About the service: 13-14 Highmount is a residential care home that was providing personal care to 7 people with learning disabilities at the time of the inspection. The home is located on a quiet cul-de-sac close to local amenities. The care home is made up of two bungalows, one built behind the other that share a communal garden.

People’s experience of using this service:

People living at the home appeared happy however we identified a number of concerns that the providers governance systems had not identified.

Records were not consistently being completed to indicate safety checks had been made and that certain policies and procedures in the home were not being followed by the staff team. We found that people's risk assessments did not highlight what was a high risk and that reviews of people's care did not always identify necessary changes.

People received their medicine on time, although not all medicines were stored securely.

We received mixed feedback on whether there were sufficient staff to meet people’s needs and complete all the tasks required.

People’s care plans were reviewed monthly however we found reviews did not always account for changes which occurred.

People’s capacity to make decisions was assessed however more clarity around specific decisions was need as well as a review of the applications made to deprive people of their liberty.

People’s privacy was not always protected.

People were supported by staff who knew how to recognise and report abuse.

People were supported by staff who had been trained. Some staff still needed to complete courses specific to people’s individual needs.

The registered manger reviewed accident and incident forms and shared lessons learnt.

People were supported to have a balanced diet.

People had access to healthcare.

People were treated well and staff understood people’s protected characteristics.

People were supported to express their views and accessible information was increasing in the home.

People were engaged in activities although people’s daily records did not always provide detail of what the activity was.

People had access to a complaints process.

People’s end of life wishes had been considered.

Staff felt supported by their manager and regular team meetings were held.

The registered manager had a continuous improvement plan and added actions to it as and when identified.

Rating at last inspection: At the last inspection dated the 23 March 2017 the home was rated as good

Why we inspected: The inspection was prompted in part by notification that someone who used the service had died. The circumstances surrounding the death are still subject to further enquiries and as a result this inspection did not examine those circumstances. However, the information shared with CQC about the death have indicated potential concerns about the management of risk in relation to health needs. This inspection examined those risks.

Enforcement: We consider the service to be in breach of Regulation 17(2)(a) Health and Social Care Act 2008(Regulated Activities) Regulations 2014. Action we told the provider to take is at the end of this report

Follow up: We will continue to monitor the service and the required improvements.

High Mount is a service which supports people who have a learning disability or autistic spectrum disorder. It provides accommodation with personal care across two bungalows for up to eight people. There were eight people living at the home on the day of our inspection.

Rating at last inspection.

At the last inspection, in July 2014, the service was rated Good. At this inspection we found the service remained Good.

Why the service is rated good

People continued to receive care which protected them from avoidable harm and abuse. Staff met people’s needs in a safe way and were available when people needed and wanted support.

People received care and support that was effective in meeting their needs. Staff had received training which gave them the skills and knowledge to support people’s specific needs. Staff respected people’s right to consent to and make their own decisions about their care and treatment. Where people did not have capacity to make their own decisions staff followed the law in ensuring decisions made were in their best interests.

People were treated with kindness and compassion by staff that knew them well. They were kept involved in their own care and staff made sure they had choices in all aspects of their daily life. Staff respected people’s privacy, treated them with dignity and encouraged them to be as independent as they could be.

People’s care and support continued to be individual to them. Staff responded to changes in people’s needs which helped to ensure they got the care they needed. People were supported to spend their time how they wanted to and were encouraged to maintain their social interests within the local community. People had opportunities to give feedback on their experiences of the care they received.

Staff continued to work for the benefit of the people who lived at the home and kept them involved in what happened. There had been a change of registered manager since our last inspection and the management of the home continued to support a positive and open culture. The provider had systems in place that continued to be effective in assessing and monitoring the quality of the service provided.

Further information is in the detailed findings below.

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 the CQC which looks at the overall quality of the service.

This was an unannounced inspection. This meant that the provider did not know we were coming out on the day of inspection.  At our last inspection in November 2013 no areas of concern were identified.

High Mount provides accommodation and personal care in two bungalows for up to eight adults with a learning disability. There were eight people living at High Mount when we visited.

The home had 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.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We saw that there were policies and procedures in relation to the MCA and DoLS to ensure that people who could not make decisions for themselves were protected. We saw from the records we looked at that where people lacked the capacity to make decisions about something, that best interest meetings were held. Best interest meetings are held with people that best know the person including relatives and professionals to make a decision where a person lacks capacity to make it themselves.

Care plans covered a range of needs and had been regularly reviewed to ensure staff had up to date information. There were also detailed assessments about the person's health that included specific care plans. We observed that staff were able to support people with dignity and respect in a safe and caring manner. We found that people who needed help to manage their anxiety were effectively supported by staff. We saw that when required other health professionals had been involved to help develop strategies for doing this.

Our observations and care records demonstrated that people were given choice.  We saw that staff supported people with their hobbies and interests, and that people’s independence was promoted. For example we saw that some people chose to go to some local shops, whilst another person was painting and drawing.

Regular meetings for the people that used the service were held. We saw the minutes from some of these meetings and found that actions had been taken by staff and the registered manager in response to what had been discussed. For example some people had said that they wished to be involved in the local carnival. We saw that staff had supported people to do this.

All of the people we spoke with were positive about how the service was managed. Systems were in place to monitor and review people’s experiences and complaints which ensured improvements were made where necessary.

High Mount was a community home for a maximum of 8 people with learning disabilities. The accommodation was provided in two bungalows each with 4 residents. People at High Mount were not able to fully express their views about their care due to their special needs. We talked with two people, two family members, the manager and three members of staff. People told us that staff were kind. Families told us they were very happy with the care and treatment of their family member. One family told us that their family member “had a fantastic life at High Mount" Families told us that people exhibited behaviours that demonstrated that they felt safe at High Mount.

We found that people gave consent for day to day activities in a number of ways according to their ability. We found staff were clear about their role and responsibilities in relation to the Mental Capacity Act. We saw that when appropriate staff participated, in multi-agency 'Best Interest' decision meetings.

Care records were well organised and comprehensive and provided information to ensure people received safe effective care. Risk assessments were carried out ensuring risks were identified and action taken to minimise risk.

We saw that appropriate steps had been taken to ensure people were protected from the risks relating to infection. We saw that the accommodation was clean and in the main well maintained. There was good access for people with a mobility disability.

This service was run as two separate living areas. Four people lived in each bungalow.

People who lived in this service had varying abilities in communicating.

Some of the people who lived in this service were unable to talk with us. Because of this we looked at records, talked with staff and observed the way that the care was provided.

However, some people were able us that they were well looked after. They said that the staff always asked them how they would like things to be done, always respected their privacy and treated them with respect.

Many people were able to make it clear to us that they liked living at High Mount. Some said such things as “I like it here” and “It’s nice”.

People told us that they felt able to raise any issues with the managers or staff should they have any concerns. Staff talked of their awareness of how to keep people safe from harm. They told us about the training that the home had arranged for them to attend so that they would recognise abuse and how to report it.

We saw that staff were always available when people needed help. People told us that staff were friendly and always acted professionally.

The service’s management held regular meetings with the people who live in the home to find out what they thought about how their care was delivered.

There were eight people living at High Mount on the day of the visit. Five people were out at a local day centre and the three people remaining at the home were unable to give their views verbally.

We spoke to the temporary manager and three staff.

We saw that people’s needs were assessed before they started using the service to make sure they could be met.

Care plans contained good detail about people's needs and clear guidance to staff about how those needs should be met.

Support is offered to people in a variety of ways to make sure that they are seen as individuals and their lifestyle choices and preferences are respected.

Staff told us that they felt well supported by an effective management team and were provided with all the training they needed to carry out their role effectively.

Effective management systems were in place to make sure that the home is safe and well maintained. Quality assurance systems were in place to monitor the effectiveness of the service and identify any issues of concern or areas for review.