Highbray Residential Care Home is a residential home registered to provide accommodation and personal care support to three people with learning disabilities, autistic spectrum disorder or mental health needs. They were in the process of expanding the service user group to include people living with dementia. At the time of the inspection there were three people living at the home. The home was managed and staffed by the provider’s immediate family.

The registered manager lived on site, and was the main member of care staff. 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.

At our last inspection we rated the service good. 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.

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Why the service is rated Good.

People remained safe at the home. There were trained and experienced staff available over a 24 hour period to meet people’s needs and to spend time socialising with them. Risk assessments were carried out with people which promoted their independence while minimising risks. People received their medicines safely.

People continued to receive effective care because staff had the skills and knowledge required to effectively support them. Their communication needs were recognised and met. People lived in a service which had been adapted to meet their needs. Their healthcare needs were monitored by the staff and they had access to healthcare professionals according to their individual needs. 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 home continued to provide a caring service to people. One person said, "The whole thing has a real warmth about it. Its very comforting. Very relaxing.” Staff promoted people’s independence and treated them with dignity and respect. They were familiar with people’s history and backgrounds, respected their choices and acted in accordance with their wishes. People were accepted for who they were regardless of their sexuality, faith or culture. The service was able to provide effective support to people at the end of their lives.

The service remained responsive to people’s individual needs. Care plans were person centred and provided detailed information about people’s needs and preferences. As the main carer the registered manager had current and detailed knowledge of people’s needs. People could choose to participate in a range of activities, both in the home and out in the community. There was a complaints policy in place, and concerns or complaints were managed effectively in line with the policy. There had been no formal complaints since the last inspection.

The service was well led, although improvements were needed to quality assurance processes to simplify them and ensure their relevance to the service. The provider and registered manager had a strong value base, and worked to promote a person centred, open and empowering culture. They had an ethos of honesty and transparency, reflecting the requirements of the duty of candour. The duty of candour is a legal obligation to act in an open and transparent way in relation to care and treatment.

Further information is in the detailed findings below

This inspection took place on 18 and 19 April 2016 and was unannounced.

The last inspection of the home was carried out on 21 July 2014. No concerns were identified with the care provided to people at that inspection.

The service is registered to provide accommodation for three people with learning disabilities and/or mental health needs, requiring personal care. At the time of the inspection there were two people living at the home.

The home was managed and staffed by the provider’s immediate family. The service had a registered manager who lived on site, and was the main member of care staff. 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.

Although the registered manager had detailed knowledge of the systems used in the home, a comprehensive audit of the service was not in place at the time of the inspection. They were in the process of adapting audit tools from a nearby residential home to look at areas such as the quality of service provision, the management of records and procedures related to consent to care and treatment. This would allow the provider and registered manager to see whether the service was being effective, and where improvements were needed.

Both people living in the home had been there for several years. This meant the registered manager knew them very well. They had a good understanding of people’s needs and how they wanted them to be met. The people living there told us they felt as if they were part of the registered manager’s family. They were invited to participate in family outings and events.

Risks were assessed and managed effectively, which meant people were kept safe. People were involved in the development of their care plans, and care and support was provided in line with these. People’s nutrition and health needs were met with the support of the registered manager, who offered healthy food choices and ensured all health appointments were attended.

People were encouraged to be independent and make decisions in relation to all aspects of their lives, with the registered manager providing assistance with communication or reassurance as required. They took part in a range of activities according to their interests, either independently or with support, and could be involved in the running of the home if they wished. This had impacted positively on their well-being and one person told us, “I’m more confident than I was before”.

Confidentiality and privacy was respected and people were treated with dignity and kindness.

People were supported to maintain ongoing relationships with their friends and families, and could see them in private whenever they wished. Their families were invited to the home for “roast dinners and birthday cakes”.

The registered manager was committed to maintaining their skills and knowledge through ongoing training and links with other residential care providers. New staff, including family members who provided occasional support, were required to develop and maintain the skills needed to work with people at the home. They had been referred to the DBS (Disclosure and Barring Service). The DBS checks people’s criminal history and their suitability to work with vulnerable people.

An additional member of staff was being employed with a view to increasing the number of people living at the home. This would also give the registered manager more time to improve the quality of the service. For example, a programme of refurbishment was underway, with plans to review and update the homes policies and improve the existing quality assurance arrangements.

We considered our inspection findings to answer questions we always ask:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found.

On the day of our inspection there were three people receiving a service from Highbray Residential Care home.

The summary is based on our observations during the inspection, we spoke with the three people using the service and the registered manager who is also the provider and the one other staff. The inspection was undertaken by one inspector over one day.

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

Is the service safe?

The service was safe because the registered manager and staff understood the people they cared for and put their well-being at the centre of the support provided. Examples included assessments of risk, such as unexpected absence from the home and fire safety from smoking.

The service was safe because the two staff had ensured they were trained and skilled in the care and support they delivered. Equipment was checked for safety and each person knew how to respond should the fire alarms sound. Medication was handled in a safe way. Records were detailed and up to date. People told us they felt safe at the home.

Is the service effective?

The service was effective because each person’s needs were understood and there were detailed plans in place to identify people’s abilities, needs and how to meet those needs. People told us they were involved in planning their care and support and it was as they wanted.

People were supported to maintain their health and well-being. Each person had medical conditions which required the support of the staff to manage with them. These included hearing, footwear, anxiety and diabetes. Their health was optimised by the effective support provided.

Is the service caring?

People told us "Yes, the home is caring. If anything is worrying me I tell (the registered manager) and she understands. Sometimes she knows before I do!"

The service was caring because people had the quality of life they wanted and were treated with respect. One person said “I love it. Kind.” People spent their days in very varied ways according to their preferences. The home atmosphere was relaxed and friendly. People got on well together and there was banter and fun.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Whilst no applications have needed to be submitted, we heard from the manager how she had received training which covered how these safeguards applied to people to protect their rights. One person told us when asked if there were any restrictions at the home “None at all”.

Is the service responsive?

The service was responsive because people were consulted about their day to day lives. This included whether they wanted staff to attend medical visits with them. We were told how one person was unable to manage the bath anymore and within two weeks a special seat had been provided to help them with this.

We observed how people were continually consulted about what they wanted and people told us this was normal.

Is the service well-led?

The service was well led because people were very happy with the care and support they received. There were effective policies and procedures in place. Advice was sought where necessary, examples being from health care professionals and pharmacy.

The registered manager was running an efficient service in a homely and friendly environment.

Our inspection was unannounced and lasted approximately six hours. Highbray Residential Care Home is registered to provide care to three people. At the time of the inspection there were no vacancies. All the staff at Highbray were related by family connections. We spoke with all three people living at Highbray Residential Care Home. We also spent time with people in the kitchen where people tended to congregate, so we could make a judgement about how well people were cared for. We spoke with the registered manager and following the inspection, to one relative. We looked at care records for all three people, focussing on how people’s health and well-being were supported, including people’s dietary and medication needs.

We saw people looking relaxed and at ease with each other and the registered manager who was providing all care for the people during our visit. Whilst people were happy for periods of time this was not always the case. People did not experience care, treatment and support that met their needs and protected their rights. People’s nutritional needs were well met and the home was clean and hygienic.

We found that medicines were not always managed in a way as to ensure safety. Not all staff had undertaken essential training and there was no support or supervision to ensure they were suitably knowledgeable to deliver the care required.

We visited the home on 25 May 2012 and met all the three people who were living there. We gave short notice of our visit as we were aware that people often went out and we wanted to arrange a time to see them. The providers were on holiday, the manager was on duty. All the staff at Highbray were related by family connections. This has been the case since the home opened many years ago.

The people living at the home had been there for approximately six years. There were no vacancies. Everybody told us it was a good place to live as they were given lots of attention and had many opportunities for going out or pursuing interests. One person told us they were considering moving on. They said they wanted to live in a bigger home with en-suite facilities. Other people told us they did not mind sharing the bathroom with the family who live at the service. Each person had a sink in their room but shared the toilet and bath.

We found that peoples health needs were closely monitored and people had regular health check ups. People were encouraged to be independent. Risk assessments were in place, although some would benefit from greater detail.

People were safe, but formally assessing some people’s ability to make important decisions under Mental Capacity legislation would further protect people’s rights.

Asked what they thought about the home, one person responded ‘I like it here!’, with a very happy smile. Another person said they could ‘just do as they liked’, explaining they were free to do as they wished, without the home setting their daily routine for them.

People made visits to the city centre, various local towns, and went to visit or stay with family and friends. Some used public transport independently for these outings, sometimes the manager took them in her car.

Care records and conversations during our visit clearly showed people's views, preferences and lifestyle choices were noted, and taken into account to provide them with individualised support or care. The small size of the home and staff team meant people's needs and preferences as to how they should be met were well known to the staff. But records were not always written or sufficiently fit for purpose to ensure that people receive safe and appropriate care which meets their needs and promotes their rights as safely as possible. There was not always a written care plan showing how people's various needs were to be met, and there was no evidence of formal assessment of their capacity to make various decisions about their daily life.

The physical and mental health of the people living at the home was monitored well. One person who used to cycle great distances had been helped to obtain a bus pass recently, as staff noted risks to their safety had increased. People confirmed they had were helped to access various health care services, including dentists, opticians, and for hearing aid checks. They had the medicines they needed in a timely and generally safe way, although more needed to be done by the home to ensure anyone who self-medicates will do this appropriately and safely.

The main meal of the day, with the exception of the 'Sunday roast', was usually in the evening, as people tended to be out during the day. One person told us they weren’t often given a choice at mealtimes but they were always given something they liked, adding ‘I’ll eat anything.’ Another, when we asked them if they liked the food, said they did, and added ‘You get plenty of it’. One person told us they were able to make themselves a hot drink when they wanted one, whilst others confirmed the staff made them a drink when they wanted one.

People using the service said they felt safe at the home and with the staff who supported them, as individuals and in terms of their skills as carers. However, they were not protected against the risk of abuse because the service did not have robust arrangements in place to prevent abuse and to respond appropriately if an allegation of abuse were made.

People told us they felt the home was kept sufficiently clean, confirming that their bedrooms were cleaned regularly. We found staff lacked current information and guidance on prevention and control of infection, something that could affect standards of hygiene.

The home appeared to be in a good state of repair, well decorated and comfortably furnished. People we met were relatively physically able, requiring few environmental aids or adaptations. They told us they had no issues regarding hazards to their safety, and said repairs were usually attended to in a timely way. We heard from people that they liked their bedrooms, their beds were comfortable, and the lighting was good enough at all times for those who liked to read. They also told us a second toilet in the home would be appreciated.

No new staff have been employed since our last visit, and people confirmed this meant they were only supported and cared for by the owner, her husband or the registered manager. We saw that people communicated freely with staff, and received responsive support. Whilst staff were experienced, they would benefit from ongoing training and development, so that they can continue to meet people's diverse or changing needs appropriately and safely.

People didn’t think they were specifically asked by the home for their views of the service they received. The manager explained to us that she and the owner had regular contact with each person, obtaining their views informally, and were thus able to provide an individualised service. However, we found the registered persons were not referring to the current essential standards of quality and safety that the service should meet, to assess and monitor the service.

Some people felt that the manager listened to their suggestions or concerns but, as she didn’t have a budget and had to rely on the owner’s support in some matters, she wasn’t able to follow them up or act on them herself. The manager confirmed this had sometimes been the case.

When we had asked people using the service if they felt able to make a complaint, some responded that they were happy at the home and had no complaints. They all said they would speak to either the owner and/or the manager, if necessary. Information about the complaints procedure was not as available to individuals as it could be.