This was an announced inspection carried out on 8 November 2018.

This was the first inspection of Highgrove since its new registration.

Highgrove is registered to provide accommodation and personal care to people with a learning disability, some whom may have challenging behaviour and complex needs. The service provides short break stays for a maximum of three younger adults aged from 18 years. An outreach service is also provided with additional staff which was not looked at during this inspection. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.

The building as an older building does not conform to the model of care proposed from 2015 and 2016 guidance that people with learning disabilities and/or autism spectrum disorder which proposed smaller community based housing. However, the care service has been developed and designed in line with other 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.

A registered manager was in place. 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.

Due to their health conditions and complex needs not all people were able to share their views about the service they received. People were well-cared for, relaxed and comfortable. Staff knew the people they were supporting very well and we observed that care was provided with great patience and kindness. Staff upheld people's human rights and treated everyone with great respect and dignity.

The atmosphere in the service was welcoming and the building was well-maintained with a good standard of hygiene.

There were sufficient staff to provide safe and individual care to people. People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. When new staff were appointed, thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support.

People were able to make choices where they were able about most aspects of their daily lives. They were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible, the policies and systems in the service supported this practice. Information was made available in a format that helped people to understand if they did not read. This included a complaints procedure.

Appropriate training was provided and staff were supervised and supported. Staff had a good understanding of the Mental Capacity Act 2005 and best interest decision making, when people were unable to make decisions themselves. People received a varied and balanced diet to meet their nutritional needs.

Records were personalised and reflected people's care and support needs. Care was tailored to each individual. Risk assessments were in place and they identified current risks to the person as well as ways for staff to minimise or appropriately manage those risks. Positive behaviour support plans were in place that were the least restrictive to the person.

People were appropriately supported in maintaining their health and they received their medicines in a safe way. We have made a recommendation about medicines management.

People were provided with opportunities to follow their interests and hobbies and they were introduced to new activities. They were supported to contribute and t