This inspection took place on 16, 23, 24, 25, 30 and 31 October 2018. The provider was given 48 hours' notice because the location provides a supported living service for adults who are often out during the day, so we needed to be sure someone would be in.

This service provides care and support to people living in 12 'supported living' settings, so that they can live in their own home as independently as possible. People's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people's personal care and support.

People who use the service have learning disabilities, autism spectrum disorders or physical disabilities. People who use the service are supported with personal care, medicines, cooking, shopping, activities and other day to day tasks. At the time of our inspection 71 people were using the service. The service provides support to people living in County Durham.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

This service was previously registered at a different address. We last inspected this service in February 2016 when we gave the service an overall rating of good. During this inspection we found the service had deteriorated and have awarded an overall rating of requires improvement. This is the first time the service has been rated requires improvement.

The service had a registered manager. The registered manager joined the service as a service manager in May 2018 and took up the post of registered manager in July 2018. 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.

During this inspection we found breaches of Regulations 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which relate to good governance and staffing. This was because ‘when required’ medicines (such as pain relief) and topical medicines (such as creams or ointments) were not always managed effectively as records were incomplete. Support plans did not always contain enough information about people's specific needs and were not always up to date. Records relating to people's finances and procedures for handling people's finances were not robust. Staff had not completed up to date training to enable them to perform their job role effectively.

Although we found several areas for improvement during this inspection, the provider’s quality assurance system had recently identified most areas for improvement within the service. The provider had not always acted on areas for improvement in a timely manner. The registered manager, who had only been in post since July 2018, was keen to address all of the areas for improvement found during this inspection, which were already in progress.

Staff understood their safeguarding responsibilities and told us they would have no hesitation in reporting any concerns about the safety or care of people. Staff said they felt confident the operations manager would deal with safeguarding concerns appropriately.

Accidents and incidents were recorded and dealt with appropriately,

Personal emergency evacuation plans (PEEPs) were in place which contained details about people’s individual needs, should they need to be evacuated from the building in an emergency. These had been completed with people’s involvement.

A thorough recruitment and selection process was in place which ensured staff had the right skills and exper

This inspection took place on 25 and 29 February 2016. We gave the provider 48 hours’ notice that we would be visiting to ensure someone would be at the service.

Highlea Care Limited is a domiciliary care service which provides support to people with a learning disability, physical disability and mental health needs. On the day of our inspection there were 58 people using the service.

The service had a registered manager in place. 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.

Highlea Care Limited was last inspected by CQC on 27 February 2014, when the location was registered as The Grange, and was compliant with the regulations in force at that time.

Accidents and incidents were appropriately recorded and investigated. Risk assessments were in place for people who used the service and staff and described potential risks and the safeguards in place. Staff had been trained in how to manage behaviour that challenged and in safeguarding vulnerable adults. Medicines were stored safely and securely, and procedures were in place to ensure people received medicines as prescribed.

The homes we visited were clean, spacious and suitable for the people who used the service and appropriate health and safety checks had been carried out.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff. Staff were suitably trained and received regular supervisions and appraisals.

The provider was working within the principles of the Mental Capacity Act 2005 (MCA).

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of visits to and from external health care specialists.

People who used the service, and family members, were complimentary about the standard of care provided by Highlea Care Limited. Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

People had been involved in planning their care and care records were written in a person centred way.

Highlea Care Limited had a full programme of activities in place for people who used the service.

The provider had an effective complaints policy and procedure in place and people knew how to make a complaint.

The service had links with community services and other local organisations. The service had a positive culture that was person-centred, open and inclusive. The provider had a robust quality assurance system in place. People who used the service, family members and staff were regularly consulted about the quality of the service.