The inspection took place on 8 August and was unannounced.

We last inspected the service in June 2017 and at that time identified breaches in three of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches were related to staffing, dignity and respect and good governance.

During this inspection we found improvements had been made and the matters we identified at the previous inspection had been addressed. As a consequence of these improvements the service was no longer in breach of regulations.

Highfield (Stockton) 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.

Highfield (Stockton) can accommodate up to 40 people in one purpose built building. At the time of our inspection there were 37 people using the service.

The service had 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.

At the last inspection we found that staff were not up to date with all training. At this inspection we found more than 90% of staff were now fully up to date with training, with other staff booked on to upcoming courses. People we spoke with were confident that staff had the skills to meet their needs and staff told us they were happy with the training they received.

The environment was now more suitable for people living with dementia. Clear signage had been put up around the building to help people find their way around. Corridors and communal areas had been newly decorated and people had photographs on their bedroom doors.

A more effective system of audits was now taking place. Although they had not identified every issue we found the registered manager was very responsive and made changes in light of our feedback, both during and immediately after the inspection. The audit system was still improving with more changes having been recently introduced.

People who used the service felt safe living at Highfield (Stockton). People’s relatives also told us they felt their loved ones were cared for safely.

Safeguarding incidents were correctly investigated. Staff had received safeguarding training and knew how to report any concerns.

The provider recognised people’s human rights and had policies in place to ensure people were protected from discrimination.

Falls, accidents and incidents were recorded and analysed to ensure lessons were learned and actions taken to minimise the risk of future incidents.

People had individual risk assessments on their care files but they did not always contain the most up to date information. We received confirmation after our visit that risk assessments had been updated.

Staffing levels were sufficient to meet people’s care needs. Safe recruitment procedures were in place and appropriate pre-employment checks were undertaken to prevent unsuitable people from being employed.

Regular maintenance and safety checks of the premises and equipment were carried out and plans were in place to support people in emergency situations.

People received their medicines safely. Records confirmed medicines were received, disposed of, and administered correctly.

People and their relatives were happy with the cleanliness of the service however there were some areas of the home which had an unpleasant smell. There was an issue with the flooring in one of the communal toilets and some areas within bathrooms and toilets required redecoration and repair. We received confirmation after our visit that all areas had undergone a deep clean whilst awaiting refurbishment.

Staff received supp

We inspected Highfield (Stockton) on 13 and 20 June 2107. The first day of the inspection was unannounced. This meant the provider and staff did not know we would be visiting. The service was last inspected in April 2015 and was rated good.

Highfield (Stockton) is a purpose built care home located on the outskirts of Yarm. At the time of our inspection the location was registered to provide accommodation to 40 people.

The home had a registered manager in place. 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 staff training was not up to date. The provider’s target for training was a minimum of 85% of staff training to be current. We found the average percentage of staff who had current training across all courses was 73.2%. Less that 50% of staff had current dementia training despite a high number of people who used the service living with some form of dementia.

The environment was not dementia friendly. There were not contrasting colours between walls and handrails and there was insufficient signage to help people navigate around the building independently. Following our inspection signage was put in place but further work was needed to improve the environment for people living with dementia.

Although staff were observed administering medication safely, records were not always correct. We have made a recommendation about medicines management and records.

There were systems in place to monitor and improve the quality of the service provided. People’s views were sought via regular meetings and an annual survey. We saw there were a range of audits carried out both by the manager and senior staff within the organisation. However these checks were not effective as they had not picked up the issues we found during the inspection.

There were systems and processes in place to protect people from the risk of harm. Risks to people’s safety had been assessed by staff and records of these assessments had been regularly reviewed. Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected. Staff we spoke with were able to describe the organisation’s whistle blowing and safeguarding procedures and told us they would be confident to report any concerns.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety.

People and staff told us there were enough staff on duty to meet people’s needs. A dependency tool had been completed to calculate safe staffing levels and rotas we looked at indicated showed the service was staffed in line with these figures.

We found safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards which meant they were working within the law to support people who may lack capacity to make their own decisions.

We saw staff had received supervision on a regular basis and an annual appraisal.

We saw people were provided with a choice of healthy food and drinks which helped to ensure their nutritional needs were met. The dining experience was relaxed and unhurried with people being given a choice of food and drinks and the support they required to enjoy their meal in a dignified way.

People were supported to maintain good health and had access to healthcare professionals and services.

There were positive interactions between people and staff. We saw staff treated people with dignity and respect. Observati

The inspection visit took place on the 9 April 2015 and was unannounced which meant the staff and provider did not know we were visiting.

Highfield Stockton is a 40 bedded purpose built care home located on the outskirts of Yarm, providing people with accommodation and personal care. Although registered for three regulated activities, it is not currently providing nursing care or treatment of disease, disorder or injury or diagnostics and screening procedures.

We last inspected the service on 28 November 2013 and found the service was compliant with regulations at that time.

There was a registered manager in post who was on duty at the time of the 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.

There were policies and procedures in place in relation to the Mental Capacity Act and Deprivations of Liberty Safeguards (DoLS). The registered manager had the appropriate knowledge to know when an application should be made and how to submit one. The registered manager also ensured that capacity assessments were completed and ‘best interest’ decisions were made in line with the MCA code of practice. This meant people were safeguarded.

We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

All people told us they felt safe at the service. Staff were aware of procedures to follow if they observed any concerns. The staff team were supportive of the registered manager and each other and feedback from visiting professionals on the day were very positive about the service at Highfield.

Appropriate systems were in place for the management of medicines so that people received their medicines safely. Medicines were stored in a safe manner. We witnessed staff administering medication in a safe and correct way. Staff ensured people were given time to take their medicines at their own pace.

There was a regular programme of staff supervision in place and records of these were detailed and showed the service worked with staff to identify their personal and professional development. We fed back to the registered manager and deputy that the quality of recording around supervisions and appraisals was good. We spoke with kitchen staff who had a good awareness of people’s dietary needs and staff also knew people’s food preferences well. They also told us that they received any equipment and supplies that they requested promptly.

We saw people’s care plans were personalised and had been well assessed. Staff told us they referred to care plans regularly and they showed regular review that involved, when they were able, the person. We saw people being given choices and encouraged to take part in all aspects of day to day life at the service.

The service encouraged people to maintain their independence and the activities co-ordinator ran a full programme of events which included accessing the community with people. We saw people popping in and out of the manager’s office to chat and spend time with them and it was evident that everyone knew the manager well and were comfortable to speak with them at any time.

We observed that all staff and the registered manager were very caring in their interactions with people at the service. People clearly felt very comfortable with all staff members and there was a lovely warm and caring atmosphere in the service and people were very relaxed. We saw people being treated with dignity and respect and relatives and people told us that staff were kind and professional.

The service undertook regular questionnaires, not only with people who lived at the home and their family, but also with visiting professionals and staff members. We also saw a regular programme of staff and resident meetings where issues where shared and raised. The service had an accessible complaints procedure and people told us they knew how to raise a complaint if they needed to. We saw that complaints were responded to and lessons learnt from them. This showed the service listened to the views of people.

Any accidents and incidents were monitored by the registered manager to ensure any trends were identified. This system helped to ensure that any patterns of accidents and incidents could be identified and action taken to reduce any identified risks.

The service had a comprehensive range of audits in place to check the quality and safety of the service and equipment at Highfield and actions plans and lessons learnt were part of their on-going quality review of the service.

During the inspection, we talked with five people who lived there and others informally. We spoke with the deputy manager and staff and four relatives. We spent time looking round the home and throughout the inspection, observed staff supporting people to make choices about what they wanted to eat, whether to spend time in their room or take part in activities.

We saw that people looked clean and well cared for. Communal areas of the building had been refurbished, the home was welcoming and staff were friendly. We observed positive interactions between staff and people living in the home and we saw that people were treated kindly and with respect by staff. One person who lived in the home told us, " They're all kind here and patient with you all the time".

We found that medication was administered in line with the policy and procedures by trained staff and processes were in place to monitor the administration of drugs and minimise the risk of error.

We talked with staff during the visit and looked at training records. We found that staff were supported to attend training, had regular supervision and annual appraisals to enable them to develop and maintain their skills.

We saw that the home had a range of different mechanisms in place to gather feedback on the quality of the service provided and we found that the manager responded positively to issues raised through surveys, audits, complaints and comments from people who used the service and their relatives.

We spoke with three people who live at Highfield Care Centre and had informal discussions with others. We spoke with the manager and staff and spent time looking around and observing life within the home. We observed staff interacting with people, giving appropriate support and supervision. We saw staff engaging in a positive way with people, they were kind, sensitive and respectful.

We observed people being offered a range of choices, such as options to remain in their own rooms or spend time in the communal lounges, choice of meals at lunchtime and choice of hot drinks. One person we spoke with said, "I make my own decisions, I decide where I want to spend my time, visitors are able to come at any time, we always have choices, if you want anything you just have to ask."

We saw that people had been consulted about their care and support needs and care records contained a good level of person centred information. We spoke with three people about the care and support they received. They were all satisfied with the care and service provided at the home. One person said, "I believe that the staff know me as an individual and know what my care needs are."

From the records we looked at, we saw that there were good systems in place for ensuring the environment was safe. We did note that there was the need for redecoration and refurbishment, however there are plans underway for this.