About the service: Highwater House provides accommodation and personal care for up to 22 people who have been homeless or are at risk of being homeless. People accommodated have a mental health disorder and a drug and/or alcohol dependency. The service is situated in the centre of Norwich.

People’s experience of using this service:

People at Highwater House received outstanding care and were supported by a staff team that were committed, passionate and knowledgeable. People were treated with exceptional kindness and people were extremely positive about the care they received.

The staff team were highly motivated and there was a strong commitment from the organisation on the development of their competence and knowledge and on ensuring that they felt valued.

People were at the very heart of the service and staff were really proud of what people had achieved. People had strong relationships with their keyworkers. There was a mutually respectful culture and people were involved in how the service was run at every opportunity.

The staff team embraced new initiatives and the feedback that we received evidenced that outcomes people experienced on their physical and mental wellbeing were exceptional.

The service worked in partnership with other organisations to share awareness of the client group and to ensure effective, joined up care.

Staff encouraged and supported people to take part in a wide range of activities which promoted their self-esteem and wellbeing. Staff were creative in ensuring that people were engaged and stimulated. There were good community links and people accessed the community regularly.

Effective management systems were in place to safeguard people and promote their wellbeing.

The management team provided a high-quality, person led service with a strong emphasis on continual improvement and best practice.

Rating at last inspection: Good (report published 09 May 2016)

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor all information received about this service to ensure that the next planned inspection is scheduled accordingly.

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

This inspection took place on 11 February 2016 and was unannounced.

Highwater House is a residential care home that can accommodate up to 22 people who have been homeless or are at risk of being homeless. People also have a mental health disorder and a drug and/or alcohol dependency. It does not provide nursing care and is one of the two residential care homes that are owned and operated by St Martin's Housing Trust.

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 harm by staff who understood the importance of preventing, recognising and reporting potential signs of abuse.

Risks to people in all areas of their lives were identified when they started using the service and were regularly reviewed to ensure that the management of the risk remained appropriate.

People were supported by staff who were well training and competent. They had undergone the appropriate recruitment checks to ensure they were safe to work in health and social care. There were consistently enough staff to meet people’s needs and keep them safe. The service also had plans in place to further develop staff’s skills and knowledge.

People received their medicine when they needed it and the service managed medicines safely and appropriately.

The Care Quality Commission is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. People were not being deprived of their liberty unlawfully. Staff understood about people’s capacity to consent to care and had a good understanding of the MCA and DoLS which they put into practice. At the time of our inspection none of the people living at Highwater house were subject to DoLS.

People living in the home were supported to have enough to eat and drink and they were supported to make choices about what they ate and how they lived their lives

People living in the home were registered with local health services and were supported to attend any necessary health appointments.

People benefited from a staff team who were motivated, worked well as a team and felt supported. Staff were happy in their work and supported people with kindness, compassion and thoughtfulness. Staff had good knowledge of the people they supported and they maintained people’s independence and dignity whilst encouraging choice. Staff supported people in their likes and dislikes and people were encouraged to be involved in decisions around the care and support they received.

People’s plans of care were developed around the individual. Care plans gave staff full and clear guidance on how people wished to be supported. People’s developing needs were regularly assessed and the plans updated accordingly.

The service had an open, supportive and transparent culture and people felt they were listened to. People’s views and feedback was encouraged in order to improve and develop the service. Suggestions were listened to and actioned where appropriate.

Regular audits were completed effectively and contributed to the development of the service.

At the time of our inspection there were 21 people living at Highwater House. Two other rooms were reserved for people who were being considered for admission. We met and spoke with six people who were using the service. They all told us that they felt safe, they were happy living there and that staff treated them well. We also spoke with staff.

People were asked about their experience of the service through an annual customer care questionnaire. We found that the responses to the June 2013 survey were universally positive. One person described Highwater House as an “...excellent service.” Another said it was “The best home I have ever seen.” When asked what they liked most about the service one person replied, “Safety.”

Staff worked effectively with partner agencies to provide a coordinated package of care that met people’s individual needs. People were supported by staff and independent agencies to make decisions about the care and treatment they received. They told us that they understood what the service offered and could raise any concerns or complaints they may have with staff. People were made aware of the provider’s complaints procedures. The provider had arrangements in place to manage the premises safely and to ensure that the environment and facilities met people’s needs. Records were complete, accurate and stored securely.

People using the service said they were very happy with it. One person said, “You can’t fault the staff, this is the best place I have ever stayed”. Another person said, “The staff are great, they really listed to me”.

Care plans showed that people were involved in making decisions about how they wished to be supported, and their individual choices respected. Each person was encouraged to set their own goals about what they wanted to achieve.

Staff spoke with people in a respectful manner. People told us that staff accepted their choice to be alcohol and/or drug dependent and did not judge them. They explained that staff supported them to make decisions about what they wanted to achieve, and helped them make small steps to leading an independent life.

There were enough suitably trained and experienced staff to meet the needs of people using the service. Staff were well supported and had access to various education programmes to meet the needs of people.

People using the service told us that they felt safe and there were plenty of educational, social and relaxing activities that they could choose to take part in. We saw that the premises were well maintained and the service promoted involvement of the people using it.

We spoke with two people who used the service. They told us that their needs were met and that they were consulted about the care and support that they were provided with. People told us that the staff encouraged them to make changes to their lifestyle, always treated them with respect and that their privacy was respected. They were complimentary about the staff that cared for them and told us that there were educational, social and therapeutic activities that they could choose to take part in. They told us that they felt safe living at the home and that the environment was comfortable and clean.

Staff members with whom we spoke told us that they had completed training. They told us that they were given the information they needed and could read in the plans of care of anyone living in the home the changes made to their care and support. They told us that they accepted the choice of people living in the home to be alcohol and/or drug dependant but they encouraged and supported anyone wishing to make positive changes to their lifestyle and habits.

The Manager with whom we spoke told us that every effort was made to ensure the needs of people living at the home were met and that staff were fully trained. They told us that people living in the home made their own decisions on all aspects of their lives and were assisted to be as independent as possible.