We carried out a comprehensive inspection of Highfield Hall on 18 and 19 July 2018. The first day was unannounced.

Highfield Hall is registered to provide accommodation, nursing and personal care for up to 75 people. This includes older people, younger adults, people with mental ill health and people living with dementia. Accommodation is provided over two floors. There are three separate units; a nursing unit, a residential unit and a unit specifically for people living with dementia. At the time of our inspection there were 66 people living at the home.

The service 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 we looked at both during this inspection.

At the last inspection on 7, 8 and 12 June 2017, we found two breaches of the regulations. These related to appropriate action not always being taken to manage people’s risks and a lack of sufficient staff on duty to meet people’s needs. Following our inspection, the provider sent us an action plan and told us that all actions would be completed by 25 September 2017.

At this inspection we found that improvements had been made and the provider was meeting all regulations reviewed.

Most people who lived at the home and their relatives were happy with staffing levels. They told us staff provided them with support when they needed it.

Records showed that staff had been recruited safely and the staff we spoke with understood how to protect people from abuse or the risk of abuse.

Staff received an effective induction and appropriate training. People who lived at the service and their relatives felt that staff had the knowledge and skills to meet their needs

People told us the staff who supported them were caring and respected their right to privacy and dignity. They told us staff encouraged them to be as independent as they could be and we saw evidence of this during the inspection.

People received appropriate support with nutrition and hydration and their healthcare needs were met. Referrals were made to community healthcare professionals to ensure that people received appropriate support.

We received mixed feedback about the meals available at the home. We discussed this with the registered manager, who provided evidence to show that concerns expressed about the meals at the home were being addressed and improvements were being made.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way; the policies and systems at the service supported this practice. Where people lacked the capacity to make decisions about their care, the service had taken appropriate action in line with the Mental Capacity Act 2005.

People told us that they received care that reflected their individual needs and preferences and we saw evidence of this. Staff told us they knew people well and gave examples of people’s routines and how people liked to be supported.

People were supported to take part in activities and events. They told us they were happy with the activities that were available at the home.

Staff communicated effectively with people. They supported people sensitively and did not rush them when providing care. People’s communication needs were identified and appropriate support was provided.

None of the people living at the home that we spoke with had made a complaint but told us they would feel able to. One person’s relatives told us they had raised concerns and were not happy with the response they had received.

The registered manager regularly sought feedback from people living at the home and their relatives about the support they received. We saw evidence that she used the feedback received to develop and improve the service.

We received mixed feedback about how the service was being managed. However, most people felt it was being managed we

We carried out a comprehensive inspection of Highfield Hall on 7, 8 and 12 June 2017. The first day of the inspection was unannounced.

Highfield Hall provides personal and nursing care for up to 75 people, including older people, younger adults, people with mental ill health and people living with dementia. Accommodation at the home is provided in single ensuite rooms. The home is divided into three units, with a unit for people with residential care needs, a unit for those with nursing needs and a unit for people living with dementia related needs. The service is situated in Haslingden in Rossendale, East Lancashire. At the time of our inspection there were 67 people living at the home.

At the time of our inspection the service had a registered manager who had been in post since July 2015. A registered manager is a person who has registered with the CQC 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 a previous inspection on 22 December 2014, we found a breach of our regulations relating to the recording and management of one person’s risks. We carried out a follow up inspection on 19 March 2015 and found that improvements had been made and the provider was meeting all legal requirements.

During this inspection we found two breaches of our regulations related to staffing levels and the management of people’s risks. You can see what action we told the provider to take at the back of the full version of the report.

Most people we spoke with were happy with staffing levels at the home. However, we found that there was not always an appropriate number of staff on duty to meet people’s needs.

We found that people who were at risk of falling, were not always supported appropriately. Care plans and risk assessments were not always updated when people’s needs changed. This meant that it was difficult to ensure that staff were managing people’s needs and risks effectively.

During our inspection we found that there were appropriate policies and procedures in place for the safe management of medicines. We observed staff administering medicines safely.

People who lived at the home liked the staff who supported them and felt that staff had the knowledge and skills to meet their needs.

We saw evidence that staff had been recruited safely. The staff we spoke with understood how to safeguard vulnerable adults from abuse and were clear about the action to take if they suspected that abusive practice was taking place.

We found that staff received an appropriate induction, effective training and regular supervision. Staff told us the registered manager was approachable and they felt well supported by her.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way; the policies and systems at the service supported this practice.

The service had taken appropriate action where people lacked the capacity to make decisions about their care and needed to be deprived of their liberty to keep them safe. We found evidence that where people lacked the capacity to make decisions about their care, their relatives had been consulted

Most people who lived at the home were happy with quality of the meals provided. However, four people felt that they needed to be improved.

People received support with their healthcare needs and we received positive feedback from community health care professionals about standards of care at the home.

We observed staff communicating with people in a kind and respectful way. People told us staff respected their privacy and dignity and encouraged them to be independent.

People were supported to take part in a wide variety of activities inside and outside the home. People living at the home and their relatives were very happy with

People using the service told us they were involved in making decisions about their care and support needs. One person said, “It’s the best place I’ve been in.”

We saw that members of staff were courteous and attentive to people’s needs. One person said, “I’ve lived here a long time, we are all well looked after.”

We found that a sufficient number of staff was employed at the home in order to meet the health and social care needs of people using the service.

We noted that systems were in place to monitor the quality of the service provided. There was evidence to demonstrate that people were regularly consulted about the care and facilities provided at the home.

We saw that appropriate and accurate records were kept for people using the service and the overall effective management of the home.

People using the service told us they liked living at Highfield Hall and were satisfied with the care provided. Members of staff explained what they were doing before they carried out care tasks so that people could give their consent. One person said, “The staff are excellent, they’ll do anything for you.”

We saw that suitable arrangements were in place for the safe keeping and handling of medicines.

We found that staffing levels were sufficient to meet people’s needs. Members of staff received the training they needed in order to provide safe and appropriate care for people using the service.

We saw that appropriate and accurate records were kept for people using the service and the overall effective management of the home.

People told us they liked living at Highfield Hall. One person said, “It’s a good place, you couldn’t find better, the staff are smashing.” Another person said, “I like it here, I’ve got a nice room and I’ve brought things from home.”

The visitors spoken with were very satisfied with the quality of care provided and felt that their relatives were looked after in a caring and sensitive manner.

One visitor said, “It’s first class, clean and the carers are polite and pleasant.”

People told us the daily routine was flexible and they could choose when to get up and go to bed. One person said, “I can go to my room when I want.” Another person said, “I can stay up late if I want.”

All the people we asked said the food was good and they had a choice of menu for all meals.

People using the service and their relatives could speak with the registered manager or a senior member of staff at anytime to discuss any issues relating to the care and facilities provided at the home.

We carried out an unannounced comprehensive inspection of this service on 22, 23 and 30 December 2014 and identified a breach of regulation. This was because documentation relating to people's care was not kept up to date and did provide sufficient information to ensure people received safe, effective and co-ordinated care.

We asked the provider to send us an action plan to tell us how they would ensure they met the legal requirements in relation to the breach. We undertook a focused inspection on the 19 March 2015 to check that they had followed their plan and to confirm that they now met regulatory legal requirements. During our inspection on 19 March 2015 we found that the provider had followed their plan which they had told us would be completed by April 2015 and legal requirements had been met.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Highfield Hall’ on our website at www.cqc.org.uk’

Highfield Hall provides nursing and personal care for up to 75 older people in single ensuite bedrooms. There are comfortable lounges, dining rooms, sensory room, hairdressing salon and a kitchenette for people and their visitors to use. Various aids and adaptations to support people to maintain their independence are available in addition to assisted bathing facilities. There is a separate dementia unit to care for people living with a dementia.

There was a registered manager in post on the day of our 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.

We found that risk assessments and care planning had improved. Care plans had been reviewed and were being routinely checked by senior management. Staff had been provided with clinical supervision and given the right guidance on how to manage and report on distressed reactions from people using the service.