This inspection took place on 13 and 14 December 2017 and was unannounced. This meant the staff and provider did not know we would be visiting. We also contacted family members and relevant health and social care professionals immediately following the inspection.

Highview House is a ‘care home’. People in care homes receive accommodation and personal care as single package under contractual agreements. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Highview House accommodates up to eight people in one adapted building providing support for people with learning disabilities who have a forensic history. At the time of our inspection visit there were eight 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 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.

We last inspected the service in September 2015 and rated the service as ‘Outstanding’ overall. At this inspection we found the service remained ‘Outstanding’ and met all the fundamental standards we inspected against.

The service has built on their previous success and sustained the outstanding model of support provided to people living in the home referred to as the ‘Total Attachment' approach, in which professional ‘parenting’ is used throughout the service. The directors of the company, management team and staff continued to find ways to improve the service and remained driven by their passion to support people to have the highest quality life experiences whilst managing the risks people still may present.

The inspection took place on 7 and 11 September 2015. The inspection was unannounced.

This was the first comprehensive inspection carried out at Highview House since the home was registered by CQC in October 2014.

Highview House is a community based forensic learning disability service providing care and support services for up to eight men with learning disabilities. The service is working effectively in partnership with other care professionals in order to achieve positive outcomes for people who had previously committed serious offences and had been detained under the Mental Health Act 1983. For some people, Community Treatment Orders still applied. On the day of our inspection there was a total of seven 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 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.

On the days of the inspection there was a relaxed family orientated atmosphere in the home and we saw staff interacted with people in a very calm, friendly and respectful manner. One person told us, “It is excellent living here, I am very safe and I have got my independence back.” Another said, “It’s a haven here, I feel very safe indeed. I spent so many years in and out of secure hospitals; I had given up hope of having any kind of decent life. Since coming here last year, my life has changed for the better. I am now stable and I can look forward to having a good future.”

Throughout both days staff interacted with people in a very caring and compassionate way. When staff spoke with people they listened and respected their wishes. For example, during the afternoon two people preferred to have some quiet time in their rooms and they later told us staff respected their wishes.

We saw people’s care plans were detailed, person centred and clearly described their care, treatment and support needs. These were regularly evaluated, reviewed and updated. The care plan format was pictorial and was easy for people who used the service to understand. We saw evidence to demonstrate that people were fully involved in all aspects of their care plans and service delivery. One person told us, “I keep mine up to date through discussions with my keyworker, registered manager and my consultant. They listen to what I have to say, this is very important to me because In the past, other people and medical staff made decisions for me rather than with me.”

People had their psychological, emotional and mental health needs monitored closely. There were regular reviews of people’s health and the service responded immediately to people’s changing needs. People were assisted to attend appointments with various health and social care professionals to ensure they received care, treatment and support for their specific conditions.

A clinician quoted in a survey, “There is a good work ethos at Highview House.”

We saw activities were personalised for each person. During house meetings held every Sunday, people also made suggestions about their educational opportunities, work placements, household chores, menu planning, activities, outings and holidays. For example, people received one to one support for their health, personal care and support needs, and this enabled regular community based support on a daily basis. On the first day of our inspection, several people were escorted to go to a football training session at Sunderland football stadium and others were working at a community conservation project, restoring war graves.

People told us with support from staff, they received a wholesome and balanced diet. As part of their independent living skills and development, all were supported to prepare and cook meals for each other on a daily rota basis. People told us the food was varied with options always available. Everyone was involved with menu planning, budget keeping and the food shopping. To support family orientation within the service, people and staff ate their meals together.

The provider had an effective pictorial complaints procedure which people told us they felt they were able to use.

The provider is a registered educational provider delivering qualifications in skills for employment, training and personal development. It provided people who used the service with an opportunity to acquire skills up to diploma level.

The four staff we spoke with described the management of the home as open and approachable. Throughout the day we saw that people and staff appeared very comfortable and relaxed with the registered manager on duty.

We found staffing levels at the service were appropriate for the number of people living there. Some people who used the service required one to one support and we saw this was provided.

All staff we spoke with said they received appropriate training, good support and regular supervision. We saw records to support this.

We saw the service had in place personal emergency evacuation plans (PEEPs) and these were accessible to emergency rescue services.

We found people’s medicines were well managed and in line with current NICE guidelines. Some people were supported to manage their own medicines.

Staff had received training in how to recognise and report abuse. We spoke with four staff and all were clear about how to report any concerns. Staff said they were confident that any allegations made would be fully investigated to ensure people were protected.

We saw people who used the service were supported and protected by the provider’s recruitment policy and practices. We saw records that showed us a process was in place to ensure safe recruitment checks were carried out before a person started to work at the service

The home was immaculately clean and well maintained, and equipment used was regularly serviced. The home had an infection control champion who supported the registered manager to ensure people were protected from risks associated with cross infections.

The provider had a quality assurance system in place, which was based on seeking the views of people, their relatives and other health and social care professionals. There was a systematic cycle of planning, action and review, reflecting aims and outcomes for people who used the service.

We saw evidence that the service had sustained practice, development and improvement since the home opened. We saw leadership in the service worked towards, and had achieved outstanding practices to provide a quality service that contributed to the development of best practice for people who used the service. Staff told us they had encompassed these changes and new ideas that had been introduced by the provider such as, Total Attachment theory, Harbottle (2013). We saw this was a model of intervention and systemic management which was a whole system model of leadership and therapeutic practice in one. Staff recognised the importance of new concepts of care. Staff told us these had motivated them to aim for continuous improvement.