This inspection took place on 7 October 2016 and was unannounced. We last inspected this service on 14 and 22 May 2014, and found that they needed to take action to improve the care and welfare of people who used services and the management of records. These previous shortfalls had been addressed.

Highfield Residential Home provides care and accommodation for up to 23 older people, some of whom live with physical disabilities and dementia. At the time of our inspection there were 21 people using the service, with one person in hospital.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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.

There were enough staff to meet peoples' needs. Staff had a good understanding of their roles and responsibilities to safeguard people, and to provide care that was person-centred. Staff were recruited safely and were trained and supported by the managers.

People’s care needs had been identified and appropriate care plans put in place to meet these needs in a way that was consistent. People’s care plans were detailed, up to date and followed by staff . Risks to people’s health and well-being had been assessed and management plans that took account of people’s views and choices. Staff were aware of the risk assessments and supported people accordingly. People’s medicines were managed and stored appropriately, and staff supported people to access healthcare services when required.

People were supported by staff that were friendly, kind and caring. They had their privacy, dignity and choices respected by staff who sought their consent before providing any care. The requirements of the Mental Capacity Act 2005 were met. People told us the meals provided were tasty and they had the support they needed to remain healthy and well.

The provider had a quality assurance system in place, and people, their relatives and staff commented positively about the management team. We did not meet with the registered manager during our inspection because they were on leave. However, the two deputy managers who supported the registered manager were knowledgeable and clear in their role and responsibilities. There were policies and procedures in place to effectively manage complaints, concerns and the quality of the service.

We spoke with four people who used the service. We also spoke with the manager, senior staff and two staff members.

People told us they were happy with the service they received and that staff looked after their needs. They said that they received the health and personal care they needed and that they were comfortable. People said that their likes and dislikes were taken into consideration. People told us they were asked for consent before any care or support was given and that their dignity was respected.

Staff recruitment records showed that new staff had been thoroughly checked to make sure they were suitable to work with vulnerable people.

Systems were in place to ensure the safe management and administration of medication.

We found that improvements had been made to the care plans and record keeping.

Everyone we spoke with said that they were very happy with the service provided at Highfield Residential Home.

People told us that they felt safe and well looked after. They told us the staff were polite and respected their privacy and dignity. People said the staff knew how to care for them well and they always responded quickly when they pressed the buzzer.

People said: "After the first night here I felt at home". "This is my home, I feel completely safe here". "There is plenty of choice here, the food is very good indeed, if you don't like something they give you something else". "This home is very good, you can not fault it". "The food is excellent".

Relatives, staff and people using the service told us that the home was always clean and tidy. They said the staff worked hard to make sure their rooms was clean and there were no unpleasant odours.

Relatives were satisfied with the service and would recommend the home.

People told us they were satisfied with their care. They were aware of their records and some people said they had been involved in their plan. However, care plans did not always reflect the individual and personalised care being provided and did not show how risk would be managed. Records were therefore not fully accurate or up to date.

People using the service told us that they were happy with the care they were receiving and one person commented that ‘The quality of the care here is second to none’. People said there were always enough staff on duty to help them and that the staff took the time to stop and chat with them and to listen to any concerns they had. They told us that they had been involved in making decisions about their care and that their views had been respected. Everyone we spoke with told us that they felt safe in the home and knew how to make a complaint if they needed to. They said that the manager often asked for their views of the service and always listened to their suggestions.

People told us that they always had a choice of meals and that they enjoyed the food provided. They said they could choose whether they wanted to be involved in the daily activity session and had plenty to do to keep them occupied during the day.

People told us that the staff gave them the help they needed to take any medicines they were prescribed and some people told us they had been given the choice to stay with their own GP when they moved to the home. They said that the staff were quick to recognise their health needs and made appointments with the GP or other health professionals when they needed it. The district nurses that visit people in the home told us that the staff worked well with them and provided sensitive care. They said that any advice they had given about a person’s care was always followed.

The inspection was carried out by one Inspector over eight hours. During this time we met and talked with people living in the home and with staff on duty. They helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? 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 people who used the service, the staff supporting them and looking at records.

Is the service safe?

People’s needs had not been fully assessed and care had not been planned to meet each person’s needs. Each person had a care plan containing basic information about their care and support needs. However, we saw that clear plans of how care was to be delivered including guidance for staff to follow was not included in the plans. This meant that people may be at risk of receiving care and support that was inappropriate or unsafe. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Systems were in place to make sure that managers and staff learned from accidents and incidents, concerns, and complaints. This reduced the risks to people and helped the service to continually improve.

People were cared for in a safe environment. The home had been maintained and decorated regularly. We found that people using the service were protected from risks associated with the building and grounds because the provider had taken action to minimise and manage risks appropriately.

People's care needs and the qualifications, skills and experience of the staff were taken into account when making decisions about staffing numbers required to the meet the needs of people who used the service.

Is the service effective?

The service was effective. People told us that they were happy with the care that had been delivered and that their care needs were met. One person we spoke with told us, “The staff come quickly when I use my call bell”. We saw that staff were attentive to people using the service and responded promptly when needed.

Is the service caring?

The service was caring. People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when supporting people. People were given care and support by staff in a way that suited them best. People we spoke with said they felt staff respected their privacy and dignity and staff were polite and caring.

People said that staff were polite and spoke to them kindly.

Is the service responsive?

The service was responsive. People told us that they were happy with the service. People we spoke with said they felt that there were enough staff to meet their needs. We saw that staff responded quickly to people’s requests for support.

We found that people were supported to attend health appointments, such as, doctors. We saw records to show that the service worked closely with health and social care professionals to maintain and improve people's health and well-being.

Is the service well-led?

On the whole the service was well-led. Quality assurance processes were in place. Staff told us they were clear about their roles and responsibilities and that they felt supported by the management team.

Systems were in place to ask people who used the service, and their relatives for their views about the service. Staff told us that they could raise concerns about individuals with the manager if they needed to but there were not asked for their views on the service they provided overall. Therefore we have asked the provider to note that no process was place to ask staff for their views on the whole service.

The service worked well with other agencies and services to make sure people received

their care in a joined up way.