Highstone Mews is a care home registered to provide accommodation and residential or nursing care for up to 60 older people, some of who are living with dementia. The ground floor of the home is configured to provide personal care for up to 30 people. The first floor provides nursing care for up to 30 people. The first floor has been separated into two units since our last inspection; one unit offered nursing care and the other unit specialist care for people living with dementia.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

Why the service is rated Good

The home was warm and welcoming and there was clear leadership evident throughout the home. Staff were knowledgeable and knew people well, there were positive caring relationships between staff and the people they supported and these positive relationships were extended to relatives we spoke with.

The home offered person centred support which was clearly recorded in people’s care plans. There were life histories of people to give staff insight into the lives people had led and what was important to them; this was particularly relevant where people were living with dementia.

The home was well-presented and had been adapted for people who were living with dementia, and offered an interesting array of tactile areas and a sensory room in addition to the clear signs and coloured doors, which helped people identify their own rooms and communal areas.

The home had introduced new practices since our last inspection which were benefitting people who used the service for instance the ‘react to red’ programme (which is an awareness tool to remind staff to react to red areas on people’s skin, or to red items in the home), the home was also extending support to the families of people who lived at the home and those who no longer had relatives at Highstone Mews but may have needed some continued support following a death of a loved oneby offering the opportunity to continue visiting the home in a social capacity for as long as they wished.

People 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.

Further information is in the detailed findings below

The inspection took place 10 January 2017 and was unannounced. The home was last inspected in September 2016, at which time we found there were multiple breaches of the Health and Social Care Act (Regulated Activity) Regulations 2014. We found the provider had made significant improvements since the last inspection and that the breaches of Regulations relating to person centred care (Regulation 9), Dignity and respect (10), Need for consent (Regulation 11), Safe care and treatment (Regulation 12), Premises and equipment (Regulation 15) and Good governance (Regulation 17) were no longer present at this inspection.

Highstone Mews is a care home registered to provide accommodation and residential or nursing care for up to 60 older people, some of who are living with dementia. The ground floor of the home is configured to provide personal care for up to 30 people. The first floor provides nursing care for up to 30 people and both floors support people who are living with dementia. The first floor had been separated into two units since our last inspection; one unit offered nursing care and the other unit specialist care for people living with dementia.

There was no registered manager at the time of the inspection; however there was a manager in post who was in the process of registering with the Care Quality Commission (CQC). 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.

People and their relatives told us they felt the care and support was safe and of a good standard.

Staff understood their roles and responsibilities in keeping people safe and protecting them from harm.

There were comprehensive risk specific assessments in place, which showed the risk and the measures which needed to be taken to minimise the risk. Personal emergency evacuation plans were in place for each person and described the assistance they would need to safely exit the building should there be an emergency.

Medicines were managed safely and people were receiving their medicines in line with the prescriber’s instructions.

There were sufficient staff to keep people safe and their needs were met in a timely manner.

Staff had undertaken training to ensure they had the skills and knowledge needed to carry out their roles. Staff were supported by the management team and received supervision and appraisal meetings to discuss and monitor their performance.

The recruitment processes which were in place were robust and pre-employment checks were carried out to ensure staff were of good character and were suitable to work with vulnerable adults.

There was a good supply of drinks and snacks available at all times. There was a good choice of meals and alternatives were always on offer. People told us they enjoyed their meals.

There had been an extensive programme of improvements undertaken since our last inspection to the environment and décor which resulted in a welcoming and homely atmosphere. There had been thought given to the needs of people living with dementia, and dementia friendly adaptations made, such as coloured doors and reminiscence boxes outside bedroom doors.

There had been thorough assessments carried out in line with the Mental Capacity Act 2005, and where a person had been deemed not to have capacity there had been Deprivation of Liberty Safeguards (DoLS) applied for to ensure people were only deprived of their liberty where this was lawful to do so.

Staff were kind, caring, sympathetic and patient. Staff knew people well and there were positive relationships between people and all members of the staff team. People were treated with dignity and respect and staff were mindful to protect people’s privacy.

Care plans were detailed and person-centred. The care plans we reviewe

The inspection took place on 9 & 15 September 2016. The registered provider had taken over the home in June 2016 and had introduced a new management team after a period where the home did not have a manager in post.

Highstone Mews is a care home registered to provide accommodation and residential or nursing care for up to 60 older people, some of who are living with dementia. The ground floor of the home is configured to provide personal care for up to 30 people. The first floor provides nursing care for up to 30 people and both floors support people who have a diagnosis of dementia. The registered provider told us they were planning to split the home into four smaller units to meet people’s needs more efficiently.

There was no registered manager in place at the time of our inspection; however there was a newly appointed manager and deputy 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 we spoke with gave mixed views about whether they were safely cared for in the home on the first day of the inspection, however people were feeling more positive about the level of safety on the second day.

Risk assessments were in place for all aspects of people’s care, however we found that whilst a lot of work had been carried out between the first and second days there was still conflicting and inconsistent information present.

We found some concerns about the maintenance of the building, and there were some areas which had not been maintained as frequently as they needed to be.

There were personal emergency evacuation plans in place, however these did not contain key information about people’s needs and there was no instruction to tell staff how to assist people from the building in the case of an emergency.

There had been concerns raised prior to the inspection that there were not enough staff to meet people’s needs. We found there were staff from other services on the first day who did not know people or how to meet their needs. There had been an increase of regular staff when we returned on the second day which had led to an improvement in the level of care and support people were receiving.

There were multiple concerns about the management of medicines in the home. These included incorrect use of medicines, unsafe storage (due to temperature) and medicines being out of stock and unavailable to people.

The recruitment process in place was robust and all appropriate checks were made to ensure staff were of good character.

The service had not ensured there were appropriate Deprivation of Liberty Safeguards in place for all the people who required these. We found there had been work carried out to rectify this between our visits however there was still more work which needed to be completed to ensure people’s rights were protected.

Staff training had been identified as an area of concern during an audit carried out prior to our inspection. We found there had been a programme of training planned and this was in progress to ensure staff had the relevant skills and knowledge to carry out their roles effectively.

We had received information of concern in relation to the amount and choice of food available to people, and concerns about people who had lost weight prior to our inspection. We found there were no concerns about the availability of food, however there had been some people who had suffered weight loss. The management team were taking action to ensure people were receiving the correct support to maintain a healthy diet and weight.

People had access to a range of healthcare professionals, including GPs, district nurses, opticians and chiropodists. We did find however that people who were living with some conditions were n