This inspection took place on 19 and 21 April 2017 and was unannounced.¿

This was a comprehensive inspection carried out at Highfield House Residential Care Home. At ¿the last inspection on 20 October 2014, the service was rated ‘Good’. At this inspection we found ¿the service was now ‘Outstanding’.¿

Highfield House is a care home, registered to provide care for up to 22 people. The home ¿specialises in the care of older people but does not provide nursing care. It is situated in the ¿centre of Castle Cary, in easy walking distance of local shops, churches, post office, library, ¿cafes, pubs and park. There were 22 people living at the home when we inspected.¿

The service 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 and associated Regulations about how the service is run.¿

People were supported by very kind, caring and compassionate staff who went the extra mile to ¿provide people with excellent, high quality care. One person said, "The care is superb. All the staff ¿are wonderful, compassionate and kind people who really understand the meaning of care.” This ¿high standard of care enhanced people's quality of life and wellbeing. The whole staff team were ¿extremely passionate about providing people with support based on their individual needs and ¿aspirations.¿

There was a strong culture within the service of treating people with dignity and respect. People ¿and the staff knew each other well and these relationships were valued. The staff, registered manager, care manager and the provider were always visible and listened to people and their relatives and friends, ¿offered them choice and made them feel that they mattered. ¿

Care was planned around people's individual preferences and this included their spiritual ¿wishes. People's diverse needs were considered and their human rights respected. The service ¿had a recognised approach to support people at the end of their lives to ensure that it was ¿dignified and comfortable. People received exceptionally compassionate care at the end of their ¿life, which was planned in advance with them. A relative told us, “The end of life care was ¿excellent, it really was.”¿

There was a culture of openness and transparency at the service. Staff were extremely positive ¿about the management and leadership which inspired them to deliver a high quality service. The ¿registered manager, care manager and the provider (collectively known as 'the management team') demonstrated exceptional leadership. They encouraged ¿ideas from staff to benefit the people in their care and maintain a strong, stable staff team with a ¿shared goal. ¿

People were looked after by staff who all shared the provider's commitment to providing high ¿quality care. The registered manager said, “People here are at the heart of everything we do; they ¿are consulted and involved in everything. The culture here has been built over years and years of ¿hard work and dedication by the owners.” ¿

Feedback from people who used the service and their relatives was used to make changes to the ¿service and to drive improvements. The management team had a strong emphasis on continuous ¿improvement of the service. An effective and efficient system of monitoring checks and audits ¿identified any improvements that needed to be made and action was taken as a result. Comments ¿included: "The home is superb” and “Highfield is exemplary; a superb place for residents to live.” ¿

People felt safe. There were systems in place to record safeguarding concerns, accidents and ¿incidents and take appropriate action when required. Staff had received safeguarding training ¿and understood their responsibilities to report any unsafe care. There were plans in place to ¿protect and promote peop

Highfield House is a care home which is registered to provide care for up to 22 people. The home specialises in the care of older people but does not provide nursing care. There is a registered manager who is responsible for the home. 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.

On the day of the inspection there was a homely and relaxed atmosphere in the home and we saw staff interacted with people in a friendly and respectful way. People were encouraged and supported to maintain their independence. They made choices about their day to day lives which were respected by staff.

People said the home was a safe place for them to live. One person said “I think it is a safe place to live. I’ve lived here for six years and I am very happy here. I don’t know why you wouldn’t be.”  Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns. Staff spoken with were confident any allegations made would be fully investigated to ensure people were protected.

People said they would not hesitate in speaking with staff if they had any concerns. People knew how to make a formal complaint if they needed to. One person said “I have lived here for a long time and I have never had to complain. If you are unhappy about anything you can speak to any of the staff and they will sort it out for you.”

People were well cared for and were involved in planning and reviewing their care. They were encouraged to be as independent as they could be. There were regular reviews of people’s health and staff responded promptly to changes in need. People were assisted to attend appointments with appropriate health and social care professionals to ensure they received treatment and support for their specific needs.

Staff had good knowledge of people including their needs and preferences. Staff were well trained; there were good opportunities for on-going training and for obtaining additional qualifications. One staff member said; “The training is nonstop so you are kept up to date.”

People’s privacy was respected. Staff ensured people kept in touch with family and friends. People were provided with a variety of activities; they could choose to take part if they wished. Staff at the home had been able to build good links with the local community.

There were effective quality assurance systems in place. The management structure in the home provided clear lines of responsibility and accountability. The registered manager and both care managers provided strong leadership and good support for the staff team.

People’s views were acted upon where possible and practical. In addition to the resident’s meetings, the service used annual satisfaction surveys and reviewed suggestions, complaints and compliments to continually develop the service.

Highfield House has an 'open door' visiting policy so that relatives and friends can visit at any time. People who lived in the home had individual rooms furnished with personal possessions and effects. We noted that some of the rooms had a photograph of the occupant on the door to assist those people whose memory was failing, to find their own room.

We spoke with a total of 12 people who all praised the staff and the care they received. All the people we spoke with told us that the staff were very kind and caring 'nothing is too much trouble' 'the quality of care here is amazing.' We found a wealth of activities offered to people in the home including film afternoons, exercise classes, quizzes, various card and board games, organised trips, music sessions and other activities chosen by people.

We observed staff supporting people to maintain their independence as much as possible and comprehensive risk assessments for all of the people to enable individual choice of activities. People told us that their privacy and dignity was always respected, staff knock on the door before entering and that they felt 'safe and secure' at Highfield House.

We spoke to a visiting community nurse who told us they had no concerns about the home and that the people always seemed very happy and that communications from the home were very good.

We spoke to a visiting family member of one person who told us 'I felt as soon as I walked through the door here that this was a special place'

People who lived in the home told us that staff provided the care and support they needed. Everyone spoke very highly of the home; they said staff were very patient and kind and they listened to them. One person told us “This is the best home I have lived in.” Regular activities were arranged, as were occasional trips out of the home.

People said their privacy and dignity were always respected by staff; they were very well cared for and said that staff were available when they needed them. Staff helped them to do the things they needed help with. One person said “The staff are very good, very helpful. They know what care I need.” The visitors we spoke with were very happy with the care provided to their relatives. One visitor told us “This home is excellent.”

People told us the home was a safe place for them to live. One person said “Oh yes, absolutely I feel safe. No one has ever upset me here.” Staff knew how to report any concerns if they were to have any. Thorough checks were carried out to make sure that staff members were suitable to work in the home.

People who lived in the home told us they knew how to complain and would not hesitate to do so if they were unhappy about any aspect of their care or the home more generally. The visitors we spoke with said they had never had cause to complain. They felt able to raise any issues should they have any. One relative said “There is nothing to complain about. This home is how it should be done.”

Everyone asked was very happy with the care that they received. Comments included “I like it here they look after me very well,” “They know what I need and they are always there to help” and “You get everything you need, you only have to ask and they are always happy to help you.”

One person said that since being at the home their needs and abilities had changed and the level of care had changed with it. They said “They know when you are finding things difficult and so they just help you that little bit more. Because they do it naturally you are never embarrassed about not being able to manage something.”

People told us that they were involved in, and consulted on, all aspects of their day to day care. One person said “They let me be independent and I just ring the bell when I want help. I always tell them how I want things done.” Another person said “You can please yourself, whatever suits you really.”

People said that they were encouraged to express their views about all aspects of their care and the running of the home. People said that they were invited to formal meetings and had regular private time with the home managers. We were told that all staff, including the homes’ management, were always ready to listen to their opinions and there were lots of opportunities for this.

Everyone we asked said that they would not hesitate to speak with a member of staff if they were unhappy about any aspect of their care, or the staff who supported them. One person commented “We are very lucky with the staff, if they weren’t polite I would complain straight away and it would be sorted out immediately.” Another person said “You can always talk to one of the managers, they are never in a hurry and always have time to listen. I know they would do something if I had a complaint.”

People said that there was always enough staff on duty and that staff responded very quickly if they rang their bell or asked for assistance. One person told us “Day or night, nothing is too much trouble” another person commented “They are always checking to make sure you are alright, they’re never in a rush and always have time for you.”