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Inspection carried out on 8 August 2018

During an inspection to make sure that the improvements required had been made

This focused inspection took place on 8 August 2018. It was unannounced and commenced at 5:50am.

Highview Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service is registered to accommodate a maximum of 19 people who require either personal care. The building was originally a private dwelling which has been converted and extended to become a care home. There were 18 people living at the home when we inspected. The service specialises in providing care to people living with dementia.

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 spoke very highly of how caring the staff and managers were and we received only positive comments about Highview Residential Home throughout our inspection.

This inspection was carried out because we received concerns that insufficient numbers of staff were on duty at night and this meant that people were being woken early contrary to their wishes.

All of the people living at the service were living with dementia. The registered manager explained that the progression of the condition meant, for many of the people living in the home, that they no longer understood times of the day. In addition, many people chose to go to bed very early which, in conjunction with lack their lack of awareness of time, meant that they also woke very early.

Many people were up and dressed or awake in their rooms when we started our inspection. Staff told us that people had woken at times of their choosing. The registered manager was aware of this change in people's routines and was taking steps to ensure staffing levels were amended to ensure people’s needs and preferences were responded to.

People received the support they required with their medicines. However, the change in people’s night time routines had affected when staff administered some medicines. The registered manager agreed to seek advice from GP’s and ensure that care plans and records of administration contained the required information about this.

Following the inspection, the registered manager confirmed that they had taken action to address the issues discussed and to ensure that the improvements were monitored and reviewed.

Inspection carried out on 15 May 2018

During a routine inspection

Highview Residential Home (referred to in this report as Highview) is a residential care home providing personal care for up to 19 older people, some of whom are living with dementia. Nursing care is not provided at the home. This is provided by the community nursing service. At the time of our inspection there were 18 people living in Highview.

At the last inspection in April 2016 the service was rated Good overall. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated Good.

The people who lived in Highview were provided with high quality; caring support which was person centred and met their individual needs. We received positive feedback about the staff at the home and the quality of the care provided. Some of this feedback included comments like, “I am as happy as I can be here”, “I can’t fault them. They’re magic” and “Highview is an amazing place. I cannot fault it in any way.”

People were protected from risks relating to their health, their dementia related behaviours, mobility, medicines, nutrition and possible abuse. Staff had assessed individual risks to people and had taken action to seek guidance and minimise identified risks. Staff knew how to recognise possible signs of abuse.

Where accidents and incidents had taken place, these had been reviewed and action had been taken to reduce the risks of reoccurrence. Staff supported people to take their medicines safely and staffs’ knowledge relating to the administration of medicines was regularly checked. Staff told us they felt comfortable raising concerns.

Staff treated people with respect and kindness. There was a warm and pleasant atmosphere at the home where people and staff shared jokes and laughter. Staff knew people and their preferences well. People were supported to have enough to eat and drink in ways that met their needs and preferences. Meal times were social events and people spoke highly of the food at the home.

Recruitment procedures were in place to help ensure only people of good character were employed by the home. Staff underwent Disclosure and Barring Service (police record) checks before they started work. Staffing numbers at the home were sufficient to meet people’s needs. Staff had the competencies and information they required in order to meet people’s needs. Staff received sufficient training as well as regular supervision and appraisal. Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and put this into practice.

People, relatives, staff and healthcare professionals were asked for their feedback and suggestions in order to improve the service. There were systems in place to assess, monitor and improve the quality and safety of the care and support being delivered.

Further information is in the detailed findings below

Inspection carried out on 19 February 2016

During a routine inspection

This inspection took place on 19 and 22 February 2016 and was unannounced. This meant the staff and the provider did not know we would be visiting. At the time of our inspection there was a registered manager in post. A registered manager is a person who has registered with 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 2008 and associated Regulations about how the service is run.

Highview Residential Home provides accommodation and support for up to 19 older people who may be living with dementia. There were 18 people living in the home during our inspection.

People were encouraged and supported to make their own decisions and choices whenever possible in their day to day lives. People's privacy and dignity was maintained. We observed the staff supporting people with kindness and patience at all times.

People were protected by safe recruitment procedures. Staff were supported with an induction and ongoing training programme to develop their skills and staff competency was assessed. People, visitors and staff we spoke with felt there were sufficient staff on duty.

People had access to healthcare professionals to make sure they received appropriate care and treatment to meet their health care needs, such as district nurses and doctors. Professionals said the staff followed the guidance they provided. This ensured people received the care they needed to remain safe and well, for example people had regular visits by district nurses to check their blood sugar levels.

People's medicines were managed safely. Medicines were managed, stored and disposed of safely. Senior staff administered medicines had received medicines training and confirmed they understood the importance of safe administration and management of medicines.

The registered manager and staff had sought and acted upon advice when they thought people's freedom was being restricted. This helped to ensure people's rights were protected. Applications were made and advice sought to help safeguard people and respect their human rights.

Staff had undertaken safeguarding training, they displayed a good knowledge of how to report concerns and were able to describe the action they would take to protect people against harm.

People were supported to maintain a healthy, balanced diet. People told us they enjoyed their meals and we observed mealtimes did not feel rushed.

People's care records were mostly comprehensive and detailed people's preferences. Records were regularly updated to reflect people's changing needs. People and their families were involved in the planning of their care.

People's risks were considered, managed and reviewed to keep people safe. All the people we spoke with told us they felt safe at Highview Residential Home. Where possible, people had choice and control over their lives and were supported to engage in activities within the home.

We saw people participated in a range of daily activities both in the home which were meaningful and promoted their independence.

There were systems in place to monitor and improve the quality of the service provided. Regular checks and audits were undertaken to make sure full and safe procedures were adhered to.

People using the service and their relatives had been asked their opinion via surveys. However responses were not analysed to address lower scoring areas.

Inspection carried out on 17 April 2014

During an inspection to make sure that the improvements required had been made

We visited Highview Residential Home on 17 April 2014 to review two compliance actions related to the management of medicines and nutrition in the home. We also looked at three additional outcomes, care and welfare of people who use the service, safeguarding people who use the service and assessing and monitoring the quality of service provision.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

• Is the service safe?

• Is the service caring?

• Is the service responsive?

• Is the service effective?

• Is the service well led?

This is a summary of what we found.

Is the service safe?

Care was planned to meet people's needs. Where a need was identified a plan was in place to meet this need. For example, one person's care record stated that they required assistance to change position. This plan detailed the frequency of position changes, the equipment required and the numbers of staff.

There were enough staff on duty to meet the needs of people living in the home and two members of the management team were available on call in case of emergencies.

People were supported by staff who were able to perform their role. We looked at the staff training matrix and this showed that all staff who worked at Highview Residential Home had completed training about safeguarding vulnerable adults. We spoke with staff who understood what safeguarding was and what they would do if they suspected someone was being abused. All of the staff we spoke with could name types of abuse a person could be subjected to, and said they would report any suspicions to the manager or the local authority.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which apply to care homes. No applications had been submitted; however the registered manager explained that due to the recent Supreme Court ruling, they were in the process of preparing DoLS applications to submit to the local authority. The provider had a policy and relevant staff understood how an application should be made.

Is the service caring?

People were treated with consideration and respect and their privacy was maintained. We spoke with four people and the relatives of one person. One person told us, "It’s all very well run." Another person said, "They are nice and polite." A person's relative commented, "There are no problems."

Staff communicated with people in a sensitive and considerate manner. For example, we saw a member of staff go out for a walk with one person who was becoming unsettled. We observed another member of staff sat at a table supporting a person with their meal. The staff member waited until the person had finished what was in their mouth before offering more food. We saw that bedroom and bathroom doors were kept closed when people were being supported with personal care and staff knocked on doors before entering.

Is the service effective?

Peoples’ needs were assessed and care was planned and delivered to meet their needs. For example, we looked at the accident records for people living in the home. We found that where one person had fallen several times during the month, the registered manager had contacted the person's GP for further advice. We saw that as a result the GP subsequently visited and changed the person's medication. We noted that since the change, no further accidents had been recorded. One person's relative told us, that they felt that their mother’s care needs were being met. People's needs were taken into account with signage and the layout of the home, enabling people to move around freely and safely.

Is the service responsive?

People accessed the services of healthcare professionals as required. A relative told us, "I am kept informed of any changes. Just recently the manager asked me if I would like to review Mum’s care plan". Records of visits from healthcare professionals were kept. For example, we found that visits from chiropodists, district nurses, opticians and GPs were documented.

Is the service well led?

The provider undertook a variety of audits to check the quality of the service. For example, we looked at audit reports relating to privacy and dignity, personal care, dementia, medication, health and safety and accidents. We found that actions had been taken as a result of this monitoring. For example, a recent dementia audit highlighted the need for social evenings for residents and families.

People were able to comment on the service provided. People told us that they had recently attended a resident/relative meeting which included topics such as ongoing redecoration, menus, activities and staff.

Inspection carried out on 4 October 2013

During an inspection in response to concerns

We carried out an inspection visit to Highview Residential Home on Friday 4 October 2013 because concerns had been raised with us regarding the care provided to people.

At this unannounced inspection we spoke with the deputy manager, three members of staff, three relatives and three people who used the service.

All of the people and relatives we spoke with expressed satisfaction with the service provided. People told us that staff were "caring". One person said "It’s very good here". A visitor told us that they had "no concerns" about the care provided for their relative.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

People did not receive consistent support to ensure they had sufficient amounts to eat and drink.

Appropriate checks were undertaken before staff began work.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

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

Inspection carried out on 20 February 2013

During a routine inspection

We spoke with five people who lived at the home. We also spoke with four members of staff, the manager and two relatives of people living there.

People living at Highview were positive about their experience of living there. No one we spoke to had complaints about the home or how it was managed. People told us they were happy living there and the staff were helpful. Some of the comments we received included – “I enjoy living here and I like the food”. One family member commented "my relative receives a lot of stimulation here, it's magic".

People told us that they were involved in decision making and the staff would ask them if they required support and respected their decisions. Family members we spoke to said they were involved in their relatives care and involved in decision making. People told us they were always offered choice giving examples such as meals, drinks, what time they would like to wake up. People told us they could choose to live how they liked and the staff respected their wishes.

We found that staff administered medications appropriately and the provider had an effective system in place to record the administration of medication.

We found that people received appropriate care based on detailed risk assessments and care plans.

We found that people using the service were protected from the risk of abuse because staff had received safeguarding training and appropriate policies and procedures were in place.

Inspection carried out on 26 August 2011

During a routine inspection

As a majority of people who live at the home were not able to communicate with us as they have dementia, we observed the interactions between staff and people.

We have used a formal way to observe people during this visit to help us understand their experiences. This involved our observing four people for two separate 30 minute periods, and recording their experiences at five minute intervals. We observed their mood state, how they engaged in activities, and interacted with staff members, other people, and the environment.

We observed people in the large lounge over lunch time and the small lounge after lunch.

We found that staff were engaged with people throughout our observations and the interactions between staff and people living at the home were positive. This had the effect of both stimulating and inducing positive responses from the people we observed.

People and staff were observed to enjoy each others company and chatted and laughed with each other.

People actively sought the company of staff. Staff gently redirected and supported people when they became unsettled.

We observed lunchtime and people told us that they enjoy the food at the home. Staff supported people to eat sensitively, discretely and at their pace.