This inspection took place on 23 November 2017 and was unannounced.

Highmead House 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.

Highmead House provides care for up to thirty two older people. At the time of inspection, thirty one people were receiving a service.

At the last inspection in January 2016, the service was rated Good. At this inspection we found that the service remained Good.

People and their family were able to contribute to the way in which they were supported. The service was proactive and innovative in planning people's care so that they felt listened to and empowered. People were supported in a creative and innovative way that identified their wishes and supported them to take part in meaningful activity.

People's needs were identified and responded to in a creative way, so that people felt cared for and had maximum opportunities to pursue interests that were important to their history, culture or religion.

Strong links and activities were created with the community to enable people to feel a sense of

belonging and develop positive relationships.

People received end of life care that was personalised and dignified. The service excelled at creating a caring, comfortable and empathetic environment for people and their families through end of life care.

There was 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.

Staff had an understanding of abuse and the safeguarding procedures that should be followed to report abuse and risk assessments were in place to manage risk within a person’s life.

The staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service. Adequate staffing levels were in place.

Staff induction training and on-going training was provided to ensure they had the skills, knowledge and support they needed to perform their roles.

Staff were well supported by the registered manager and senior team, and had regular one to one

supervisions.

People's consent was gained before any care was provided.

Staff treated people with kindness, dignity and respect and spent time getting to know them and their specific needs and wishes.

The provider had systems in place to monitor the quality of the service as and when it developed and had a process in place which ensured people could raise any complaints or concerns.

The inspection took place on 20 January 2016 and was unannounced.

Highmead house provides accommodation and personal care for up to 32 older people and people with dementia care needs. At the time of our inspection, the service was providing support to 32 people.

The service had a registered manager. 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.

People felt safe. Staff had an understanding of abuse and the safeguarding procedures that should be followed to report abuse and people had risk assessments in place to enable them to be as independent as possible.

Effective recruitment processes were in place and followed by the service and there were sufficient numbers of staff available to meet people’s care and support needs

Medicines were stored, handled and administered safely within the service.

Staff members had induction training when joining the service, as well as regular on going training.

Staff were well supported by the registered manager and had regular one to one supervisions.

People’s consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 were met.

People were able to choose the food and drink they wanted and staff supported people with this.

People were supported to access health appointments when necessary.

Staff supported people in a caring manner. They knew the people they were supporting well and understood their requirements for care.

People were involved in their own care planning and were able to contribute to the way in which they were supported.

People’s privacy and dignity was maintained at all times.

People were encouraged to take part in a range of activities and social interests of their choice.

The service had a complaints procedure in place and people knew how to use it.

Quality monitoring systems and processes were used effectively to drive future improvement and identify where action was needed.

During our site visit we met people who used the service and people who were visiting Highmead House. They all told us they were very satisfied with the care provided. A relative of a person who used the service said, "We are so thankful that dad is at Highmead, he is so lovingly cared for." Another person said "They address any problems immediately, the care is very good and they are flexible regarding the visiting times."

We found Highmead House to be compliant against the judgements we inspected against.

People told us what it was like to live at this home and described how they were

treated by staff and their involvement in making choices about their care. They

also told us about the quality and choice of food and drink available. This was

because this inspection was part of a themed inspection programme to assess

whether older people living in care homes are treated with dignity and respect

and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by an Expert by

Experience (people who have experience of using services and who can provide

that perspective).

When we asked five people about their experience of living at the home, they made positive comments about how staff had supported them. People told us that staff had treated them with respect. People told us "Staff are very good and respectful" and

"They are very caring and respect me."

We were also told " Nothing to complain about, the girls are very good, they keep their eye on me when I wash myself, I have no complaints at all" and "The girls are very respectful when they wash me."

One person summarised their general experience saying, "You would have to be a very poor person if you didn’t like it here, they really look after you.”

Five people we spoke with told us that they had either not seen their care plans or did not know what care plans were. Comments included "Never saw a care plan, don’t know what it is" and "I have no idea what a care plan is, never discussed my care."

"Not sure what you mean by a care plan. I don’t get involved with my care."

One person told us "I have been here five years come July. Haven’t seen a care plan, I leave it to them, they do it all for me, I don’t say anything." That person's relative said, “I saw a care plan five years ago. We have had no discussion about it since”. We were told by another person "I have been here two years. I’m not involved with my care, nothing changes really. I have never sat down with my sister in law and staff and discussed my care."

People we spoke with said that the food was hot, there was sufficient quantity and a good choice. Referring to meals one person told us "The quantity is just right, always nice and hot" and another said "The food is excellent, I’m not joking, I have seconds, they spoil us. It’s always served at the right time."

Another person told us "The food is very nice. If I don’t like what’s on the notice board, I talk to the cook and she gives me something different."

Not everybody we spoke with felt that they had a choice of what to eat at main meal times. One person told us, "The food is different every day, they don’t ask you what you want, they just bring it." Another person told us, "I don’t choose my meals; they just give them to me. Meals are fine but we don’t get a choice."

Three people told us that snacks were not offered, but two people said snacks were offered.