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Inspection carried out on 3 December 2019

During a routine inspection

About the service

Highfield Cottage is a residential care home providing personal care for up to two people living with learning disabilities. People are supported in a domestic bungalow with a garden. At the time of our inspection two people were using the service.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service and what we found

People well settled living at Highfield Cottage. Relatives told us staff were caring. Staff knew how to protect people from abuse. Risks to people were identified. Staff knew the actions to take to reduce such risks.

Medicine management was generally safe. However, we identified some additional protocols were needed for some ‘as required’ medicines. Recruitment systems reduced the risk of unsuitable candidates being employed.

Staff had the right skills and knowledge to deliver care and support in a person-centred way. They were supported through training, supervision meetings and an annual appraisal.

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. The service used positive behaviour support principles to support people in the least restrictive way. People’s health needs were met. The service worked closely with a range of health professionals.

Staff encouraged people to be as independent as they were able. Care and support was based on people’s individual needs and preferences. They were encouraged to take part in the activities that interested them. Staff encouraged and supported people to be part of their local community.

People and relatives told us the service was well led. They told us communication with the service was good.

We have made a recommendation about review of the service's policies.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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

Rating at last inspection

The last rating for this service was good (published 30 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Inspection carried out on 2 June 2017

During a routine inspection

This inspection took place on 2 June 2017 and was announced. We informed the provider at short notice (two days before) that we would be visiting to inspect. We did this because the location is a small service for people who are often out during the day and we wanted to make sure the people who lived there would be in when we visited.

Highfield Cottage is a terraced domestic bungalow with its own garden. It provides support for up to two people who have a learning disability. At the time of our inspection two people were using the service.

At the last inspection on 31 March 2015 the service was rated Good. At this inspection we found the service remained Good.

Risks to people using the service were assessed and plans put in place to reduce the chances of them occurring. Accidents and incidents were monitored by the registered manager to see if actions could be taken to improve people’s safety. People’s medicines were managed safely. Staffing levels were based on the assessed level of support people needed, and were regularly reviewed to ensure they were sufficient to keep people safe. The provider’s recruitment processes minimised the risk of unsuitable staff being employed.

Staff received training in a number of areas to support people effectively. Newly recruited staff had to complete the provider’s induction programme before they could support people unsupervised. Staff were also supported with regular supervisions and appraisals. People’s rights under the Mental Capacity Act 2005 were protected. People were supported to maintain a healthy diet and to access other healthcare professionals involved in their care.

We saw numerous examples of kind and caring support during our inspection. Staff were very familiar with people’s individual communication needs, and used this knowledge to deliver kind and caring support. Staff treated people with dignity and respect at all times. People were encouraged to maintain their independence. Procedures were in place to arrange advocacy support where needed.

Care was personalised. Staff we spoke with were able to describe the support people needed in detail, and we saw them following the guidance laid out in care plans throughout the inspection. Care plans were regularly reviewed to ensure they reflected people’s current support needs. People were supported to access activities they enjoyed. Procedures were in place to investigate and respond to complaints.

Staff spoke positively about the culture and values of the service and said they enjoyed their work. Staff also spoke positively about the registered manager, who they said was supportive. The registered manager and provider carried out a number of quality assurance checks to monitor and improve standards at the service. Staff regularly checked that people were happy at the service, and feedback was sought from staff, relatives and external professionals. The registered manager had submitted required notifications to CQC.

Inspection carried out on 31 March 2015

During a routine inspection

We inspected Highfield Cottage on 31 March 2015. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.

Highfield Cottage is a terraced domestic bungalow with its own garden. Highfield Cottage provides support for one person who has a learning disability.

The home had a registered manager in place who has been in post since the home opened. 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.

The person living at the home had no verbal communication and required staff to provide support to manage all aspects of their day-to-day care needs as well as to manage their behaviour. We found that the registered manager had taken appropriate steps to ensure staff provided consistent and effective responses. They had ensured that all the staff were able to understand the way the person communicated and used the same objects of reference to support the person and understand what they needed to do. For instance all the staff showed the person their coat when it was time to go out; and their sponge when it was time for a bath.

We observed that staff had developed very positive relationships with the person and appeared to understand fully what was being communicated. Interactions between the staff and person were warm and supportive. The person was involved in activities and outings that they enjoyed. Staff were kind and respectful.

Staff had received Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards training and understood the requirements of the Act. We saw that staff routinely and appropriately used the ‘Best Interests’ framework to ensure the support they provided was appropriate. This meant staff worked within the law when supporting the person.

Staff told us about the person’s diet and how they ensured that individual’s nutritional needs were met. We saw that person’s preference was catered for and they were supported to manage their weight and they were encouraged to eat an ever widening range of healthy foods.

The person’s needs were assessed and care and support was planned and delivered in line with their care needs. The care plans contained comprehensive and detailed information about how the person should be supported. We found that risk assessments were very detailed. They contained person specific actions to reduce or prevent the highlighted risk.

We reviewed the systems for the management of medicines and found that the person received their medicines safely.

The person was supported to maintain good health and had access to healthcare professionals and services. We found that staff worked well with the person’s healthcare professionals such as their consultants and community nurses.

There were enough staff on duty to meet the person’s needs. The registered manager was available during the weekday. A senior support worker and a support worker were on duty during the day and overnight one waking night and one sleep-in care staff member were on duty overnight. We found staffing levels were determined by the person’s needs.

Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work. The checks included obtaining references from previous employers to show staff employed were safe to work with vulnerable people. We saw that the provider had a system in place for dealing with people’s concerns and complaints.

Staff had received a wide range of training, which covered mandatory courses such as basic food hygiene as well as condition specific training such as working with people who had learning disabilities. We found that the provider ensured staff received refresher training on on an annual basis and offered staff regular access to a wide range of other courses.

We found that the building was very clean and well-maintained. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety.

We found that the registered manager constantly critically reviewed the service and looked at what more could be done to make sure the person lived a fulfilling life. The systems being used were extremely effective and the service was well-led.

Inspection carried out on 12 May 2014

During a routine inspection

Our inspection team was made up of one inspector. We gathered evidence against the outcomes we inspected to help answer the five key questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

We looked at a range of records, spoke with the manager and three staff. We observed the interactions between staff and people living at Highfield Cottage and engaged with people who used the service.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with the staff manager and staff and observed how staff supporting people lived at Highfield Cottage.

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

Is the service safe?

We saw that there were systems in place to keep people safe. People were provided with appropriate levels of staffing and observation to keep them safe.

There were effective systems in place for the ongoing maintenance and servicing of equipment. There were also good systems in place in respect of fire safety and fire training.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care home. The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Staff had received training in relation to these topics along with the safeguarding of vulnerable adults.

Is it effective?

People all had their needs assessed and had individual care records which set out their care needs. We observed how aspects of care detailed within a person�s care plan was delivered by staff. It was clear from our observations and from speaking with staff that they had a good understanding of the people's care and support needs and that they knew them well.

We found that nutritional screening had been carried out for people who used the service. This meant that people received timely and appropriate intervention if they lost weight. We saw that people were supported to have adequate nutrition and hydration.

Staff knew how and when to involve other health and social care professionals. We saw lots of evidence contained within people�s care records

Is it caring?

People were supported by kind and attentive staff. We saw that staff engaged with people in a positive way and showed respect, kindness and gave people gentle encouragement.

People's needs had been assessed and care plans put in place which detailed people's needs and preferences. These records provided comprehensive information to staff on what care and support people who lived at Highfield Cottage needed.

People's preferences, interests, aspirations and diverse needs had been recorded and in their care records. Care and support had been provided in accordance with people�s needs.

Is it responsive?

There was clear evidence contained within people's care plans to show how they worked with other health and social care professionals. We saw lots of evidence of multi-agency working and also of annual health checks.

It is well led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The home had a registered manager. There were systems in place to assure the quality of the service they provided. The way the service was run was regularly reviewed. Actions were put in place when needed and we were able to see that these actions had been addressed.

Staff had a good understanding of the ethos of the home and were knowledgeable about people's needs. This helped to ensure that people received a good quality service at all times.

What people told us.

During this inspection we were unable to engage people in verbal communication. We did however carry out some observations while people were in the service. We saw that staff treated people with dignity and respect. We saw that there was a real sense of well-being, with lots of smiles and positive non-verbal communication.

We saw that staff had a good understanding of people�s non-verbal cues and were very quick to respond to them. We saw them engaging a person with a range of activities including singing and watching a DVD as well as doing puzzles.

Staff told us about the various activities available. These included attendance at a local day centre, hydrotherapy sessions and going to the disco twice a week as well as going out for meals. Staff said, �They absolutely love the disco, they are up dancing the whole time.� We also saw within the home that there were lots of activity equipment available. These included sensory equipment, books, DVDs, puzzles and music equipment.

Inspection carried out on 24 July 2013

During a routine inspection

We observed the experiences of people who used the service. We saw that staff interacted and communicated well with people. The staff were attentive and demonstrated a good knowledge and understanding of the needs of people. We saw that the atmosphere in the home was friendly and relaxed.

We saw that people had their needs assessed and that care plans were in place. We saw that there were effective processes in place to ensure safe sharing of information with other providers.

We found that medicines were administered safely.

The care and support was provided by suitably qualified, skilled and experienced staff.

There was an effective complaints system available and staff were aware of how to support people to make a complaint.

Inspection carried out on 18 February 2013

During an inspection in response to concerns

Throughout our inspection we found that people who used the service experienced care, treatment and support that met their needs and protected their rights.

We responded to concerns raised over medication and found that people who used the service were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

Inspection carried out on 20 September 2012

During a routine inspection

We found that people who used the service had their privacy, dignity and independence respected. Their views, or the views of those acting on their behalf, were taken into account in the way the service was provided and delivered in relation to their care. People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

People who used the service, experienced care and support that met their needs and protected their rights and we found that people were protected from the risk of abuse.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.

We were unable to speak to any people who used the service but observations showed that people who used the service were treated with respect. People who used the service appeared to be relaxed and happy.