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Inspection carried out on 30 April 2018

During a routine inspection

We inspected this service on 30 April 2018. The inspection was unannounced. We informed the registered manager that we would continue our inspection on 1 May 2018, when we gained feedback from people by telephone conversations.

Highfield is one of eight services provided by Polesworth Group Homes Limited. Highfield is a purpose built bungalow which provides accommodation with personal care for up to five people with a learning disability. At the time of our visit, there were five people living in the home. The service also provides domiciliary care to 20 people with a learning disability in their own homes, some of whom require 24-hour support from staff.

At our last inspection in December 2015 we rated the service as good overall. However, we rated the effectiveness of the service as requires improvement because where people lacked capacity to make day to day decisions, mental capacity assessments had not always been completed. Neither had Deprivation of Liberty applications been made as required. At this inspection, we checked whether improvements had been made and found they had.

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.

Staff had received training in the Mental Capacity Act 2005 and worked in line with this to promote people’s best interests. Staff offered choices to people and gained consent before, for example, supporting them with personal care.

People were safe from the risks of harm, because staff understood their responsibilities to protect people. Staff had been trained in what constituted abuse and would raise concerns under the provider’s safeguarding policies. The provider checked staff’s suitability to deliver care and support during the recruitment process.

There were enough staff on shift to support people safely and meet their individual needs. Staff received training and used their skills, knowledge and experience to provide effective and responsive care.

People’s needs were assessed before they moved to live at the purpose built bungalow or receive a domiciliary care service in their own home. Risks to people’s safety and wellbeing were assessed and plans were in place to reduce these. Accidents and incidents were recorded by staff and investigated and actions taken to minimise the risks of reoccurrence.

People were supported to eat and drink enough and staff promoted healthy choices around food.

People were very relaxed in the presence of care staff and the registered manager. Staff were friendly toward people, showing respect toward them and that people were valued in the home. Staff knew people well and how to meet their needs.

People were able to take part in individual leisure activities according to their preferences. There were also opportunities for people with shared interests to do activities in a group.

Staff were happy in their job role and felt well supported by the team and the registered manager. Staff felt listened to and able to contribute to the way the service was delivered.

People and their relatives had no complaints about the service. They felt the registered manager would deal with any concern if they needed to raise something.

The registered manager and provider carried out a range of quality audits to ensure people received safe, effective and responsive care that met their individual needs.

Further information is in the detailed findings below.

Inspection carried out on 8 December 2015

During a routine inspection

This inspection took place on 8th December 2015 and was announced.

Highfield is a purpose built bungalow designed to support five people with a learning disability. The service also provides domiciliary care across eight supported living locations, to people with a learning disability in their own homes, some of whom require 24-hour care.

The service had a registered 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 were comfortable with staff and relatives were confident people were safe living in the home. Staff received training in how to safeguard people, and had access to the provider’s safeguarding policies and procedures if they had any concerns. Staff understood what action they should take in order to protect people from abuse. Systems were used to identify and minimise risks to people’s safety. These systems were flexible so people could take risks if they were able to do so and build their independence.

People were supported with their medicines by staff that were trained and assessed as competent to give medicines safely. Medicines were given in a timely way and as prescribed. Regular checks of medicines helped ensure any issues were identified and action could be taken as a result. There were enough staff to meet people’s needs.

The provider conducted pre employment checks prior to staff starting work to ensure their suitability to support people who lived in the home. Staff told us they had not been able to work until checks had been completed.

Some people were considered to lack capacity to make decisions. We found that assessments of capacity for these people had not always been completed, and DOLS applications had not been made as required. However, staff and the registered manager had a good understanding of the Mental Capacity Act, and the need to seek informed consent from people wherever possible.

People told us staff were respectful and treated them with dignity and respect. We also saw this in interactions between people at our inspection visit, and it was also reflected in records kept. People were supported to make choices about their day to day lives. For example, they could choose what to eat and drink and when, and were supported to maintain any activities, interests and relationships that were important to them.

People had access to health professionals whenever necessary, and we saw that the care and support provided in the home was in line with what had been recommended. People’s care records were written in a way which helped staff to deliver personalised care, which focussed on the achievement of outcomes. Staff tried to ensure people were fully involved in how their care and support was delivered, and people were able to decide how they wanted their needs to be met.

Relatives told us they were able to raise any concerns with the registered manager, and they would be listened to and responded to effectively, and in a timely way. Staff told us the management team were approachable and responsive to their ideas and suggestions. There were systems to monitor the quality of the support provided in the home, and recommended actions were clearly documented and acted upon. This was achieved through unannounced provider’s visits.

Inspection carried out on 3 December 2013

During a routine inspection

When we visited Highfield we did so unannounced which meant that no one who lived at or worked at the service knew we were coming. During our visit we met and spoke with people that lived in the home. We also spoke with visiting relatives, three members of support staff and the manager. Following our visit we spoke by telephone with one person who used the domiciliary service, a person's relative and a staff member who provided domiciliary support.

We saw that people who lived in the home appeared well cared for. We observed that they were comfortable in the presence of the staff and enjoyed lively banter throughout our visit. We saw that people who required personal care were treated with dignity and compassion by the staff team.

People told us that they were happy with the care and support they received from both aspects of the service. Relatives we spoke with also confirmed that they were satisfied with the services provided for their family members. "They go above and beyond" and "He's certainly well looked after" were comments made.

People had care plans in place that identified their care and support needs. These were up to date. Staff told us that they found the information in people's plans helpful when learning about each person's needs. "They helped me to understand the care and support people need, their individual quirks and anything else that I needed to know" was a comment made.

There were processes in place for assessing the quality of the service provided for people.

Inspection carried out on 10 October 2012

During a routine inspection

When we visited Highfield Care Home we spoke with three people who lived there, two staff members and the manager. We also spoke with two people who receive a domiciliary care service and a member of staff from the domiciliary care team.

We looked at the care planning documentation for three of the people using the service to see how their care was provided and managed.

People had care plans in place that contained information to assist staff with meeting their care needs. Staff we spoke with were knowledgeable about people's care needs and were able to tell us about them.

Staff said they were trained to help them understand how to meet people�s needs and give the support people needed.

Some of the people living in the home had complex needs which meant that they were not always able to tell us their experiences. We spent time during our visit observing care to help us understand their experiences.

We observed that people appeared comfortable and at ease in their surroundings and with the staff. We asked one person if they liked living at Highfield and they replies, �Too true.� Another person indicated that they were happy living in the home by nodding their head and smiling when we asked.

Inspection carried out on 31 May 2011

During a routine inspection

People spoken with who use the service told us they were happy with the help and support offered to them and find the staff kind and respectful.

Staff spoken with told us that they had undertaken all necessary training courses and were well supported by the manager.

We had an opportunity to speak with two visitors, who told us �This is a good home and my relative is looked after very well�. They told us the staff were skilled and competent in their role and they had no concerns about the service their relative received. They also told us the staff were welcoming and kept them up to date about their relative�s well being.

Reports under our old system of regulation (including those from before CQC was created)