The inspection took place on 17, 18, 22 and 30 August 2016 and was announced to make sure that the people we needed to speak with were available. At our last inspection on 23 January 2014, the service was found to be meeting the required standards in the areas we looked at. Hightown House operates from an office in Hemel Hempstead and provides personal care and support services to adults in the Hertfordshire and East Buckinghamshire areas. People had their own flats with a number of housing complexes. We visited three separate accommodations where people were supported to live independently in their own homes.

There was a manager in post who had registered 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 and associated Regulations about how the service is run.

Regular audits were completed by operations and senior managers; however at the homes we inspected. We found the provider’s system of audits was not always effective in identifying areas for shortfall. For example, we found errors in documenting medicines….

People were supported by Hightown House to live in their own homes .There were staff that supported people with their individual needs.

People felt safe, happy living in their homes. Staff had received training in how to safeguard people from the risk of abuse and knew how to report concerns both internally and externally. Safe and effective recruitment practices were followed to help ensure that all staff were suitably qualified and experienced.

Staff completed regular health and safety checks that included security and fire safety. Staff received training and refresher updates relevant to their roles and had regular supervision meetings to discuss and review their development and performance.

People were supported to maintain good health and had access to health and social care professionals when necessary. People were supported with shopping and meal preparation where required.

Staff made considerable efforts to ascertain people’s wishes and obtain their consent before providing personal care and support, which they did in a kind and compassionate way. Information about local advocacy services was available to help people access independent advice or guidance.

Staff had developed positive and caring relationships with the people they supported and clearly knew them well. People were involved in the planning, delivery and reviews of the care and support provided. The confidentiality of information held about their medical and personal histories was securely maintained.

Care was provided in a way that promoted people’s dignity and respected their privacy. People received personalised care and support that met their needs and took account of their preferences. Staff were knowledgeable about people’s background histories, preferences, routines and personal circumstances.

People were supported to pursue social interests and take part in meaningful activities relevant to their needs, both at their home and in the wider community. They felt that staff listened to them and responded to any concerns they had in a positive way. Complaints were recorded and investigated thoroughly with learning outcomes used to make improvements where necessary.

We inspected the service on 23 January 2014, and also one of the supported accommodation services. We spoke with four people that used the service and we spoke with six staff. We reviewed the care plans and associated records of six people using the service.

People that we spoke with all made positive comments about the service and the staff. One person told us "I work in the charity shop and go to the Gateway club". Another person told us "It's good. I like everything. I feel safe here". A third person said "I get on with my neighbours and the staff". The staff we spoke with all said that they had very good support and that communication was very clear and efficient. The interactions we saw between staff and people were all positive and friendly.

We found that the service had (robust-comprehensive or detailed) care plans in place to support people in meeting their needs and that there were well structured systems in place for supporting people to take their own medicines as prescribed..

The service had robust and effective systems for supporting staff and for matching staff’s skills to the needs of individual clients.

We found that the service had an effective complaints procedure that was responsive to any concerns that had been raised.

We visited the office from which the service operates on 13 February 2013. On 20 February 2013 we spoke, via telephone, with eight people who use the service. Everyone we spoke with said they were happy with the care they received from the provider. One person said the care was "very sufficient." Another person said "I am very happy with their care." People said the provider regularly discussed what support they should expect to receive.

We found that the provider had robust recruitment systems in place to ensure they employed staff with the necessary qualifications, experience and of good character. There were systems in place to ensure people were treated with dignity and respect. We also found that the care plans and risk assessments reflected the individual needs of people and had been frequently reviewed and kept up-to-date.The provider had quality assurance processes in place to assess and monitor the quality of service.