We inspected this service on 13 October 2017 and it was an unannounced inspection. The service provides support to five people with a learning disability. On our last inspection on 2 December 2015 we rated this service as Good overall and outstanding within our question, ‘Is this service responsive?’ At this inspection, the service remained rated as Good with outstanding in our responsive question.

There was a registered manager in the service. 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 service remained safe and people’s care continued to be planned to meet their needs and minimise risks to their safety. Staff understood their role in protecting people from harm and people received their medicine as required. Recruitment practices ensured staff were suitable to work within people.

The service remained effective and staff had access to training and support to maintain and improve their knowledge of care and enhance their skills. People were supported to eat and drink what they liked and receive nutrition to keep well. People had access to healthcare services and necessary referrals were made to ensure new health concerns were reviewed.

The service remained caring because staff knew people well and spent time learning what was important to people. People received the care they preferred because staff asked them and their relatives about their likes and dislikes. Staff understood the importance of gaining consent from people.

The service remained very responsive. People had access to a wide range of tailored support to meet their needs and to interest and them and had opportunities to do the activities they enjoyed including spending time out of the home being involved with new experiences. People had consistency in their care as there was a small team of staff people and their family knew well and their views were listened to. Care planning was personalised so that people were placed in the heart of their care and this was regularly reviewed to ensure it was still suitable for them. People and relatives could discuss any concerns or complaints with the staff and the provider and staff explored different ways to support people to communicate and express their views.

The service remained well led. The manager was approachable and relatives were given opportunities to comment on the care they received and to be involved with plans for the future. There were quality assurance systems in place to monitor the quality of the service to drive improvements in care.

This inspection took place on 2 and 4 December 2015 and was unannounced. Our last inspection took place in June 2014. At that time we found there were concerns with how the provider supported people to make decisions, how people were supported to take risks and how care was planned. During this inspection, we found improvements had been made.

The service is registered to provide accommodation and personal care for up to five people with a learning disability. At the time of our inspection, four 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 were supported to experience positive life experiences and take responsible risks, have new experiences and do the things they liked. People were protected from unnecessary harm by staff who knew how to recognise signs of abuse, how to identify if people were unhappy and how to report concerns to improve the care and support for people and prevent potential harm.

People had developed positive relationships with staff who knew people well. The staff helped people to express themselves to be able to choose what they wanted to do and to let them know if they were happy. The staff support was arranged flexibly so people could do the things they wanted to do, when they wanted to do this. People continued to be involved with activities they enjoyed and to try new activities. People supported charitable events and members of the local community were welcomed to their home to join events and develop new relationships with people. People were supported to maintain existing relationships with friends and family who were important to them.

Consent was sought before staff provided support and people were supported to make decisions. Where people needed help because they did not have capacity to make an important decision, they were supported to make decisions that were in their best interests. People could also be supported by an advocate who helped to express their views where they may have difficulty. Where people had restrictions placed upon them as they were not able to go out alone, applications to ensure these restrictions were lawful had been made and to safeguard their welfare.

People were supported to take their medicines and systems were in place to ensure that people received their medicines as prescribed and to keep well. Where people needed specialist medicines in the event of a medical emergency, staff had received training so they could give these medicines safely.

People were supported to eat and drink the food they liked and staff knew how to support people so they could eat a variety of foods safely. Some people had all food and drink through an artificial feeding system. Staff knew how to use this feeding system and how to identify problems which could lead to poor health.

People were treated with kindness and compassion by staff who knew them well. People were given time and explanations to help them make choices. Staff knew people’s likes and dislikes and how they communicated so they could express their feelings. The staff could identify where people may be concerned and raised this on people’s behalf. Any complaint raised by people or relatives was acted upon to improve the quality of the service.

Staff were supported by the registered manager and provider who displayed strong positive values and demonstrated a commitment to providing best practice support for people. The staff team were committed to ensuring people were part of the community and had their rights upheld. Staff were proud of their role in providing support and promoting the service in the community.

Quality checks were completed to continuo

At the time of this inspection there were five people using the service. They had complex needs and were not able to tell us their experiences. We therefore used other methods to help us understand the experiences of these people. We observed them receiving care, spoke with two people’s family members and examined records at the service. We also spoke with the manager, deputy manager, two members of staff and read the care plans of three people who used the service, to find out more information. Below is a summary of what we found.

Is the service safe?

Family members of the people who used the service told us their relatives felt safe living at the service. They also thought their relatives were able to communicate with staff if they were worried about anything. Staff had received training on keeping vulnerable people safe.

Family members who we spoke with told us that staff talked things over with their relatives while carrying out their care and support. However, adequate arrangements were not in place for decisions to be made on people’s behalf when they did not have the capacity to consent. We have asked the provider to tell us what they will do to meet the requirements of the law in relation to mental capacity.

Is the service effective?

Care plans provided staff with detailed guidance in meeting most people’s needs. Recorded risk assessments were in place to address risks to which people may have been exposed. However, these records were not always up-to-date and did not all accurately reflect people’s current needs. We have asked the provider to tell us what they will do to meet the requirements of the law in relation to assessing people’s needs and risks they may be exposed to.

Staff had positive views on the service. One member of staff told us that the service was good at, “keeping the needs of people in mind at all times.”

Is the service caring?

People’s privacy and dignity were respected. One family member told us, “Staff don’t talk across [my relative].”

Family members told us that staff respected their relatives’ personal preferences and interests and thought that their needs were being met. Staff confirmed this and one member of staff told us that the people who used the service had a, “brilliant quality of life.”

Is the service responsive?

People’s personal records showed that staff were encouraged to take an approach to people which was centred on their individual needs. People’s personal preferences, and likes and dislikes, were recorded and support was provided that met people’s wishes.

Family members and staff we spoke with gave us several examples of actions the service had taken to address concerns raised in the past. Staff told us they felt listened to by management.

Is the service well-led?

The service had a quality assurance system which identified, assessed and managed risks to people’s health, safety and welfare.

Staff described a sound set of values upon which the service was based. These included: “keeping the needs of people in mind at all times” and providing care centred on people’s individual needs.

None of the people using the service were able to communicate their experiences of care to us; however they appeared happy and comfortable with the support provided to them.

We spoke with people’s family members to get their views on the services provided; they told us they were happy with the support provided to their relative.

We found that the support provided to each person was individualised and comments received from professional visitors also confirmed this such as, “Highfields promote a very person centred approach to the care of their residents.”

The variety of meals available were based on people’s dietary requirements and preferences. People’s nutritional needs were monitored appropriately and professional advice and guidance was sought when needed.

People received their medication as prescribed and staff had undertaken the appropriate training to ensure this was done in a safe way. Medication audits were undertaken to identify any errors or improvements required.

Records seen demonstrated that robust recruitment practices were followed to ensure the staff employed were suitable to work with the people using the service.

Systems were in place to monitor the quality of services provided and further develop them as required; this included obtaining the views of people’s representatives.

There were five people living at Highfields when we visited. We met and introduced ourselves to the people living there. Due to people’s communication skills they were unable to communicate their experiences of care to us, but did appear happy and comfortable with the support provided to them.