About the service:

Highland House is a residential care home that accommodates up to 27 older people who maybe living with dementia. At the time of the inspection 23 people were living at the service.

What life was like for people using the service:

People continued to feel safe and that staff met their needs and preferences. However, potential risks to people’s health and welfare had not always been assessed and there was not detailed guidance for staff to reduce the risks. Audits had been completed but had not identified the shortfalls found at the inspection.

People were treated with kindness and respect, they were supported to be as independent as possible. People told us they felt listened to and their views were respected and acted on, to improve the service.

Staff knew people well and understood their needs, choices and preferences. Staff monitored people’s health and referred them to health professionals when required. People were supported to take part in activities they enjoyed. People were encouraged to maintain relationships that were important to them, visitors were welcome at any time.

More information is in the detailed findings below.

Rating at the last inspection:

Good (report published 13 August 2016).

Why we inspected:

This was a planned inspection based on the rating at the last inspection. We found that the service no longer met the characteristics of Good in all areas. The domains of safe, responsive and well led are now rated Requires Improvement. The overall rating is now Requires Improvement.

Follow up:

We will work with the provider following this report being published to understand and monitor how they will make changes to ensure the service improves their rating to at least Good.

Care service description

Highland House is a large detached property, set in large, well-maintained grounds, just outside Canterbury. It is a privately owned, family run service and provides accommodation and personal care for up to 30 older people, some of whom may be living with dementia. On the day of the inspection there were 27 people living at the service. The provider is a limited company with four directors. The service is run by two of the directors, one of whom is the registered manager. They were both present on the day of the inspection. 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 and associated Regulations about how the service is run.

Rating at last inspection

At the last inspection, the service was rated Good overall and Requires Improvement in the Well Led domain.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 30 June 2016. A breach of legal requirements was found. After the comprehensive inspection the provider wrote to us to say what they would do to meet legal requirements in relation to the breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We undertook a focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from out last comprehensive inspection by selecting the ‘all reports’ link for Highland House on our website at cqc.org.uk.

Rating at this inspection

At this inspection we found the service remained Good and is now rated Good in the Well Led domain.

Why the service is rated Good

The service had improved since the last inspection. Notifications had been submitted to CQC in a timely manner and in line with guidance.

People, their relatives and staff told us they felt the service was well-led.

The management team were visible and led by example. They promoted openness, transparency, responsibility and accountability. The registered manager and directors had a clear vision, which was shared with people, their relatives and staff, with regard to the quality of service and any future plans.

People, relatives, health professionals and staff were able to provide feedback to the management team to drive improvements of the quality of the service provided. The registered manager regularly met with people, their families and staff to encourage them to input into the day to day running of the service.

There was effective and regular auditing and monitoring of key things, such as, health and safety, infection control, staff levels and the environment.

This was an unannounced inspection carried out on 30 June 2016. Highland House is a large detached property, set in large, well-maintained grounds, just outside Canterbury. It is a privately owned, family run service and provides accommodation and personal care for up to 30 older people, some of whom may be living with dementia. On the day of the inspection there were 27 people living at the service. The provider is a limited company with four directors.

The service is run by two of the directors, one of whom is a registered manager. They were both present on the day of the inspection. 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 and associated Regulations about how the service is run.

Services that provide health and social care to people are required to inform CQC of important events that happen in the service. CQC check that appropriate action had been taken. The registered manager had not consistently submitted notifications to CQC in line with Regulations.

People said they felt safe living at the service. Staff understood how to protect people from the risk of abuse and the action they needed to take keep people safe. Staff were confident to whistle blow to the registered manager or to other organisations if they had any concerns and were confident that the appropriate action would be taken.

Risks to people’s safety were identified, assessed, monitored and managed. Assessments identified people’s specific needs, and showed how risks could be minimised. Accidents and incidents were recorded, analysed and discussed with staff to reduce the risks of them happening again.

Robust recruitment processes were in place to check that staff were of good character and safe to work with people. Information had been requested about staff’s employment history, including gaps in employment. There was a comprehensive training programme in place to make sure staff had the skills and knowledge to carry out their roles effectively. Refresher training was provided regularly. People were consistently supported by sufficient numbers of staff who knew them well.

People received their medicines safely and told us they received their medicines when they needed them. People’s medicines were reviewed regularly by their doctor to make sure they were still suitable.

The registered manager and staff understood how the Mental Capacity Act (MCA) 2005 was applied to ensure decisions made for people without capacity were only made in their best interests. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm. The registered manager had submitted applications to the local authority in line with guidance.

People felt informed about, and involved in, their healthcare and were empowered to have as much choice and control as possible. People were able to make choices about how they lived their lives, including how they spent their time. Staff had received training on the MCA and understood the principles of the MCA and how it impacted on the people they supported. They put this into practice effectively, and ensured that people’s human and legal rights were protected.

The building and grounds were very well maintained. Regular environmental and health and safety checks were completed to ensure that the environment was safe and that equipment was in good working order. Emergency plans were in place so if an emergency happened, like a fire or a flood, the staff knew what to do.

People were provided with a cho