to health care professionals as and when they required. Relatives told us that they had been involved in the review of their relatives care needs.

Staff were caring in their approach to people. Staff took time to speak with people ensuring the person’s understanding. People and relatives told us that staff had a caring approach and were respectful of their privacy.

People told us staff listened to their views and supported them to make choices. Staff understood people’s needs and preferences and respected people’s choices.

The manager was able to demonstrate a good understanding of people’s needs that lived at the home. The manager had an ‘open door’ policy and staff felt at ease to ask for support and advice as required.

We found a number of issues which the provider’s own audits had failed to identify. Quality assurance systems were not effective in identifying issues or trends which would improve service.

We carried out this inspection as part of our schedule of inspections to check on the care and welfare of people who used this service.

We spoke with the registered manager and three members of staff.

As part of the inspection, we met with one person who used the service and observed two people being supported by staff at the time.

After the inspection we spoke with two relatives of people who used the service.

One person who used the service told us: “I like it here. I like the people and staff”.

We found that before people received any care or treatment they were asked for their consent and the provider acted on their wishes.

We found that the provider met the care and welfare needs of people who used the service.

One relative told us: “[Staff] go out of their way to look after X. X is extremely happy there I can tell”.

We saw that the provider supported people to manage their medication by putting in place appropriate protocols, support and guidance for staff to follow.

We found that the provider had processes in place to ensure staff were suitably trained and supported.

We saw that the provider had an effective system to regularly assess and monitor the quality of service that people received.

Our inspection of 14 August 2012 found that Highfield House was non - compliant with outcome 16: Assessing and monitoring the quality of service provision.

At the last inspection we found that the service had some systems in place to monitor and evaluate the service. However the quality monitoring systems they had did not provide assurance that people would be protected from risk.

We completed an unannounced responsive review to look at how things had improved since the last inspection. This meant that the provider and the staff did not know we were coming.

During our visit we spoke with the registered manager about changes and improvements that had been made at the home.

Having spoken with the registered manager and reviewed evidence provided we found that the provider was compliant. The provider had an effective system to regularly assess and monitor the quality of service that people received.

During our visit we spoke with some of the people who lived at the service and staff members.

We used a number of different methods to help us understand the experiences of people using the service. Some of the people living at Highfield House had complex needs which meant they were not always able to tell us about their experiences.

We took information from other sources to help us understand the views of people living at the home to include feedback from relatives. We also observed how people living at the service were being supported during the course of the inspection.

The people we spoke with told us they were happy living at Highfield House and with the staff team.

Staff we spoke with knew the people living at the home well and had a good understanding of their support needs.