Highgrove Care Home is a residential care home for 21 older people some of whom are living with a dementia. The home has two floors with the first floor having access via stairs or a stair lift.

At the last inspection, the service was rated ‘Good’. At this inspection we found the service remained ‘Good’.

People were protected from avoidable harm as staff understood how to recognise signs of abuse and the actions needed if abuse was suspected. There were enough staff to provide safe care and recruitment checks had ensured they were suitable to work with vulnerable adults. When people were at risk of falling, skin damage, infection or malnutrition staff understood the actions needed to minimise avoidable harm. The service was responsive when things went wrong and reviewed practices in a timely manner. Records had not consistently reflected that catheter bags were being emptied or changed regularly. During our inspection the process was reviewed by the registered manager and sytems put in place to manage catheter care more safely.

People had been involved assessments of their care needs and had their choices and wishes respected including access to healthcare when required. Their care was provided by staff who had received an induction and on-going training that enabled them to carry out their role effectively. People had their eating and drinking needs understood and met. Opportunities to work in partnership with other organisations took place to ensure positive outcomes for people using the service. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

People and their families described the staff as caring and friendly and the atmosphere of the home as fun. People were able to express their views about their care and felt in control of their day to day lives. People had their dignity, privacy and independence respected.

People had their care needs met by staff who were knowledgeable about how they were able to communicate their needs, their life histories and the people important to them. A complaints process was in place and people felt they would be listened to and actions taken if they raised concerns. People’s end of life wishes were known including their individual spiritual and cultural wishes.

The service had an open and positive culture that encouraged involvement of people, their families, staff and other professional organisations. Leadership was visible and promoted teamwork. Staff spoke positively about the service and had a clear understanding of their roles and responsibilities. Audits and quality assurance processes were effective in driving service improvements. The service understood their legal responsibilities for reporting and sharing information with other services.

Further information is in the detailed findings below.

People and their representatives were involved in making decisions about their care and treatment. A relative told us, “They involve me with care reviews.”

People who used the service told us that they were looked after well. One person said, "They look after us well. I like it here."

People were cared for in a clean, hygienic environment. We saw that systems for cleaning were consistent throughout the home.

There were enough qualified, skilled and experienced staff to meet people’s needs. During our inspection we observed people being assisted promptly and staff answering call bells in a timely manner.

People’s care records were accurate and fit for purpose. We checked the care records of three people and saw that records had been updated to reflect their needs.

People and their representatives were not always involved in making decisions about their care and treatment.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. One person told us “They look after me well.”

The home did not have effective systems in place to reduce the risk and spread of infection. One member of staff told us, “We used to have an infection control lead but she left. This area has been neglected.” The manager told us that the home has not had a cleaner during the week since January 2013 but that all staff were carrying out the cleaning of people's rooms.

People who used the service told us that at times there were not enough staff to meet people’s needs. One person told us, “They are very short of staff. Staff let them down at the last minute. Can you get us some more staff.”

People’s care records were not consistently completed and did not include an accurate record of the care that they should receive. Most of the records of people's care plans we saw had been completed, however, there were some monitoring charts that contained significant gaps and omissions.

We visited the home unannounced on 27 September 2012. We did this because concerns had been raised about the care and welfare of people living in the home.

We spoke with people about the care they received. People told us that staff ensured their privacy was maintained during personal care. One person told us that staff always knocked before they entered the room.

Two people sitting in the lounge had the sun directly in their eyes, staff came into the lounge but made no attempt to close the blinds for those people who were clearly uncomfortable.

One person told us " I have to have my feet up on two pillows, staff do this for me at night".

One person we spoke with told us they preferred to eat in their room. Four people ate their meal in the lounge. We did not observe people being offered a choice of where they wanted to sit and eat.

One person we spoke with said:" staff always talk me through what they are going to do especially when moving me, this makes me more relaxed".

We spoke with people who told us that staff were kind and helpful. An agency member of staff spoke with people and reminded them which agency they came from and why they were working in the home.

We found that information recorded about people was not always accurate.

We visited the home on 31 Janaury 2012. We spoke with eight people who lived in the home. We visited the home again on 6 February 2012 following concerns. We spoke with four people.

People we spoke with were able to tell us about the choices they made in their daily lives and how they were supported to do this.

People were able to tell us about how their needs were met by staff who they had confidence in their abilities.

People were able to tell us they feel safe in the home.

Staff who work in the home are properly recruited, trained and supported to do their job.

People were listened to when they rasied concerns.

This unannounced inspection took place on the 7 and 8 September 2015.

Highgrove Care Home is registered to provide accommodation and personal care for up to 21 people.

The service did not have a registered manager. The post had been vacant since December 2014. The manager had applied to be a registered manager and was waiting for the outcome. 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 our last inspection of Highgrove Care Home, in July 2014 we found the provider was in breach of regulations in relation to the care and welfare of people who use the service, management of medicines, staffing, care records and their quality assurance systems. Following the inspection the provider sent us an action plan. They told us they would meet the relevant legal requirements by November 2014.

During this inspection we found the provider had made improvements. Care records were individualised and gave clear guidance about people’s health and support needs. Staff were able to tell us about the care and support they were providing. One healthcare professional told us the staff were “very good” at following recommendations and guidance.

Improvements had been made to staffing and there were no vacant positions within the home. The manager told us they had an open recruitment strategy and were actively advertising for staff. They planned to create a bank of staff to work on an ‘as required’ basis. There were sufficient staff to meet people’s needs.

Improvements had been made to the safe administration of medicines. People received their medicines safely. All staff responsible for administration of medicines had received training and had their competencies assessed by senior staff.

Managers and staff were motivated to improve the service they provided .Improvements had been made to ensure there were systems in place for monitoring the quality and safety of the service and to ensure people were satisfied with the care they received. There was a timetable of checks and audits which were carried out by senior staff.

People, relatives and staff told us they had confidence in the new management structure and felt they were supportive and their views listened to. There was a range of methods used to communicate with people and their families. For example by email, meetings, face to face and a suggestion box.

People were treated kindly and respectfully. Their individual needs, likes, dislikes and preferences were respected by staff and people were offered choice.