The inspection took place on 10 October and 19 October 2018 and was unannounced. Our inspection was carried out at this time because of concerns we had due to the notifications we received from the service. Notifications are changes, events or incidents the provider is legally required to let us know about.

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

The service had been developed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At the time of our inspection the service did not have a manager registered with the Care Quality Commission. Since September 2018 a service improvement manager had been put in place to manage 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.

At the last inspection in May 2017, we rated the home as good. Since then there has been a period of unsettled management and we found there were weaknesses in how the home was being run. We identified six breaches in the regulations, relating to regulation 12 Safe care and treatment, regulation 11 Need for consent, regulation 13 Safeguarding people from abuse and improper treatment, regulation 16 Responding to complaints, regulation 17 Good governance and regulation 18 Staffing.

Staff we spoke with understood what it meant to safeguard people from abuse. However, issues we identified during the day did not support this.

Staff documented accidents and incidents in people’s daily notes, but did not consistently report these incidents to the relevant statutory bodies.

Risk assessments had been completed but staff were not consistently following them.

The provider did not provide supervision and appraisal in line with their own policies and procedures.

There were processes in place to monitor the quality of safety of the service. However, these were not effective and there was little evidence of management oversight of the service.

Care plans had identified some needs did not always reflect peoples current or changing needs. We checked the records of three people and two out of the three people did not have current and up to date information in their care records. The service improvement manager was in the process of updating care plans and had completed an action plan identifying the required remedial actions and appropriate timescales for the care plans to be reviewed and updated.”

The provider had identified actions that needed to be taken to address the shortfalls within the service. We saw evidence of appropriate action been taken by the relief management team service action plan.

People were mostly supported to have maximum control and choice over their lives and staff supported them in the least restrictive way possible. Policies and systems in the service supported this practice, staff did not always understand legislation around people's mental capacity and documentation for consent and decision making was not robust.

Staff had a kind and caring approach. They showed respect when interacting with people and had good regard for people's privacy and dignity. Staff had discussions with people about their daily routine, although there was limited evidence of people being involved in their own care planning or future goals and people did not always have choice and control.

There was a complaints process but th

This inspection took place on 22 May 2017 and was unannounced, which meant no-one at the service knew we would be visiting.

Highfield Farm is a care home for young people with a learning disability and/or autistic spectrum disorder. It can accommodate up to seven people in the main house and another three in individual bungalows on the same site. At the time of our inspection there were 10 people living in the home.

The service did not have 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 and associated Regulations about how the service is run. A new manager had commenced in post the week prior to the inspection. It was their intention to register as manager of the service.

The service had been in breach of regulations since an inspection at the service on 20 October 2015. The service was last inspected on 1 and 9 November 2016. At the last inspection we found the service was not meeting the following regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: regulation 17 Good governance and regulation 19 Fit and proper persons employed. A requirement notice was issued for regulation 19, Fit and proper persons employed and a warning notice for regulation 17 good governance. At this inspection, we checked and found improvements had been made to meet regulations. The registered provider must now maintain those improvements to ensure a consistently good service is offered to people who use the service.

Our observations of the interactions between people and staff identified people were comfortable in the presence of staff and in our discussions with them no-one raised concerns about their safety. People told us and we found the service provided good care and support. People told us and we found staff to be caring, kind and that they respected their choices and decisions.

Staff we spoke with were knowledgeable regarding safeguarding vulnerable adult’s procedures and were able to explain the action required should an allegation of abuse be made.

Care records reflected the care delivered to people and the care and support they described to us. Those records incorporated relevant risk assessments in regard to people’s health, safety and wellbeing. Staff were familiar with the information about how to meet people’s needs, showing they knew people well.

There were sufficient staff to meet people’s needs and provide a regular team of care staff to people who used the service and recruitment information in place showed staff were suitable to work with people who used the service.

Medicines were stored and administered safely. The systems for monitoring medicines ensured medicines were given as prescribed.

There was a programme of training for all staff to enable them to have the qualifications, skills and knowledge to understand the care and support required for people who used the service. Staff received supervision and appraisal.

People were supported to have 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’s nutritional needs were met and the mealtime experience had been improved with the offering of a choice of desserts with meals.

Staff were aware of the values of the service and knew how to respect people’s privacy and dignity. Reducing the number of beds the service could accommodate had assisted with this, by ensuring private space was available when needed to ensure people’s confidentiality.

We found where concerns were raised these were listened to and acted on.

Systems in place for monitoring quality and compliance with regulations were effective.

The service had two registered managers, but they were not acting as the managers at the time of the inspection. A registered manager from another location was managing the location. This meant since the last inspection on 20 October 2015 the management of the service had been inconsistent, with the service having three different managers.

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 and associated Regulations about how the service is run.

The service was last inspected on 20 October 2015. At the last inspection we found the service was not meeting the following regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: regulation 13 Safeguarding service users from abuse and improper treatment, regulation 17 Good governance, regulation 18 Staffing and regulation 19 Fit and proper persons employed. The registered provider submitted an action plan telling us the improvements they would make to achieve compliance by 15 February 2016. We found the service had made some improvements, but remained in breach of two regulations. You can see what action we took at the end of the report.

Our observations of the interactions between people and staff identified people were comfortable in the presence of staff and in our discussions with them no-one raised concerns about their safety.

People were supported to have 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.

Staff we spoke with were knowledgeable regarding safeguarding vulnerable adult’s procedures and were able to explain the action required should an allegation of abuse be made.

Systems in place for monitoring quality and compliance with regulations had not always been effective in practice. This was despite improvements being identified and action plans formulated to ensure improvement, for example, the allocation and expenditure of budgets, staffing levels, recruitment of staff, people’s records and complaints.

People’s nutritional needs were met, but the mealtime experience could be improved by making information about meals available, providing more choice and offering dessert with meals.

Staff were aware of the values of the service and knew how to respect people’s privacy and dignity. However, this was not always met because we heard private conversations conducted in communal areas which could be overheard, and communal areas were used for staff purposes in the management of the regulated activity.

There was a programme of training for all staff to enable them to have the qualifications, skills and knowledge to understand the care and support required for people who used the service. Staff received supervision and appraisal.

Medicines were stored and administered safely. The systems for monitoring medicines ensured medicines were given as prescribed.

The inspection took place on 20 October 2015 and was unannounced, which meant no-one at the service knew we would be visiting.

This service was registered under this registered provider on 7 July 2014 and this was their first inspection.

Highfield Farm is a care home for young people with a learning disability and/or autistic spectrum disorder. It can accommodate up to eight people in the main house and another three in individual bungalows on the same site. At the time of our inspection there were 11 people living in the home.

The service did not have 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 and associated Regulations about how the service is run. The person managing the home, had applied to be registered.

Our observations of the interactions between people and staff identified people were comfortable in the presence of staff and in our discussions with them no-one raised concerns about their safety.

Staff we spoke with were knowledgeable regarding safeguarding vulnerable adult’s procedures and were able to explain the action required should an allegation of abuse be made. Records of safeguarding incidents showed that although immediate action was taken in response to the incident there was not always a record of outcomes and actions from investigations. These were not always overseen by the manager, which meant incidents had not been evaluated to analyse themes and trends and take appropriate action.

Monitoring systems were not in place to identify the impact of reduced staffing levels during the day and the impact on staffing levels when people were awake at night.

Not all of the information and documents had been obtained to demonstrate the registered provider had made safe recruitment decisions.

There was a programme of training for all staff to enable them to have the qualification, skills and knowledge to understand the care and support required for people who used the service.

Medicines were stored and administered safely. The systems for monitoring medicines ensured medicines were given as prescribed.

The Mental Capacity Act 2005 (MCA) sets out what must be done to make sure that the human rights of people who may lack mental capacity to make decisions are protected, including balancing autonomy and protection in relation to consent or refusal of care or treatment. The staff we spoke with during our inspection had a varied understanding of the importance of the Mental Capacity Act in protecting people and some people’s restrictions had not been reviewed.

People’s nutritional needs were met, but the choice of food and mealtime experience at lunchtime could be improved.

People were supported to maintain good health, had access to healthcare services and received on-going healthcare support. This included the monitoring of people’s health conditions and symptoms, so that appropriate referrals to health professionals could be made.

People had access to activities that were provided both in-house and in the community. There was a mini bus available for people to use so they were able to access the community.

We observed good interactions between staff and people who used the service and the atmosphere was happy, relaxed and inclusive. Staff were aware of the values of the service and knew how to respect people’s privacy and dignity.

A complaints procedure was in place, but the record of complaints was incomplete, which meant the process was not effective in monitoring complaints to identify trends and areas of risk that may need addressing.

The systems that were in place for monitoring quality had not always been effective in practice. Improvements had been identified and action plans formulated to ensure improvement.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.