About the service: Hightrees is a residential care home providing personal care and support to five people who were aged under 65 at the time of the inspection.

The care service had not originally been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. The home had been registered before such guidance was produced. The guidance focussed on values including choice, promotion of independence and inclusion so that people with learning disabilities and autism using a service can live as ordinary a life as any citizen. However, it was clear that people living in Hightrees were given such choices. The home was located in a residential suburb where people’s independence and participation within the local community continued to be encouraged and enabled.

People’s experience of using this service:

People who lived at the home continued to be supported to remain safe. Staff knew people well and supported them with kindness and consideration. We saw that staff were particularly sensitive and supportive when a person who had lived at the home for some time left during the inspection to move to another service.

People received medications safely and risks to people had been assessed and managed to identify and reduce or address the impact of any known risks. Other aspects of safety were well managed in the home, including fire safety and issues of personal safety.

People continued to be supported in a well maintained and comfortable home with access to all communal areas and private space as they wished.

People were supported to have choice and control over their day to day lives and received kind support and assistance from staff to exercise choice to make everyday decisions. Peoples rights were upheld and protected. People were protected from discrimination and supported to make full use of all community based facilities.

People continued to be supported by an established team of staff who provided kind and personalised care to people living in the home. Safe recruitment of staff ensured people were supported by staff of good character and people were supported to be involved in the recruitment process.

The registered manager encouraged staff to identify and support opportunities for people to engage in community-based activities and enjoy a range of experiences in line with their wishes or interests. People’s preferences and experiences were known to the registered manager and staff who encouraged and enabled people to do as much as possible for themselves.

There was a range of monitoring systems in place that checked if the home was well managed and effective in supporting people to have a good quality of life. People were supported by staff who were well trained and focussed on supporting people with their plans.

The home continued to meet the characteristics of a rating of good in all areas.

Rating at last inspection:

The home was rated Good at the last inspection (report published in January 2017).

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will continue to monitor the home through the information we receive.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Our inspection took place on 19 October 2016 and was unannounced.

The provider is registered to accommodate and deliver personal care to five people who have autistic spectrum disorder and/or learning disabilities. Five people lived at the home at the time of our inspection.

At our last inspection of May 2014 a breach of regulations was identified. Action was needed to ensure the correct and safe storage of food to protect people from the risks of food-borne illnesses. At this inspection we found that this action has been completed.

There was 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.

People were protected from the risk of harm and abuse because staff had received the training they needed to recognise and report abuse. Risks associated with everyday living had been identified and managed so that people were protected and staff were aware of what they needed to do to reduce risks. Staff were recruited safely and staffing levels ensured that people were safe and received the care and support that they needed in the way that they preferred. People received their prescribed medicines by staff who had been trained to do this safely.

Staff were provided with the training they needed to meet peoples specific needs. Staff had regular supervision to reflect on and develop their practice. The principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguarding (DoLS) were understood by staff who ensured that they sought people’s consent and did not unlawfully restrict their liberty. People’s dietary needs were met and they were supported to eat and drink sufficiently. People had access to a range of health care professionals to meet their healthcare needs.

People were supported by staff who were kind and friendly. Staff actively involved people in identifying their needs and preferences and this had increased people’s level of control over their lives. People were cared for by staff that protected their privacy and dignity and respected them as individuals. People were supported to pursue their hobbies and interests and maintain positive relationships with their relatives.

The management style was supportive and staff were highly motivated to develop the service to ensure that people were benefitting from a service that was continually improving.. The quality of the service was regularly monitored to ensure it remained safe and responsive to people’s needs. People’s feedback was sought and acted upon and the process for responding to complaints was effective.

Our inspection team was made up of one inspector. We spoke with four people who used the service and five members of staff. They helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People are treated with respect and dignity by the staff. All people told us they felt safe.

The provider had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. All but two staff had been trained to understand when an application should be made, and in how to submit one. This meant that people will be safeguarded against an unlawful deprivation of liberty.

The storage of food needs improvement. People who used the service were not protected from the risks of food-borne illness. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to protecting people from the risk of infection.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. Relevant staff had received training in the safe handling of medicines. We saw that medicines were monitored on a daily basis and audited fortnightly. This meant that potential errors could be investigated and there were appropriate arrangements for the safe handling of medicines.

Is the service effective?

People who used the service told us the care and support provided at the home was good.

People’s needs were assessed and care and support was planned and delivered in line with their individual care plans. Care plans considered all aspects of the person's circumstances and were centred on them as an individual. Pen pictures were included that gave detailed information on how best to provide different aspects of a person’s care. Potential areas of risk had been identified for each person and plans to manage these risks had been developed. Care plans, risk assessments and risk management plans were regularly reviewed and updated when needs changed. This meant care and support was provided according to the person’s needs and choices.

Is the service caring?

All people told us they got on well with staff. They said staff were helpful and listened to them. One person said, “I really like them, they are lovely”.

We observed effective communication and good relationships between the staff on duty and the people living in the home. Staff made sure they gave individual time to those people who needed this. This helped to make sure people felt listened to and their needs were met.

Is the service responsive?

People had regular opportunities to do things they enjoyed. We found that care plans reflected people's social interests and encouraged their independence. Examples include going to the gym, swimming and the cinema. One person said staff, “Help me do the things I want to".

Information on how to make a complaint was available in the entrance hall to the home and in the information pack given to people who used the service and their representatives. There had been no recent complaints.

Is the service well-led?

The service has a quality assurance system. We found that a range of internal audits were carried out regularly to regularly assess and monitor the quality of service that people received.

People using the service completed an annual satisfaction survey. Where shortfalls were raised these were being addressed.

Staff received appropriate professional development. They had regular supervision. We saw that any performance issues were being addressed and positive feedback given when appropriate. Staff told us that they found the formal and informal supervision meetings helpful. Staff had received mandatory training which meant they had the right knowledge to meet people's individual needs.

People’s personal records were accurate and fit for purpose. We saw records were updated as soon as practical and were clear and maintained the dignity of the people who used the services. Records were kept securely and could be located promptly when needed.

On the day of our visit we met and spoke with all four people who used the service. However, because of their complex health needs they were not able to tell us much about their experiences of the home. People smiled and told us they were having a “party” and pointed to the party clothes they were wearing. We saw people singing and dancing at the party.

We also spoke with two members of staff on duty and looked at documentation that was made available to us. We saw staff interacting in a friendly manner with people helping them to choose what they wanted to do. People appeared at ease in their environment and were appropriately dressed for the hot weather.

People made day to day decisions about their lives such as getting up and eating when they wanted. They moved freely around the home and gardens.

People received adequate nutrition and were supported to make choices about the food they ate. Staff were knowledgeable about any specific dietary requirements people had and supported them with this.

Processes for the recruitment of staff helped to ensure that people were cared for by suitably skilled and experience staff. Staff skills were kept up to date through training and information updates.

Systems were also in place to monitor how the service was run and ensure people received a quality service.

Due to the complex needs of people living at Hightrees not everyone we met was able to share their experiences of using the service with us. We therefore used a variety of other methods to help us understand people’s experiences such as observing care being given and reviewing relevant documentation.

We met three people who used the service. The people we met appeared at ease in their surroundings and chatted freely to us about the things they were interested in. One person we spoke with told us that they felt settled at the home. We saw another person returning from a trip out to the shops with staff.

At the time of our visit there were three people in the home; two had gone out for the day. Only one person spoke with us about their experience of living in the home.

We spent time observing life at the home. Some people appeared at ease in their surroundings, although this was not consistent with everyone we met.

We saw staff attending to people’s needs in a calm and relaxed way

People who lived in the home told us that they were happy living there and with the care and support they received. They told us "it's a nice home" and "staff talk to me about what I want to do". One person who lived in the home told us “it is a good home. This place is helping me”.

People were also happy with the food and the environment at the home. They told us “the meals are nice”, “I like the food”, “it’s quite clean”. Several people told us “I like my bedroom” or “I am happy with my room”.

People also told us that, if they were unhappy about something, they would talk to the manager.