Highfield Residential Home is a care home for up to 27 older people. At the time of our inspection there were 14 people using the service.

Highfield Residential Home had a registered manager in post. 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 inspection took place on the 20 and 22 June 2017 and was unannounced. This was a comprehensive inspection that was carried out to check whether the provider had made the improvements required as a result of our previous inspection on 20 and 23 May 2016. At the previous inspection we identified two breaches of the regulations relating to seeking people’s consent before providing care, the recording of information about people’s needs and the management of risks in the service. Following the inspection the provider sent us an action plan detailing how and by when they would meet the regulatory requirements.

At this inspection we found improvements had been made and the provider was meeting the requirements of the regulations.

We found improvements to how information about risks to people using the service and information about their needs were recorded. There were also improvements to how people’s consent to receiving care and support was assessed and recorded. The provider's quality monitoring systems were effective in monitoring and improving the quality and safety of the service provided. Some time was still needed to ensure appropriate pre-employment checks would always be completed in accordance with the provider’s recruitment processes in the registered manager’s absence.

People were protected from harm and abuse through the knowledge of staff and management. People’s medicines were safely managed. People received personalised care and there were arrangements in place to respond to concerns or complaints from people using the service and their representatives. People were treated with respect and kindness, their privacy and dignity was respected. They were supported to maintain their independence and keep in contact with relatives. People were enabled to be involved in activities in the home and to enjoy occasional trips out.

Staff were able to develop the knowledge and skills for their role through a programme of training and were supported through regular individual meetings and annual performance appraisals.

The registered manager was accessible to people, their visitors and staff. People and their representatives were asked for their views about Highfield Residential Home.

The inspection took place on the 20 and 23 May 2016 and was unannounced. The home was last inspected on 9 December 2015 in response to information we received. At that inspection we found a breach of regulation relating to people not being fully supported to maintain their well-being through adequate nutrition.

Highfield Residential Home is a care home for up to 27 older people. At the time of our inspection there were 14 people using the service.

Highfield Residential Home did not have a registered manager in post. The previous registered manager left their post in April 2015. 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.

Information about people’s needs and the management of risks were not always clearly or consistently recorded.

People had their prescribed medicines safely and on time. However the service needed to ensure there was sufficient guidance for staff on the administration of certain ‘as required’ medicines.

There was an inconsistent approach to assessing people’s mental capacity in relation to decisions about their care.

People were not fully protected against the employment of unsuitable staff. Health checks had not been made when staff were employed.

We heard positive comments about Highfield Residential Home from people and their relatives such as “very pleased with it” and “very nice”. A visitor appreciated the size of the home which they felt compared well to larger establishments.

Staff and management understood how to protect people from harm and abuse. People received personalised care and there were arrangements in place to respond to concerns or complaints from people using the service and their representatives. People were treated with respect and kindness, their privacy and dignity was respected. They were supported to maintain their independence and keep in contact with relatives. People were enabled to be involved in activities in the home and to enjoy occasional trips out of the home.

Staff were able to develop knowledge and skills for their role through a programme of training. However staff supervision sessions had not been taking place. The manager was accessible to people, their visitors and staff. People and their representatives were asked for their views about Highfield Residential Home. Regular audits checked areas of the service provided to identify if any improvement actions were needed.

We found breaches 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 the report.

We carried out an unannounced comprehensive inspection of this service on 27 February and 2 March 2015 where we found breaches of regulations in relation to management of medicines, deprivation of liberty, staff recruitment procedures and notification of incidents. We checked and found the breaches had been met at an inspection on 7 July 2015. After that inspection we received concerns in relation to food, drink and nutrition, how people spent their time and the management of laundry. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to those/this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk

We found some people were not adequately supported with their nutritional needs. In particular people who required individual support and monitoring. A thickening agent to help prevent one person choking on fluids was not available in the care home.

Although we received concerns about people’s beds being left with dirty bedding we did not find this was the case, beds we examined were made with clean bed clothes. There was a lack of guidance for staff in relation to the correct temperatures to wash laundry. We passed information about food storage issues to the local authority.

People did not always receive the support they needed to take part in activities of their choice.

Highfield Residential Home did not have a registered manager. A manager had recently been appointed although at the time of our inspection visit we had not received an application from them to be registered as manager for Highfield Residential 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.

We carried out an unannounced comprehensive inspection of this service on 27 February and 2 March 2015. Part of our inspection was to check breaches of legal requirements found at our inspection of 27 August 2014. We found the outstanding breaches of regulations had not been met and we found new breaches of regulations. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and a breach of the Care Quality Commission (Registration) Regulations 2009.

We undertook this focused inspection 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 those requirements. You can read the report from our last comprehensive inspection and the last focused inspection by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk

People were protected from the risk of being cared for by unsuitable staff because robust recruitment practices were operated. We found improvements to the procedures for recruiting staff. Improvements had also been made to the management of people’s medicines.

People’s rights were protected by the correct use of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards (DoLS).

The manager demonstrated an awareness of the events affecting people using the service which we must be notified about. We had received the appropriate notifications.

Highfield Residential Home had a registered manager although this person was not in post at the time of our inspection. A new manager had started who was currently applying for registration. 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.

At the time of our inspection the provider had a new manager in post. The manager had applied for registration with the Care Quality Commission. In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

Twenty five people lived in the home on the day of our inspection. We were given a tour of the home and spoke with five people who lived in the home. They told us they liked living at the home and staff were nice. We spoke with five members of staff. We read the care records of four people who lived in the home. We inspected the policies and procedures, the record of complaints and the safeguarding folder which included details of safeguarding referrals. We read the reports from quality monitoring visits. We observed staffs' interactions with people they were supporting.

A single adult social care inspector carried out the inspection. The focus of the inspection was to answer five questions: Is the service safe, effective, caring, responsive and well-led?

We found the service was safe.

Overall we found the service was safe but we found the management of medicines to be unsafe. We found inappropriate arrangements for the recording of medicines. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Staff told us they had received training about safeguarding vulnerable people. They told us they would report concerns immediately to a senior staff member or the manager. Policies, procedures and local guidelines were available for staff to follow. The policies read were dated 2010 and we found no evidence of policies being reviewed. The provider has been made aware of this.

We saw that staff had a good rapport and interacted well with the people living in the home. We saw that people freely approached members of staff when they wanted support.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS), which applies to care homes. The provider had policies and procedures in relation to the Mental Capacity Act (MCA).

We saw systems in place to ensure that the manager and staff learnt from accidents and complaints as well as comments received from people who used the service and their relatives.

Is the service effective?

People's health and care needs were assessed. However, we did not find evidence that people had been involved with their care plans. We saw involvement from external health professionals such as the community mental health team (CMHT).

We spoke with staff who told us that the induction training for their role had been thorough. They also told us they received regular meeting with their manager to discuss their personal development. The records we reviewed did not identify staff receiving annual appraisals. An appraisal evaluates staff's performance which is documented in their records. The manager confirmed they were aware of annual appraisals having not been completed.

We found the service was caring.

We spoke with staff, and observed the interactions they had with people. We found, without exception, that staff spoke kindly and demonstrated a good understanding of people's needs. Staff said they enjoyed working at the home as "each day was different."

During our visit we observed there was a relaxed atmosphere with people choosing where they wished to spend their time. We observed staff treating people with kindness and patience. Staff demonstrated they knew people's needs and ensured people were treated with privacy and dignity.

We saw people freely expressing what they wanted to do during the day, and they were supported by kind and reassuring staff. People told us staff were "very nice and friendly" and they "do the best they can."

We found the service was responsive.

People had their needs assessed on a regular basis and had been allocated a key worker. However, we found no evidence within the records read of key worker's involvement with people who used the service. A key worker is a designated member of care staff with specific responsibility for a named person who lives in the home.

Staff told us that some people had difficulty communicating although they understood what was said. Staff told us people were able to respond through various means which included the use of signs and gestures.

We found the service was well-led.

We saw that people were asked for their feedback. We saw the responses from people and found there were many positive responses for example, people said they liked their home. Suggestions for improvements included more day trips out into the community. This had resulted in additional hours being allocated to the activities co-ordinator and we saw days out scheduled on the activities planner.

The service's monitoring system was not fully effective and some shortfalls had not been identified and therefore addressed. A compliance action has been set in relation to this and the provider must tell us how they plan to improve. We observed good relationship between staff and management on the day of our visit. Staff were clear about their roles and responsibilities and told us they were supported by their manager.

People felt in control and were confident their wishes would be respected at the home. One person said, "You can please yourself in what you do here, you can have visitors any time you want. I like to spend time on my own; I join in when I feel like it."

We observed a member of staff checking whether people were enjoying their lunch and interacting with one person who did not always eat well to offer their favourite desserts as alternatives. The outcome was that they ate every mouthful of the dessert prepared for them. A staff member told us, "The food is excellent; we have got good cooks".

We saw that staff worked in accordance with the home's infection control policy when assisting with personal care and when handling food and drink. All the staff we spoke with were clear about how clinical waste and body fluid spillages should be managed.

There were effective recruitment and selection processes in place. The people and their relatives we spoke with at Highfield were complementary about the staff at the home. One family said, "They are all so helpful and friendly."

Effective systems were in place to manage risks and to monitor the quality of the service.

We spoke to four people who were using the service and asked them about the care and support they received. They made positive comments about the service such as, "really lovely, you feel relaxed" and "we like it very much".

We found that consent was obtained from people before they received care. People also told us that they received enough help to meet their needs. We found the environment of the care home had been well maintained. When we looked at staff recruitment we found that some required checks had not been made before staff started work in the service. Although we did not ask people specific questions about staff recruitment, we did hear positive comments about the staff such as, “friendly and helpful” and “all so friendly”.

We found that the service had an effective complaints system and information about this was made available to people using the service.

We spoke with a number of people living in the home and they told us about what it is like living at Highfield: "I am very fortunate to come and live here its the ideal place for me" when asked why they said "staff are wonderful and caring, you are treated with respect"

Another person told us "its one of the decent places everyone is sociable, staff are caring and helpful. Consider it one of the better homes". One individual said "I left all my worries behind, it feels like home and there's somebody here all the time.

We received a number of comments about the quality of the food and all of those we spoke with said they were satisfied with the meals and they offered variety and choice. In the area of activities there were some positive comments about the daily activities made available however some people wanted staff to have more time on a one to one basis "just sitting and having a chat".

A relative told us how they were always made to feel welcome when they visited the home and felt they they were always informed about how their relative was. She described the care as "second to none".

The GP we spoke with said how impressed he was with the flexibility of the home and that the home had built a "fantastic relationship" with his patient. He said it was a "caring home and they try to make a family atmosphere".

Some of the comments received from relatives about the care provided in the home:

"The staff and management look after my relative very well and now communicate with me far better. I have seen a great improvement over the past year"

"I am very happy with the standard of care given the staff are wonderful"

"Overall I am very happy with the friendly, homely atmosphere that exists in the home".

"I would like to take the opportunity to thank you for everything you did. The transition from living independently to moving into residential care was difficult but you helped her settle and ultimately Highfield became her "home" in the truest sense of the word.".

The inspection took place on the 27 February and 2 March 2015 and was unannounced. At the last inspection on 27 August 2014 there were two breaches in regulation which related to management of medicines and monitoring the quality of the service.

The provider sent us an action plan which showed improvements would be made by September 2014. At this inspection we found there was still a breach of regulation relating to management of medicines. The breach of regulation relating to quality assurance had been met.

Highfield Residential Home is a care home for up to 27 older people. At the time of our inspection there were 23 people living in the home.

The home 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.

Some aspects of the management of people’s medicines were unsafe. People were not protected against being cared for by unsuitable staff because robust recruitment procedures were not always applied.

We had not been notified of some incidents affecting the wellbeing of people living at the home. CQC monitors events affecting the welfare, health and safety of people living in the home through notifications that providers are required to send to us.

The Mental Capacity Act and the Deprivation of Liberty Safeguards (DoLS) had not been used correctly to uphold people’s rights.

People were protected from the risk of abuse by staff who understood safeguarding procedures. There were sufficient staff to meet people’s needs.

People received support from caring staff who respected their privacy, dignity and the importance of independence. There were arrangements in place for people and their representatives to raise concerns about the service.

The manager was accessible and open to communication with people using the service and their representatives. Quality assurance checks on the service including the views of people using the service and stakeholders had been completed as a way of ensuring the quality of the service provided.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration) Regulations 2009.This inspection took place at a time where the 2010 regulations were in force. This report refers to evidence found prior to 1 April when the 2010 regulations were in force but reported on after 1 April when the 2014 regulations came into force. You can see what action we told the provider to take at the back of the full version of the report.

We have made a recommendation about adapting the environment for the needs of people with dementia.