This inspection took place on 10 October 2018 and was unannounced. At our last inspection on 12 July 2017, we rated the service as ‘requires improvement’. At this inspection, we found improvements had been made and the service is now rated as ‘good’.

Highgate Road is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Highgate Road accommodates up to six people in one large house. At the time of inspection, five people were living at the home.

The 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.

There was a registered manager in post. A registered manager is a person who has registered with the CQC 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.

Staffing levels were sufficient to meet people’s needs and roles and responsibilities had been re-organised since the last inspection to ensure that staff could spend more time with people. People looked happy and comfortable in the home and they had access to the right equipment to keep them safe.

Staff knew how to report concerns and had good knowledge of risk assessments to ensure their practice kept people safe. Medication was managed well by staff to ensure that people received the correct medication at the right time.

Staff received sufficient training to enable them to support people effectively and the service worked well with health care professionals to ensure that expert advice was obtained and followed on a day to day basis. People had access to health services when required.

People were supported to eat and drink well by providing food in line with individual preferences and people were supported to eat in their preferred way.

People were treated with kindness and respect by staff and were supported to express their views through different communication methods which were well known by staff. Staff enjoyed working with people and were motivated to provide a high quality service.

People were supported to keep in contact with families and others that were important to them.

People had the opportunity to take part in activities and holidays that they enjoyed and their individual needs and preferences were assessed carefully and met by the staff team. People had access to cultural and religious activities that were important to them.

There was a registered manager in post who was respected by staff and who knew people and the service well. A range of audits and spot checks were carried out to ensure quality was monitored and actions were taken to improve performance.

The service worked well in partnership with other agencies to provide people access to local services and opportunities in line with Registering the Right Support.

This inspection took place on 07 and 08 June 2017 and was unannounced. At our last inspection completed on 04 March 2015 we rated the service as being ‘good’ overall. We found the service had gone through a period of significant change since this inspection. The new management team had made improvements since their appointment. However, further improvement was required overall within the service.

Highgate Road is a residential home for up to six people with disabilities. At the time of our inspection there were six people living at the service. The service supports people with a range of needs including; learning disabilities, physical disabilities and complex needs. People currently living at the service range from young adults through to older people and most had complex needs.

There was a manager in post. The manager was not yet registered with CQC. They had applied to register and their registration was in the process of being reviewed at the time of the inspection. 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 by sufficient numbers of staff to keep them safe from harm but not to protect their dignity and provide person centred care. People were supported by a staff team who could recognise signs of potential abuse and knew how to report concerns. People were protected by staff who understood risks to them and knew how to protect them from the risk of harm from accident and injury. People were supported by a staff team who had been recruited safely for their roles. People received their medicines as prescribed.

People were supported by a staff team who had mixed skill levels and abilities. Some care staff required further training to support people effectively in all areas. The management team recognised this and were developing training and support available to staff members.

People were supported in line with the requirements of the Mental Capacity Act 2005 (MCA). However, issues with records meant that the new manager did not always have the required knowledge of previous restrictions authorised for people under the Deprivation of Liberty Safeguards (DoLS).

People were supported to have sufficient quantities to eat and drink. People’s day to day health was maintained and they were supported to access healthcare professionals when required.

People were supported by a care staff team who were kind and caring towards them. Staff knew how to protect people’s dignity. Staff knew people well and worked to encourage choices and promote independence. People were supported to maintain relationships that were important to them.

People’s basic needs and preferences were meet by care staff. Care staff had a good knowledge of people and care plans were in place that reflected people’s needs and preferences. People were enabled to participate in activities and had access to the local community. People’s feedback was sought and complaints were addressed appropriately.

People were supported by a staff and management team who were committed to providing a good service and making improvements to the care provided. Staff mostly felt supported by the management team and felt involved in how the service was run.

A new quality assurance and governance system had been introduced that was successfully identifying many areas for improvement required within the service. Action was taken by management to make required improvements. Further development of this system was required to ensure that all issues and areas of risk to people were identified.

This inspection took place on 4 March 2015 and was unannounced. We last inspected this home on 17 September 2013 and found there was a breach of Regulation 12 of the Health and Social Care Act (Regulated Activities) Regulations 2010. Following this inspection the provider was requested to send us an action plan to tell us the improvements they were going to make. We found that improvements had been made during this inspection.

Highgate Road is a residential home providing accommodation and personal care for up to six younger adults with learning disabilities or autistic spectrum disorder, physical disability and sensory impairment. It is a requirement that the home has a registered manager in post. The manager left the home in September 2014. A new manager was appointed to the home in January 2015 and has applied to register with us. 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 that they felt safe living at the home. Relatives of people told us they felt the home kept people safe. Staff we spoke with told us they understood their role in keeping people safe from the risk of abuse and would report concerns. People received their medicines at the correct times and as prescribed.

People were supported by adequate numbers of staff. However, we found the provider did not have a process in place to take account of people’s changing needs when determining staffing numbers.

Staff did not have a clear understanding of their role and responsibilities with regard to DoLS. The manager was in the process of arranging training to improve staff knowledge. People’s capacity to consent and records of decisions had not been completed.

People and their relatives thought the food was good. People were encouraged to make their own decisions about the food they wanted. We saw that people who required assistance with eating were supported appropriately by staff.

People had access to other health-care professionals as and when they required it.

People thought that staff were kind and caring and that they were treated with dignity and respect.

A range of social activities were available to suit people’s needs and choices.

Relatives of people living in the home told us they found the staff and manager approachable and told us they would feel comfortable to raise any complaint or concern should they need to.

The new manager had made improvements to the quality audit systems used within the home to monitor and improve the quality of the service provided.

We found that there were five people who lived at the service on the day of inspection. We were able to speak with two of these people and three of the staff. We also spoke with the manager and a visiting nursing professional.

One person told us: “it’s very nice here”. We saw that care was planned and delivered to meet people’s individual needs.

Although the activities plan was not up to date, the people who lived there were engaged with activities or out of the building shopping with staff support.

Meals offered met people’s cultural dietary requirements and included five portions of fresh fruit or vegetables every day where possible. We saw one person make themselves a sandwich in the kitchen.

We had some concerns about the cleanliness of the home and effective prevention of infection. We discussed this with the manager who had arranged with the provider to make improvements immediately after our inspection.

We found that the service had an effective recruitment process for staff which ensured only staff suitable to work with this group of vulnerable people were employed.

We found that the service had an effective quality monitoring system for reviewing the care provided to people. We saw that people and those that mattered to them were encouraged to give their views about the service.

We carried out this review to check on the care and welfare of people using this service. We visited 91 Highgate Road unannounced, this means that the provider and staff at the home did not know that we were going to visit.

We spent some of our time in a lounge area observing the care and support experienced by people living at the home. We met with five of the six people who live at the home and held a conversation with one of these people. We met with people who were visiting one person living at the home. We discussed people's care with staff and observed activities taking place.

The manager and care staff provided us with information throughout our visit.

People we met spoke positively about the service, we were told, Staff are fantastic, "(my relative) is thriving, we are really glad that he is here." "(my relative) is going away next week for a few days with two members of staff."

We looked at the care files for two of the people that live at the home. We saw that information was recorded regarding "people who make decisions on my behalf". We also saw that mental capacity assessments had been undertaken when important decisions needed to be made for an individual. Staff told us that they had undertaken training regarding mental capacity and details of the mental capacity act were on display on the wall for staff to reference when needed.

We looked at the health and care files for two people living at the home, information recorded was detailed and had been regularly reviewed and updated. The visitor we spoke with told us that they had recently been involved in a care review and had had some input into the care planning process. The manager told us that all relatives or advocates were invited to care reviews. We saw that risk assessments were in place which detailed the risk to the person and the action that staff should take to reduce the risk of harm.

We looked at medication storage and records. It was evident from information seen that people received their medication as prescribed. Staff were aware of the medication procedures at the home.

We spoke with staff regarding staffing levels. Staff told us that they complete a lot of activities with people living at the home and felt that they had sufficient time to meet people's needs. Staff were concerned that staffing levels were being reduced. We spoke with the manager who told us that the number of care staff on duty was reducing, however a deputy manager had been employed who was a qualified learning disability nurse. The deputy would be undertaking some care shifts and also completing management duties. The manager confirmed that the staffing levels at the home had therefore not changed.

We observed staff completing activities with people and noted that staff were kind and caring. Staff were busy but took the time to speak to the people under their care and comfort them whey they appeared distressed.

The visitor we spoke with was happy with the quality of care provided at 91 Highgate Road. The manager had various audits in place to ensure that equipment was in good working order and to ensure that staff were working to procedures. Satisfaction surveys were also undertaken asking for people's views on the quality of the service provided.