About the service:

Highfields Care Home is owned and managed by Highfields Care Home Limited. It is situated in the village of Edingley in Nottinghamshire and offers accommodation for to up to 49 older people. On the day of our inspection there were 37 people using the service.

People’s experience of using this service:

¿ People and relatives said Highfields Care Home provided safe, personalised care. A person said, “Nothing is too much trouble for the staff who look after me beautifully. Everything about this home is good.”

¿ Staff knew each person well, including their likes and dislikes, their preferences, how they wanted to be supported. A relative said, “The carers put [person’s] makeup and jewellery on, it’s a little thing that means a lot.”

¿ Staff continually interacted with people and relatives. They greeted each person and relative with a smile and ask them how they were. Their friendly and inclusive approach contributed to the welcoming atmosphere in the home.

¿ People felt they had a purpose at the home. For example, a person was responsible for feeding the birds and sweeping up leaves, as they had done when they were in their own home. Another person had befriended a less able person and enjoyed helping to support them.

¿ Staff encouraged people to be creative. The registered manager said there was evidence this could improve the quality of people’s lives in their later years. An activities co-ordinator said, “Coming in to the home is the beginning of a new chapter for people and we want to look after their mind, body and soul.”

¿ The home was spacious and accessible throughout to people with limited mobility. There were a range of communal areas including a quiet lounge where people and relatives could meet in private.

¿ The registered manager involved people when improvements were made to the home. For example, the home had a new sensory garden which was designed in conjunction with the people using the service to meet their needs.

¿ The registered manager was kind, caring and efficient. People and relatives spoke highly of her and said she was approachable and helpful. Staff said she gave them excellent support and guidance. A staff member said, “She is always there for all of us, residents, relatives and staff, and wants the home to be the best it can be.”

Rating at last inspection: Good (report published 23 July 2016).`

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service remained rated Good overall.

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

This inspection took place on 22 June 2016 and was unannounced. Highfields Care Home provides accommodation, personal care and nursing care for up to 49 people. People had a variety of needs associated with dementia or physical health needs. On the day of our inspection 48 people were using the service.

The service had 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 2008 and associated Regulations about how the service is run.

People told us they felt safe living at the home and staff knew how to protect people from the risk of abuse. Risks to people’s safety, such as the risk of falling, were appropriately assessed and well managed. The building was well maintained and the required safety checks were carried out.

There were sufficient numbers of suitable staff and people received care and support in a timely manner. The provider ensured appropriate checks were carried out on staff before they started work. People received their medicines as prescribed and they were safely stored.

People were cared for effectively by staff who felt well supported. Further training was planned so that all staff would receive the training relevant to their role. People were asked to provide consent to the care they received. The Mental Capacity Act (2005) (MCA) was used appropriately to protect people who were not able to make their own decisions about the care they received.

People were provided with sufficient quantities of food and drink and most people told us they enjoyed the food. Staff ensured that people had access to any healthcare professionals they required and followed any guidance that was provided by them.

There were positive and caring relationships between staff and people. People and their relatives were able to be fully involved in planning their care and making day to day decisions about what they wanted to do. People were treated in a dignified and respectful manner by staff. Many people’s bedroom doors were left open which restricted the amount of privacy they could have.

People received care that was responsive to their changing needs and staff knew people well. There were effective systems in place to ensure that staff were made aware of any changes to people’s planned care. There was a range of activities provided and people told us they enjoyed taking part. Some people felt their opportunities to spend time outdoors were limited and felt a more secure outdoor seating area would be beneficial to them. People knew how to complain and any complaints received were appropriately responded to.

There was a positive, open and transparent culture in the home, people and staff were encouraged to speak up and their comments were listened to. There were different ways people could provide feedback about the service they received, such as a satisfaction survey and regular meetings. The quality monitoring systems used by the registered manager ensured that any areas for improvement were identified and acted upon.

Prior to our visit we reviewed all the information we had received from the provider. During the visit we spoke with eight people who used the service and two relatives and asked them for their views. We also spoke with five care workers, the maintenance person, a nurse on duty and the registered manager. We also looked at some of the records held in the service including the care files for four people. We observed the support people who used the service received from staff and carried out a brief tour of the building.

We found people gave consent to their care and treatment and received care and support that met their needs. A person told us, “I cannot think of anything they (staff) don’t let me decide for myself. I make the decisions about what care I have."

We found the equipment used was safe, properly maintained and suitable for the purpose used for. A person told us, “They keep my walking frame clean for me.”

We found the staff team were supported through training and the provider assessed and monitored the quality of the service. A person told us, “I would say they (staff) have had good training. They are very helpful and pleasant staff.” A relative told us, “The staff are great and the manager is very approachable, she will always sit and listen and reassure us about what is happening.”

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

People told us they were happy with way the staff treated them and we saw staff speaking to people in a friendly and encouraging manner.

Specific comments included:

“Staff, carers are very good, very helpful”

“They're all very good, on the ball."

We observed staff reminding people to have their drinks in the communal areas, but those in their own rooms waited longer for drinks to be served.

People we spoke with told us that if they had any concerns they could always speak to the manager or nurse in charge. One person said, "I’ve never seen anyone afraid of voicing their opinion”.

Several people in their own rooms raised concerns about the staff being busy and there not being enough staff. Other people were very complimentary about the staff that helped them. One person said, "I’m extremely well looked after, couldn’t fault them."