Higher Bank is a residential care home for up to 22 older people who require support with personal care. Accommodation is provided in 18 single bedrooms and two double rooms on two floors. The home is in a residential area close to Blackburn town centre. There were 19 people living at the service at the time of our inspection.

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.

Why the service is rated good:

People told us they felt safe in Higher Bank and that there were always enough staff available to meet their needs. Staff had been safely recruited and understood how to protect people from the risk of abuse.

People were cared for in a safe and clean environment. The provider had made a number of improvements to the home since the last inspection. We have made a recommendation in relation to creating a 'dementia friendly' environment when further improvements are considered. Arrangements were in place to deal with any emergencies which might occur in the home.

People had their medicines as prescribed and these were managed safely. The provider had systems in place to learn when things went wrong.

Staff received the induction, training and support necessary to enable them to provide effective care. Staff had a good understanding of the care and support that people required. Interactions between staff and the people who used the service were warm, friendly and relaxed.

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. People were provided with high quality meals of their choice and had their health needs met.

Care plans and risk assessments were person centred and provided guidance for staff on how to meet people’s needs and preferences. There were established arrangements in place to ensure the care plans were reviewed and updated regularly. People were encouraged to remain as independent as possible and were supported to participate in a variety of activities. People were also offered the opportunity to attend events in the local community.

The registered managers provided strong, supportive leadership to the staff team. Systems were in place to monitor the quality of the service provided and ensure people received safe and effective care; these included seeking and responding to feedback from people in relation to the standard of care. We noted all the responses in the annual satisfaction survey completed in April 2018 were positive about the way the home was run.

Further information is in the detailed findings below.

This was an unannounced inspection which took place on 20 April 2016. The service was last inspected in April 2014 when it was found to be meeting all the regulations we reviewed.

Higher Bank provides accommodation for up to 22 older people who require support with personal care. Accommodation is provided in 18 single bedrooms and two double rooms on two floors. The home is located in a residential area close to Blackburn town centre. There were 22 people living at the service at the time of our inspection.

The service had two registered managers in place. The position was shared between two members of the partnership which was also the provider of the service. 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.

During this inspection we found a breach of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. This was because not all people who worked in the service had received the training they required to be able to deliver safe and effective care. You can see what action we have told the provider to take at the back of the full version of the report.

People who used the service told us they felt safe in Higher Bank and that staff were always kind and caring. We found there were sufficient numbers of staff available to meet people’s needs. There was a stable staff team in the service with no new staff having been employed since 2012. However we found the recruitment policy needed to be more robust to help ensure people who used the service were protected from the risk of unsuitable staff being appointed in the future.

We saw that suitable arrangements were in place to help safeguard people from abuse. Guidance and training was provided for staff on identifying and responding to the signs and allegations of abuse.

All areas of the home were clean and we saw that procedures were in place to prevent and control the spread of infection. Risk assessments were in place for the safety of the premises and systems were in place to deal with any emergency that could affect the provision of care.

We saw that the equipment and services within the home were serviced and maintained in accordance with the manufacturers' instructions. This helped to ensure the safety and wellbeing of everybody living, working and visiting the home.

The staff we spoke with had a good understanding of the care and support that people required. We saw people looked well cared for and there was enough equipment available to promote people's safety, comfort and independence. Interactions between staff and the people who used the service were warm, friendly and relaxed.

Although there were systems in place to assess whether people had the capacity to consent to their care and treatment in Higher Bank, we found some of the records contained conflicting information. The registered managers told us that in their opinion all the people who used the service had the capacity to consent to their care in the home and there were no restrictions in place. However we found improvements needed to be made to the arrangements to assess whether DoLS applications needed to be made in order to protect the rights of people who used the service.

People's care records contained enough information to guide staff on the care and support required. Care records showed that risks to people's health and well-being had been identified and regularly reviewed.

People told us they enjoyed the meals provided in Higher Bank. Our observations during the inspection showed the food was of high quality and well presented. Systems were in place to help ensure people’s nutritional needs were monitored and referrals made to specialist services when any concerns were identified

The inspection team included an inspector and an expert by experience. The team gathered evidence against the outcomes we inspected to help us answer our five key questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with six people who used the service and three relatives. We also spoke with a professional visitor to the home, the two registered managers who job share this role, three staff members and looked at records.

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

Is the service safe?

People told us they felt safe and comfortable in Higher Bank. People had been cared for in an environment that was safe, clean and hygienic. Comments made to us included, “I have no concerns about the cleanliness of the home” and “I have had two relatives here. The rooms are always kept spotless”.

All the people we spoke with told us they could speak to staff if they had any worries or concerns. They were confident they would be listened to and their concerns acted upon.

Systems and processes were in place to assess and manage the risks related to the premises and the use of equipment in the home. This should help protect people who used the service, staff and visitors.

Is the service effective?

People told us they were happy with the care they had received and that their needs had been met. It was clear from our observations and from speaking with staff that they had a good understanding of people’s care and support needs and that they knew them well. One person told us, “My mum is well looked after here”.

Staff had received training to meet the needs of the people who lived at Higher Bank.

Is the service caring?

People were supported by kind and attentive staff. One person told us, “The staff are very good they will do anything for you”. People’s preferences had been recorded and care had been provided in accordance with people’s wishes.

Is the service responsive?

People who used the service were offered regular opportunities to comment on the care and support they received.

People were offered the opportunity to participate in a range of activities both in and outside of Higher Bank. The home had its own minibus which helped people to access their local community.

People knew how to make a complaint and were confident any concerns they raised would be dealt with by the home managers.

Is the service well led?

The home had two managers who were registered as a job share with the Care Quality Commission. The managers were also the owners of the home and arranged their shifts so that at least one of them was always available to provide support to staff and people who used the service.

There were systems in place to ensure the health and safety of people who used the service and staff and visitors were protected.

On the day of our inspection we spoke with seven people who lived at Higher Bank and four visitors. We also spoke with four staff. People told us they were happy with the care and support provided by the home. Comments included, "It’s like a big family here. It’s homely and welcoming” and “It’s lovely here: staff can’t do anything better”.

We reviewed the care files of three people who lived at Higher Bank. We found evidence there were systems in place to record people’s consent for staff to meet their care needs, including the administration of medication. Staff told us they understood the need to seek agreement from people before providing any care or support.

We found people's care was planned and delivered in accordance with their needs. People had individual care plans which were supported by a series of risk assessments.

People told us they enjoyed the food served at the home. Comments included, "The food is good” and “The food tastes good and is cooked well”.

We found there were sufficient staff to meet the needs of people at Higher Bank. Most of the care staff had achieved a recognised qualification in care, which would help them to look after people properly.

We found that suitable arrangements were in place to manage an effective process for identifying, receiving and handling complaints for people in Higher Bank.

At our last inspection visit in July 2012 we found that people were not protected against the risks associated with the unsafe management of medicines. We also had concerns that the recruitment procedures for the home did not fully safeguard the health and welfare of people who used the service.

Following the inspection visit we were sent an action plan informing us how the provider was going to improve the management of medicines within the home and amend the recruitment and selection procedures to ensure they met current regulations.

We revisited the service and looked at the recruitment and selection procedure and the records of two staff who had been recently appointed. We found that the necessary arrangements were in place to ensure that people were protected from unsuitable staff.

We reviewed the systems for the administration of medicines within the home and found that improvements had been made which meant that people were safeguarded against the risk of the unsafe management of medication.

People spoken with were satisfied with the service provided, one person told us, “I don’t think you could find better, the staff are very nice” and another person said, “I’m settled here, I have no complaints at all”. People told us their rights to privacy, dignity and independence were upheld and respected.

People’s care was planned and delivered in accordance with their needs. People had individual care plans which were supported by a series of risk assessments. People told us they had discussed their needs with staff, but they could not recall discussing their care plan.

Staff had access to appropriate safeguarding policies and procedures and were aware of how to raise a safeguarding concern. All people spoken with said they felt safe and comfortable in the home.

Whilst people told us they received appropriate support with their medication, we found the medication records were not always clear and up to date.

We found some aspects of the recruitment and selection procedure were outdated and full checks had not always been carried out on new staff.

There were systems in place to monitor the quality and operation of the service. We saw evidence to demonstrate that people and their relatives were asked for their opinion of the service.