We carried out a review of the data available to us about Highfield House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Highfield House, you can give feedback on this service.
Highfield House is a residential care home providing accommodation and personal care for up to seven adults with a learning or physical disability, in one adapted building which has an enclosed garden. At the time of our inspection four people were living there.
The service was developed and designed before Registering the Right Support came into existence. Despite this, the service was managed 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’s opportunities to follow their goals and live as full a life as possible had been impacted by COVID-19. The service had reviewed restrictions on people’s activities and movements in line with national guidance and additional internal activities had been set up to ensure people were protected from feelings of isolation.
Highfield House is a large home, bigger than most domestic style properties. The negative impact of the size of the service on people was mitigated by the buildings design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when supporting people.
People's experience of using this service and what we found
Since our last inspection, systems to assess, monitor and improve the quality and safety of the service had been implemented. An external auditor had also been commissioned to support the service in identifying any shortfalls and to ensure any identified actions were rectified without delay. In some areas, the new systems introduced required further review to ensure that these systems were consistently applied.
Staff told us they felt supported and that the new manager was leading an improving service. Staff told us the culture was open, and we saw evidence people were supported to achieve positive outcomes. Under this new leadership structure, the services visions and values are being reviewed with a focus on person centred care and developing a culture that is fair and open. More time is needed to ensure that these changes have the desired effect on staff morale and service culture.
People were supported to take their medicines as prescribed. Staff received training to enable them to administer medicines and processes were in place to ensure staff were competent, however, the system of auditing medicines stock needed to be improved to ensure the audit sheet matched available stock.
The service was clean, tidy and odour free. There were robust infection control processes being observed and systems were in place to reduce the risk of any visitors to the service in relation to COVID 19.
The service provided sufficient numbers of trained staff to meet people's needs. People's relatives told us the service was safe and homely.
Staff had received training to ensure they could recognise the signs of abuse and told us how they would report these. Records showed people had risk assessments in place and that these were reviewed regularly.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People’s capacity to make decisions had been assessed and where required, external health professionals were involved in planning support strategies to meet people’s mental health needs.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Why we inspected
We undertook this focused inspection to check the service had followed their action plan and to confirm they now met legal requirements. We also looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.
This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Highfield House on our website at www.cqc.org.uk.
The home provides accommodation over three floors, with communal rooms on the ground floor. The building was typical of the residential area and the other domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.
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:
Audits and quality checks supported the registered manager to identify areas where the service needed improvement. However, these systems were not always effective in identifying shortfalls in the service provided. We found shortfalls in environmental health and safety monitoring, medicines management and in ensuring timely reviews of incidents/accidents took place. There had been a failure to submit some required notifications to CQC when they were due.
There had been no impact on people as a result of these shortfalls. Action was taken by the registered manager and provider during the inspection, to start addressing safety concerns we found. As a result, the potential risks to people were immediately reduced. However, people were placed at risk of receiving unsafe care as systems to identify risks or shortfalls were not operated effectively.
Risks to people related to their personal care and activities they enjoyed at Highfield House, or in the community, had been assessed. Measures to reduce these risks to people were in place and these were understood and followed by staff. People felt safe and supported by staff and were protected from the risk of abuse. People were supported by sufficient numbers of suitable staff.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. The policies and systems in the service supported this practice. People were supported to make healthy choices and access health care services. Staff received effective support and were encouraged to develop their knowledge and skills and obtain appropriate qualifications for their role.
People were supported in an inclusive caring environment where they were treated with respect and kindness. People’s privacy and dignity was upheld and they were supported to maintain their independence as much as possible. People and their representatives were always involved in the planning and review of their care.
People's individual needs and wishes were known to staff who had achieved positive relationships with them. People enjoyed a range of activities in line with their interests, they were part of their local community and were supported to follow any cultural interests and beliefs. People were supported to maintain contact with the people who were important to them. People and their representatives were able to raise concerns about the service and these were addressed.
Managers were visible and accessible to people and their visitors.
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. People's support focused on them having opportunities to gain new skills and become more independent.
Rating at last inspection: The last rating for this service was Good (published 18 October 2016).
Why we inspected: This was a planned inspection based on the previous rating.
We have found evidence that the provider needs to make improvements. Please see the Safe and Well-Led sections of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Highfield House on our website at www.cqc.org.uk. You can see what action we have asked the provider to take at the end of this full report.
Enforcement: We have identified a breach in relation to monitoring and improving the quality of the service at this inspection.
Follow up: We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook a focused inspection on the 13 January 2017 to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Highfield House’ on our website at www.cqc.org.uk’
Highfield House is a residential home for seven people living with learning disabilities or an autistic spectrum condition.
The home has 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 and associated Regulations about how the service is run.
At our focused inspection on the 13 January 2017, we found that the provider had followed their plan and the legal requirements had been met.
People were supported by project workers who had been through a comprehensive recruitment process before they started working at Highfield House. Records relating to the recruitment of new project workers showed relevant checks had been completed before they worked unsupervised at the service.
Highfield House has 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 and associated Regulations about how the service is run.
We last inspected the service during July 2014. At the July 2014 inspection we found that the provider was meeting all of the requirements of the regulations at that time.
The provider and registered manager did not always ensure that new staff were of good character before they worked with people. People’s care records were detailed and refleced people’s needs.
People felt safe living in Highfield House. Project workers (service support staff at Highfield House are called project workers) knew their responsibilities to protect people from the risk of abuse. People’s legal rights were protected and project workers ensured people’s right to make decisions were respected.
People spoke positively about the staff. Project workers knew people, their needs, likes and dislikes and used this information to ensure people were kept comfortable and safe. There were enough project workers deployed to safely meet people’s needs. People enjoyed the time they spend with project workers, which included going for a coffee in the community.
Project workers were responsive to people’s needs and ensured people were safe and comfortable. Where people’s needs changed staff ensured their support changed to reflect their needs.
Project workers had access to supervisions and appraisals. They were supported and had access to training and professional development. Project workers felt involved in the day to day running of the service and were encouraged to make suggestions on how the service could improve.
The registered manager had systems in place to assess, monitor and improve the quality of the service. The registered manager promoted a caring ethos which all project believed in and accepted. People spoke positively about the registered manager.
We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.
The inspection was unannounced. The previous inspection was completed in April 2013 and there had been no breaches of legal requirements at that time.
Highfield House is a care home, registered to provide accommodation for up to seven people. The service cares for people who have learning disabilities or mental health issues, or have both. There were seven people living in the home when we visited. Highfield House is a large semi-detached property, near the centre of Stroud and accommodation is spread over three floors. The staff team were led by a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law: as does the provider.
People told us they were happy and enjoyed their life at Highfield House. Our observations, discussions with the staff team and the records we looked at supported the fact the seven people who lived at Highfield House were content, chose how they spent their time, and were supported to lead meaningful lives. People were supported to be as independent as possible but were supported with those tasks that they may not be able to achieve on their own. Each person took part in a range of meaningful activities, some to meet their individual needs and others as a group.
People were safe because staff knew how to recognise and respond to abuse correctly and had received safeguarding training. Staff recruitment procedures ensured that only suitable staff were employed to work in the home. The manager had completed Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) training and had arranged for all staff to complete on-line training. The MCA is legislation that provides a legal framework for acting and making decisions in a person’s best interests. DoLS is a lawful process whereby a person could be deprived of their liberty because it was in their best interests. Appropriate referrals had been made.
Staffing numbers were arranged around what activities people were undertaking which meant people were supported with their activities.
People were looked after and supported by staff who were well trained and supervised. The staff team provided a consistent approach to people as they shared ideas and suggestions. People enjoyed their meals and had a choice of food. People were supported to cook meals and decide what the weekly menus were to be. People were supported to access healthcare services and to receive on-going healthcare support. The staff team worked well to support people to have a healthy life.
People’s care and support needs were assessed, planned and then delivered in a way that took account of their individual choices and preferences. The plans were kept under continual review.
The staff team was led by the registered manager who was very much involved in the day to day running of the home. Clear leadership was provided and the staff team spoke about being well supported. There were good systems in place to monitor the quality and safety of the service and to take account of people’s views.
We heard people being spoken to nicely and being treated with respect. All five people looked well cared, were nicely dressed and had a good rapport with the staff on duty.
People were supported to use community facilities and participated in daily living activities within their home.
People were made aware of the complaints procedure because a laminated copy of the procedure (summary version) was displayed in each person's bedroom. The home had introduced a 'Wishes, Wants and Requests' book and everyone was encouraged to express their views and make suggestions.
Staff talked about their responsibilities for safeguarding the seven people who live in the home however incidents that had occurred between people and staff in July and August had not been reported properly. This meant that people were not being safeguarded effectively and were therefore placed at risk of further harm. Improvements were needed.
People told us that the staff asked them what help and support they needed. They said that the staff understood the care and support that they needed and they received the right support. People said that they felt safe in the home.
They told us that the staff asked them their views about the care and support they received and about the quality of the service.