Our inspection took place on 30 and 31 July 2018 and was unannounced.

The last inspection of Hightown Road took place on 11 March 2016 and the service was rated as good. We rated the ‘safe’ domain as requires improvement due to a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because staff had not received the training they required to support people safely and infection and environmental risks had not been fully assessed or mitigated to reduce the risk of harm to people. We found at this inspection that the provider had acted to mitigate risks of harm noted at our last inspection and that staff had completed appropriate training courses. The service was no longer in breach of this regulation.

Hightown Road 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.

Hightown Road provides accommodation, care and support for up to four people with learning disabilities. The home is a purpose built residential property with two ground floor, and two first floor bedrooms.

There were four people living at Hightown Road when we inspected.

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.

Processes and checks were in place to ensure the safety of the premises and equipment was maintained. Some checks were completed on behalf of the housing association landlord by external contractors. The provider did not have copies of these records. We recommended that the fire alarm and water safety monitoring check records, to include a copy of the legionella risk assessment, should be kept on site.

Recent good weather had caused temperature levels in the medicine store to exceed safe levels. Staff had managed to reduce the temperature by opening windows however the room housing the medicine cabinet was in a warmer part of the house. We recommended that these actions and readings are recorded and that a permanent solution is sought to maintain safe medicine storage temperatures.

Prescribed fluid thickeners were stored in the kitchen on the top shelf of a cupboard that people living in the home could not access. We asked that the registered manager risk assess where the thickening granules were stored.

People’s needs were assessed before they moved into the home then regularly reviewed and care plans updated to reflect changing needs.

People were protected from being cared for by inappropriate staff by a robust recruitment procedure. Staff were trained to ensure they had appropriate skills to support people and sufficient staff were deployed to care for people.

People were supported with their nutritional needs. Advice was sought from healthcare professionals such as the GP, speech and language therapist and dieticians to ensure people were provided with appropriate meals prepared as per individual needs.

Activities were provided in the home alongside some people attending day services. People were encouraged to participate however could take time to relax as they wanted.

Positive feedback was received from relatives and staff about the registered manager and senior support worker.

This unannounced inspection took place on 11 and 18 March 2016. Hightown Road is a small care home that provides accommodation and support for up to four people. At the time of the inspection there were three people living at the home.

Hightown Road 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.

The house had a homely and friendly feel. Staff and people looked relaxed and staff supported people in an unhurried, friendly and reassuring way. A member of staff told us, “I think the people who live here are happy, it’s like a family”.

Staff had an empowering approach and recognised the rights of people living at the home. One staff member told us, “This is their house, I feel privileged to be able to support them with all aspects of their lives”.

We found some shortfalls in the safe management of medicines. Staff had addressed these by the second day of the inspection. People were safeguarded and any accidents or incidents were analysed to minimise the chances of an accident happening again. There were some risks to people that had not been fully mitigated and we drew these to the manager’s attention during the inspection.

People were not fully protected because there were infection control and building maintenance issues that had not been assessed to reduce the risks to people. You can see what action we told the provider to take at the back of this report.

Staff told us they felt supported and could gain informal advice or guidance whenever they needed to. However, there were some training issues that affected people’s safety within the home environment. You can see what action we told the provider to take at the back of this report.

People were supported to make decisions and their rights were protected when they lacked mental capacity to make a specific decision. People were supported to maintain their physical well-being and saw healthcare practitioners as and when they needed to.

Our observations showed people were treated with kindness and compassion in their day-to-day care. Staff knew the people they are caring for and supporting, including their preferences and personal histories. This meant they were better able to form good relationships and support people in the way they wanted or needed to be supported.

People had support plans that reflected their personal history, individual preferences and interests. Staff had read people’s support plans and used the information to make sure they helped the individual in the way they wanted or needed to be supported.

Our inspection of 75 Hightown Road (the home) took place on 17 April 2014. We considered our inspection findings to answer five questions we always ask; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

We pathway tracked the three people who lived at the home at the time of our inspection. This meant that we looked records the home kept about the people including care plans that contained information about people’s needs and how they were given assistance and support. None of the three people were able to talk with us because of their many and different needs. We therefore spoke with two relatives, the home’s staff and a social worker. Where it was appropriate we observed staff as they supported and assisted people to meet their needs. This was in order to see if people received the support they needed in accordance with their care plans. We also looked at documents about the management of the home.

We followed up matters of concern that had been identified at our last inspection of the home in November 2013. We found they had been put right.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff.

Staff understood how to protect the people they supported from harm.

The provider had arrangements in place to check the home was managed properly and safely and they learned from mistakes in order to make things better.

The home had policies and procedures in place about the Mental Capacity Act and Deprivation of Liberty Safeguards. This meant that people’s freedom and rights would be protected.

Checks were made to make sure that people who wanted to work at the home were honest and had the right experience and knowledge.

The likelihood that something dangerous could happen to staff and people living in the home was checked to make people were protected.

Is the service effective?

The home had arranged for an organisation to be able to find out what people wanted and speak up for them if they wanted help to understand things.

The help and support people needed with health and care was checked with them or their relatives or people such as social workers. They were involved in putting together the plans about people’s needs and how their care and support would be provided. Plans set out details of specialist dietary, mobility and equipment where they were needed.

Is the service caring?

People were supported by experienced, kind and attentive staff. We saw that care workers were patient and encouraged and supported people to meet their needs.

Visiting relatives we spoke with told us they thought the staff were “wonderful”.

A social worker we spoke told us they had been “impressed” by the home. They said “The staff team appeared very supportive and engaged with people. They did lots of activities in the community. They appeared to know their clients well and respond to their needs appropriately”.

People who used the service, their relatives, friends and other people involved with the service had completed a satisfaction survey. Where shortfalls or concerns had been identified plans had been put in place to put them right.

People’s life style choices, preferences, interests, and different needs had been written in their plans and care and support had been provided to make sure these were upheld.

Is the service responsive?

People joined in a range of activities that took place in the home or were available to them in the local community.

Relatives we spoke with knew how to make a complaint if they were unhappy. The home also had a complaints procedure in place that clearly set out the action people could take if they were unhappy with the home. People could be confident that complaints would be investigated and action is taken as necessary.

Is the service well-led?

The provider had arrangements in place to check that the home was managed properly. Records we looked at showed that problems were put right quickly promptly to make sure the quality of the service got better.

Staff told us that they felt part of a team and that the manager was approachable. They also knew what they had to do to support people who lived at the home. This all helped to make sure that people received a good quality service at all times.

At our inspection of 25 February 2013, we found that people were not protected from the risks of unsafe or inappropriate care and treatment because records were not always up to date and people's risks were not always assessed. We judged that this had a moderate impact on people who used the service and served a warning notice.

During this inspection we found that improvements had been made. Records were complete, up to date and risks were assessed. Support plans reflected professional guidance.

We used a number of different methods to help us understand the experiences of people using the service. This was because people using the service had complex needs which meant they were not able to tell us their experiences.

People were treated with consideration and respect but their assessments and support plans did not detail how to meet their individual needs.

People received support to enable them to eat and drink and they were offered alternative foods according to their preferences.

Staff had not completed appropriate training.

Audits had not identified concerns about the quality of the service. Records were not completed or up to date and risks were not always assessed.

This unannounced inspection took place to follow up on a compliance action, about cleanliness and infection control, that we made at our last visit in July 2011. We wanted to check that the provider was now compliant with the law.

We met one person who used the service during our inspection but they were not able to tell us their views about the cleanliness of the home.

We looked around the home and found that all shortfalls identified at our last inspection had been addressed. New furniture, equipment and flooring had been installed where needed and kitchen work surfaces and tiles had been replaced. This meant that good hygiene could be maintained and people who used the service were protected from the risk of cross infection.

People who used the service, staff and visitors had access to suitable hand washing facilities throughout the home to promote good hand hygiene. The home was clean and tidy providing a suitable environment for the people who lived there.

People using the service told us they were happy living at the home. They received the care and support they needed in the way they preferred because staff listened to their wishes and involved them in the care planning process. They told us care staff help them to visit health care professionals such as doctors and dentists when they need to.

They told us they enjoyed the meals provided at the home and that they were involved in planning the menus each week.

We found that the provider had made some improvements to the service since our last inspection. For example, where there were specific risks in relation to the welfare of one person who lived in the home, we saw that action had been taken to reduce these risks and ensure their safety.

Staffing had been reviewed to ensure there were enough staff, with the right skills and experience, to support people at all times during the day and night.

Staff were receiving training, supervision and appraisal to support them in working safely with people who lived in the home.

Both staff and relatives of people who lived in the home told us that they had experienced improvements in the running of the service. For example, one relative told us, "It has been a lot better just recently.", while another relative said, "In the last few months, there has been a tremendous improvement...things seem to be happening." People told us that the home had a new manager and they had confidence that the home would continue to improve under their leadership.

Although we observed some evidence of improvement, we continued to find non-compliance in relation to some aspects of people's care. For example, it was not always clear that care plans were followed to ensure people's needs were met and that all risks had been considered. It was also not evident that the home sought people's views about the home and used their feedback to develop and improve the service. We met with the new manager of the home and the quality manager on 21 November 2013. They have assured us that they are taking action to achieve compliance with the regulations.