We inspected Highdowns Residential Home on 7 January 2017, the inspection was unannounced. The service was last inspected in January 2016, at which time we found one breach of regulations in respect of the cleanliness and infection control processes at the service. At this inspection we found action had been taken to address the concerns and the service was now meeting the requirements of the legislation.

Highdowns provides care and accommodation for up to 14 people who have autistic spectrum disorders. At the time of the inspection 13 people were living at the service. Highdowns is part of the Regard group. The service is made up of five separate buildings, three of which are single occupancy.

The service is required to have a registered manager and there was one in post at the time of the inspection. 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.

There were sufficient staff on duty at all times to meet people’s individual needs. Staffing levels identified as necessary for the service were consistently met in all of the five houses. Recruitment practices helped ensure staff working in the service were fit and appropriate to work in the care sector.

Staff received training when they first started work at Highdowns in a wide range of areas including supporting people whose behaviour could challenge staff and others. Training specific to people’s health needs had been regularly refreshed.

People were protected from the risk of abuse including financial abuse. The service kept people’s personal monies for them and records of all expenditures. Staff received training in safeguarding adults and were confident about reporting procedures.

People were assessed in line with the Deprivation of Liberty Safeguards (DoLS) as set out in the Mental Capacity Act 2005 (MCA). DoLS provide legal protection for vulnerable people who are, or may become deprived of their liberty.

The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals when appropriate. Records showed applications for DoLS were being made appropriately and some people had DoLS authorisations in place. For people recorded as not having capacity to agree to staff supporting them with their medication, formal mental capacity assessments had not been conducted. This applied to two people who lived at Highdowns. This issue had also been highlighted during a recent internal quality assurance audit.

Staff were positive about their jobs and spoke highly about people they supported. People were relaxed with staff and approached them for reassurance and support when they needed to. Staff responded quickly and with humour and empathy. They demonstrated an understanding of people’s needs including their preferences, likes and dislikes and communication styles.

There were clear lines of responsibility in place. The service was managed on a day to day basis by a registered manager supported by a deputy manager and a team of support staff. The registered manager had oversight of the service and staff told us she was approachable and had a good understanding of the service. There was a key worker system in place. Key workers are members of staff with responsibility for the care planning for a named individual.

We inspected Highdowns Residential Home on 9 January and 19 January 2016, the inspection was unannounced. The service was last inspected in April 2014, and we had no concerns at that time.

Highdowns provides care and accommodation for up to 13 people. At the time of the inspection thirteen people were living at the service. There was a registered manager in post. 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.

Highdowns is part of the Regard Partnership group which provides services to people living with a learning disability. The service is made up of five properties on the same site located on the outskirts of Camborne.

Overall the premises were well maintained and, pleasant. However, we saw that cleaning schedules in the main house had not been consistently followed or reviewed to ensure standards of cleanliness remained high; this was also the case in communal bathrooms where we found overflowing bins. We saw a number of pieces of old furniture had been stacked at the back of the property. The registered manager arranged for this to be removed.

The service had a main house (which accommodated six people), a cottage (which accommodated four people) and three separate independent units. Two people agreed for us to see their living areas in the independent units. These units comprised of a bedroom, lounge/kitchen and private bathroom area. We saw that their living areas were decorated to reflect people’s personal tastes.

Recruitment practices helped ensure staff working in the service were fit and appropriate to work in the care sector. Staff had received training in how to recognise and report abuse. They were clear about how to report any concerns and were confident that any allegations made would be appropriately investigated to help ensure people were protected. There were sufficient numbers of suitably qualified staff to meet people's needs and keep them safe.

Staff monitored people's behaviour and routines in order to help ensure people's needs were not negatively impacting on others. Families and other professionals were involved in regular discussions about how best to support people. The registered manager told us they were continually assessing people's needs to check these were still being met.

People's individual abilities and strengths were recognised and respected. People received as much support as they needed but were encouraged to be independent wherever possible. There was a key worker system in place. Key workers had oversight of each individual's plan of care. Staff took a flexible approach to support, according to the needs of the individual. People approached staff for assistance and reassurance as they needed it and staff responded with understanding and good humour.

The registered manager had a clear understanding of the Mental Capacity Act 2005, and how to make sure people who did not have the mental capacity to make decisions for themselves, had their legal rights protected. However, the legal requirement to inform CQC about the granting of a Deprivation of Liberty application for a person, by completion of a notification, had not been sent.

Information was presented in easy to read formats to aid people's understanding. Support plans contained one page profiles and simple text was supplemented with pictures. Communication tools were available and staff supported people to use these to plan their days.

The registered manager took an active role within the service. However, we found that lines of accountability and responsibility within the management structure were not clear. For example, cleaning tasks that had been delegated to help ensure the smooth and efficient running of the service had not been com

The inspection team gathered evidence against the outcomes we inspected to help answer our five key questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with seven people who used the service, a relative, the staff supporting them and from looking at records.

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

Is the service safe?

People were cared for in an environment that was safe, clean and hygienic.

Care plans were individualised and contained information that directed and informed staff to provide appropriate care and support. There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies.

People told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard people they supported. Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints and concerns. This reduced the risks to people and helped to continually improve the service. Highdowns had policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). We saw that they were using these protections appropriately.

Staff knew about risk management plans and showed us examples where they had followed them. People were not put at unnecessary risk, but also had access to choice and remained in control of decisions about their care and lives.

The registered manager set the staff rotas and took people’s care needs into account when making decisions about the numbers, qualifications, skills and experience required. This helped to ensure that people’s needs were met.

Is the service effective?

People’s health and care needs were assessed with them, or their representative, and where possible people, or their representatives, were involved in writing their plans of care. People told us that their care needs were met, and relatives told us they felt staff met their family members care needs “as best they can”. People’s preferences, interests, aspirations and different needs had been recorded and care and support had been provided in accordance with people’s wishes.

We found all people who used the service had a care plan and found the information was up to date and had been reviewed regularly.

We observed how staff interacted with people and saw there was a relaxed atmosphere in the home. We saw different methods of communication being used with each person who lived at the home. Some people were able to verbalise clearly what they wanted to do, whereas other people, whilst able to understand staff verbal communication, were not able to respond in the same manner. Therefore staff used different methods of communication for example a communication board.

From quality assurance surveys, discussions with staff and management team plus a tour of the home, it was acknowledged that some parts of the environment in the home needed to be updated in the main house. In addition, Highdowns had built a new self-independent unit and this was overall to a good standard. This unit is not presently used. We expressed concern regarding installation of CCTV and the position of the door handle in this unit and therefore the potential impact on the privacy and dignity of a future user of this unit. We noted the room lacked natural ventilation and natural light. We requested that the provider inform us when they proposed to use this bedroom and how they would address these issues before the unit began to be used.

Is the service caring?

We spoke with people being supported by the service and a relative. We asked them for their opinions about the staff that supported them. Feedback from people was positive, for example, “The staff are brilliant”, “They listen to me” and “I love it here”.

People were treated with respect and dignity by the staff. We saw how people who used the service interacted with staff and saw that people approached staff without hesitation. We observed staff interacting with people who used the service in a kind and calm manner. We saw that staff showed, through their actions, conversations and during discussions with us, empathy and understanding towards the people they cared for.

People who used the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. The findings of the surveys were positive in all aspects of care delivered.

Is the service responsive?

We found that people who used the service were involved in making day to day decisions and participated in tasks at home, such as cleaning and doing their laundry. During the inspection we noted that people attended a variety of activities this meant they had opportunities to pursue their interests.

People knew how to make a complaint if they were unhappy. We saw records where people had raised concerns and saw their concern had been investigated and the findings where explained to the person. I If further actions to improve the service had been identified these were shared with the individual and put in place. We saw that concerns raised had been completed in line with the service’s complaints policy. The service worked well with other agencies and services to make sure people received care in a coherent way.

Is the service well-led?

The service had a quality assurance system, and records showed problems and opportunities to change things for the better were addressed promptly. As a result the quality of the service was continuously improving. Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

We saw ‘house meeting’ minutes. This was an opportunity for people who used the service to meet and express their views on the service provided and to be involved in how the service continued to be developed.

We saw minutes of regular meetings held with the staff and management team. This showed the management consulted with staff regularly to gain their views and experiences and improve support for people who lived at the service.

Staff told us they were offered relevant and useful training on a regular basis. Staff also told us they felt supported by the registered manager and could approach them at any time if they had a concern.

We spoke with four people who lived at Highdowns. People told us they were happy living at the home and liked the staff who assisted them. They said the home was comfortable and clean. We observed each person had individualised their own room to suit their personal taste. People told us they chose how they spent their time and had free choice about areas of their life such as when they went to bed and what choice of meals they had. We saw people coming and going from various activities during the day including work, college and from activities outside the home. People were happy to spend time socialising together, talking with staff or spending time in their own rooms. We saw people moved around the home with no restrictions.

People told us they felt safe living at Highdowns and would talk to their key worker if they had any concerns. Staff reported they were able to raise concerns to management and appropriate external agencies if the need arose.

We observed there were enough qualified and experienced staff on shift at all times to ensure the care and welfare of people who used the service. Staff were supported by training and supervision processes to carry out their work and ensure the welfare of people who lived at Highdowns.

Some of the people using this service had limited verbal communication skills and subsequently it was difficult, during a short visit, and not being able to get to know people well, to ascertain people's views. However the people we could speak to said they liked living in the home, and our observations concluded people seemed happy with the service and the people that supported them.

People who use the service were complimentary about the staff group. One person using the service told us that staff were ‘marvellous”. We observed staff asking people who use the service what they wanted for dinner, and one person was asked if they wanted to go out for a walk. We saw two people going out in the car with staff. One person told us that they were visiting family and looking forward to the trip.

We saw staff talking with people who use the service in a patient and relaxed manner. We saw staff knocking on peoples doors before entering their rooms, speaking to people at their pace and at their level.

We saw people’s privacy and dignity being respected and staff being helpful. There were no issues raised by people using the service or staff. People who use the service were moving freely around the home and staff stopped what they were doing to interact with them at every opportunity.

People told us that they can speak to any member of staff about anything. They added that they feel like they are involved in how the home is run.

We saw people making their own choice about how they were going to spend their time. We saw people returning from a shopping trip and heard the person in charge organising a driver to take and pick up other people from other activities.

We saw that the routines being observed during the inspection showed that people are able to get up when they want and have choices about where they spend their time. People we spoke with confirmed that they chose how to spend their days, and that they could do what they liked. They told us they had enough to do to keep them occupied, and that they received frequent visitors.

People told us about clubs and colleges they attend during term time and how much they enjoyed them.

We observed staff and people who use the service interacting and were impressed with the patience and care shown to them. People told us they were happy with the care they received at Highdowns Residential Home.

We saw that people who use the service were engaged in a number of activities some of which required the help and support of a member of staff. People have access to communal areas, which they help to personalise and they told us that they are encouraged to personalise their own rooms to reflect their personal taste.

We spoke to eight people who lived at Highdowns. They said they were very comfortable and happy living in the home. They said that the home was well maintained and kept clean. They told us they chose what they did each day, for example, they went to bed and got up when they liked, what clothes they liked to wear, they were involved in the planning and preparation of meals and that they participated in group and individual activities. We saw, during our visit, people returning to Highdowns following a day at work, day centers or college. We saw people helping cook, spending time socializing with others or that they spent time in their own bedrooms.

People told us they would be able to raise concerns to staff or the manager if the need ever arose.

Our observations concluded people appeared happy with the service and the staff that supported them. We observed that people’s privacy and dignity was respected during our visit. Staff were observed talking to people and asking them what they would like to do. We saw that people’s wishes were respected. We observed that people moved around the home with no restrictions