Highfield is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Highfield provides accommodation and support for people who have various physical and neurological conditions, including dementia. The home is situated in a residential area of Bedford and is registered to accommodate up to 34 people.

We previously inspected the provider in January 2017 and February 2017 and rated them as requires improvement overall due to concerns in the areas of Safe, Caring and Well-led. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question to at least good. At this inspection we found the provider had made improvements in these areas.

The home had a registered manager. 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.

People were safe because there were effective risk assessments in place, and systems to keep them safe from abuse or avoidable harm. There was sufficient numbers of staff to support people safely. Staff took appropriate precautions to ensure that people were protected from the risk of acquired infections. People's medicines were managed safely, and there was evidence of learning from incidents.

People's needs had been assessed regularly and they had care plans in place that took account of their individual needs, preferences, and choices. Staff had regular supervisions and they had been trained to meet people's individual needs effectively.

The requirements of the Mental Capacity Act 2005 were being met. 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 supported by caring, friendly and respectful staff. Staff understood their roles and responsibilities to seek people's consent prior to care and support being provided. Where required, people had been supported to have enough to eat and drink to maintain their health and wellbeing.

Staff regularly reviewed the care provided and were guided through regular input by the person receiving care to ensure the care provided continued to meet their individual needs, in a person centred way.

The provider had an effective system to handle complaints and concerns.

The service was well managed and the provider's quality monitoring processes had been used effectively to drive continuous improvements. The registered manager provided stable leadership and effective support to the staff. They worked well with staff to promote a caring and inclusive culture within the service.

Collaborative working with people, their relatives and other professionals resulted in positive care outcomes for people using the service.

Further information is in the detailed findings below.

During our inspection on 1 February 2017, we found that the cleanliness of the service had not been maintained to an acceptable standard. We saw that there were a number of areas of the service which were not clean and we found that effective cleaning processes were not being implemented. During the inspection we saw that cleaning practices were not robust which had resulted in dust, dirt and stains to communal areas, toilets and bathrooms and people's bedrooms.

This was a breach of regulation 15 (1) (2) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This report only covers our findings in relation to the outstanding breach of regulation. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Highfield on our website at www.cqc.org.uk.

This inspection was unannounced and took place on 7 March 2017.

During this inspection, we found that improvements had been made to the systems in place within the service, to ensure that cleaning took place regularly, and to a good standard. We saw that the areas throughout the home that were previously not clean had been deep cleaned and maintained as clean. Thorough checks were in place where senior staff would monitor the on-going cleanliness, and staffing hours had increased within the cleaning and housekeeping team.

While improvements had been made we have not revised the rating for the key questions; to improve the rating to 'Good' would require a longer term track record of consistent good practice. We will review our rating for safe and well led at the next comprehensive inspection.

This unannounced inspection was carried out on 01 February 2017. We had preciously inspected this service in November 2014 and rated it Good. This inspection was carried out to review the current care being provided by the service.

Highfield provides accommodation and support for people who have various physical and neurological conditions, including dementia. The home is situated in a residential area of Bedford and is registered to accommodate up to 34 people. On the day of our inspection there were 33 people 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.

The cleanliness of the service had not been maintained to an acceptable standard. We saw that there were a number of areas of the service which were not clean and we found that effective cleaning processes were not being implemented. During the inspection we saw that cleaning practices were not robust which had resulted in dust, dirt and stains to communal areas, toilets and bathrooms and people's bedrooms.

At times, people's dignity and respect were not being maintained. The service had not implemented sufficient systems to ensure that people always got their own clothing back from the laundry and people routinely had clothing go missing or had to wear somebody else's.

There were quality assurance systems in place at the service, however, they were not always effective. These processes had failed to identify areas of concern which were highlighted during the inspection and did not pick up on the fact that some paperwork was not being completed on a regular basis.

People felt safe living at the service. Staff members were knowledgeable about abuse and potential signs that it had occurred. They were prepared to report it and any other incidents, to ensure people were kept safe. Risks to people were assessed to ensure they could be as independent as possible whilst keeping safe. Staffing levels were sufficient to ensure that people's needs were being met and that staff were able to spend time with people engaging in conversation and positive interactions. Staff members also managed people's medicines and there were systems in place to ensure they were administered, stored and recorded correctly.

Staff members were provided with the training and support they needed to perform their roles. New staff were inducted to the service and were supported to get to know the people living there and the way the service worked. Staff received supervision to allow them to raise concerns and discuss any development needs they may have.

People were encouraged to make choices about their care and staff members sought their consent as much as possible. Where people could not give their consent, the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards were followed, to ensure that decisions were made in people's best interests. People had choices about what they wanted to eat or drink and were provided with the support they needed to maintain a nutritious diet. They were also supported to book and attend appointments with healthcare professionals to help them be as healthy as possible.

There were positive and caring relationships between people and members of staff. Staff made sure they treated people with kindness and compassion and spent time talking to them and getting to know them. Care plans were in place to help guide staff and these were reflective of the care and support that people needed. People had been involved in the production of these care plans and they were regularly reviewed with people's input, to ensure they remained up-to-date.

Activities were available at the service to help people k

The inspection of Highfield took place on 17 November 2014. It was an unannounced inspection.

Highfield is a care home offering personal care for up to 34 older people. 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.

People who used the service told us they felt safe. We found that the staff knew about the systems in place to protect people from the risk of harm and they knew how to recognise and respond to abuse correctly. There were sufficient staff over the 24 hour period to meet people’s needs. They had been recruited appropriately and were checked regularly to confirm they remained safe to look after and work with vulnerable people.

Some people who used the service did not have the ability to make decisions about aspects of their care and support. Staff understood the systems in place to protect people who could not make decisions and followed the legal requirements outlined in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The CQC is required by law to monitor the operation of the 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 make decisions for themselves were protected. Where people lacked the capacity to make decisions about something, best interest meetings were held and documented in people’s care records. Whilst inspecting the home we reviewed cleanliness and infection control because we were told there had been an outbreak of diarrhoea and vomiting the previous week. No concerns were identified in this area.

People had their personal care needs met in a timely manner and staff were attentive and kind when responding to them. One person said of the staff, “They do everything with a smile on their face.” Staff understood people’s needs and how they wanted to be supported even though we noted that people’s wishes were not always documented. We observed that staff were mindful of people’s privacy and dignity and gave them choices. For example, people chose where to sit, where to have their meal and what to wear as well as how they spent their time.

Staff received a variety of relevant training to meet the needs of people using the service. We saw that they had the opportunity to request any additional training. The provider encouraged and supported the staff to update their skills and knowledge in order to provide the best care and support to people using the service.

People and the staff told us they had a good relationship with the manager and felt they could speak with her at any time. One person said, “She checks on us each day. She is lovely and caring.” Visitors confirmed they knew the process to raise concerns.