The Highviews

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support: People were being supported by staff to pursue their interests and to achieve their aspirations and goals. People told us their quality of life had improved since the last inspection. One person said, “I go out more now, it’s much better.” Improvements in the quality of risk assessments and care plans meant staff had the information they needed to support people effectively.

Right Care: The service had enough appropriately skilled staff to meet people’s needs and keep them safe. People were benefitting from a more personalised approach since the last inspection. Staff told us they could spend more time with people.

Right Culture: The service enabled people, and those important to them, to work with staff to develop the service. Staff valued and acted upon people’s views. The registered manager was working with staff to develop an enabling culture based on best practice for supporting people with learning disabilities and/or autism.

The registered manager had implemented a service improvement plan to make changes following the last inspection. New systems were in place and progress was evident, but it was too soon to say improvements were fully embedded and sustained.

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

Rating at last inspection and update: The last rating for this service was inadequate (published 6 June 2023) and there were breaches of regulation. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 5 June 2023. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We undertook this focussed inspection to check whether the Warning Notices we previously served in relation to Regulations 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well- led which contain those requirements.

We 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 COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Highviews on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Highviews is a residential care home providing personal care to up to 6 people in an adapted house in a residential area. The service provides support to people with learning disabilities or autistic spectrum disorder, people with mental health conditions, physical disabilities, sensory impairment, dementia, older people and younger adults. At the time of our inspection there were 6 people using the service.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support:

The service did not have enough appropriate staff to support people’s needs and keep them safe. Risks to people were not always assessed and managed to ensure people’s safety, including environmental risks and fire safety. People did not always receive the support they needed, including when people were at risk of choking.

People were not always receiving their medicines safely and staff were not all trained and assessed as competent to administer medicines.

The insufficient staffing levels had a negative impact on people’s quality of life and meant that people were not always supported to have maximum choice and control of their lives. There were restricted opportunities to go out and pursue activities in the local community. One person told us, “I miss being able to meet up with my friends.”

Right Care:

Care plans did not include all the information that staff needed and did not reflect current guidance and best practice to provide a planned approach with a focus on people’s quality of life. This meant that staff did not have clear guidance in how to support a person who had mental health needs when they were distressed.

People received kind and compassionate care from staff who knew them well. Staff protected and respected people’s privacy and dignity. Staff considered matters of consent and understood the importance of protecting people’s rights. People told us they were happy living at The Highviews and they had developed positive relationships with staff. One person said, “All the staff are my favourites.”

Right Culture:

There had been a lack of leadership at the service. Systems were not in place to support effective oversight and governance. This meant that risks to people were not always identified and managed and records were not consistent and accurate.

Some staff knew people very well and understood their needs and preferences, but people were not supported to increase their skills or independence or to identify and plan for future goals and aspirations.

Following this inspection we asked the provider for assurances about staffing levels and risks to people’s safety.

A new manager had recently been appointed and had already identified most of the concerns that we found at this inspection. They had created a service improvement plan with a timescale for actions and this gave us some assurance that the necessary improvements would be made.

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

Rating at last inspection

This service was registered with us on 2 December 2021 and this is the first inspection. The last rating for the service under the previous provider was good, published on 10 July 2019.

Why we inspected

The inspection was prompted in part due to concerns received about staffing, risk management and care planning. A decision was made for us to inspect and examine those risks.

We 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 COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to staffing, management of risks, administration of medicines, personalised care planning and management oversight at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.