This inspection was carried out on 25 July 2017 and was unannounced.

Highwell House provides accommodation and nursing care for up to 34 people. At the time of our inspection there were 28 older people living at the home some of whom were living with dementia ,

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 and associated regulations about how the service is run.

We last inspected Highwell House in May 2015 and rated the service as Good overall. Since this time further improvements have been made for the benefit of people who live there. The service provided excellent and innovative approaches to person centred care that maintained people’s health and wellbeing. Staff supported people to maintain hobbies and interests, promoting people’s abilities and skills.

The provider's approach to care and support to people was focused on maintaining and improving people's quality of life. The provider was always looking at ways to adapt and improve the care and support to reduce the impact of their health conditions and to improve people’s wellbeing.

People, relatives and professionals were consistently positive about the care provided at Highwell House.

The provider had maintained very high quality care and constantly strived to be the best in the area. The provider was recognised both locally and nationally as being an outstanding contributor to the care field.

People's health needs were monitored and changes were made to people's care in response to any changes in their needs. Current best practice was used to enhance how people’s needs were assessed and addressed. People had access to other health professionals and were referred to them by the registered manager if there were any concerns about their health needs.

There were strong established links with the local community that promoted positive approaches to the people that lived there.

Staff were motivated and had excellent levels of support as well as extensive and on-going training to enable them to meet the individual needs of people living at the home. There were sufficient numbers of experienced and trained staff to ensure people were supported safely and people’s health needs responded to quickly. Medicines were managed safely and people received their medicines in line with their prescription.

People's needs and preferences were responded to effectively. People were supported by a provider and staff team who were focused on getting to know the people they supported. Relatives told us the service was responsive and well managed. People and relatives knew the registered manager and the provider. People were encouraged to be actively involved in the running of the home through regular meetings. They felt that if they had any concerns they were able to speak with the registered manager or provider. The provider welcomed people's views and opinions and acted upon them.

People were consistently treated with dignity and respect. People had good positive relationships with staff. The provider supported people to promote dignity and respect to the wider community and worked to challenge people’s perceptions.

There were a range of audits and checks to make sure that excellent standards of care and support were maintained. Feedback from the people and relatives was gathered on a regular basis and where any actions were identified these were actioned quickly.

People felt safe and knew how to raise concerns. Staff felt comfortable to raise any concerns about people’s safety and understood about how to keep people safe. Staff supported people to take positive risks. Where risks had been identified risk assessments were in place and action had been taken to reduce the risks.

People enjoyed the food and had t

This inspection was carried out on 14 May 2015 and was unannounced.

Highwell House provides accommodation, nursing and personal care for up to 34 people. The service also provides up to four beds for use by the NHS as a step down facility for people leaving hospital to rehabilitate prior to returning home. This is a project with the local NHS clinical commissioning group. At the time of our inspection there were 27 people living at the home.

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 and associated Regulations about how the service is run.

When we last inspected the service on 25 February 2013 we found them to be meeting the requirements of the regulations we assessed them against.

People living at the home and their relatives were positive about the home, the manager and the staff.

People’s needs were met in a kind and caring way by staff. Staff were knowledgeable about people’s needs and the care provided was good.

People received support when they needed it. People told us that they were able to pursue their own hobbies and interests, and if they needed help with anything staff were quick to respond.

People’s human rights were protected. The registered manager sought people’s consent around all aspects of care and treatment.

People had choice of fresh nutritious food, and where recommendations had been made by other professionals regarding their diet or health needs these had been acted upon. People told us that they felt their health needs were met, and some people told us about how their health had actually improved since living at the home.

People told us they found the staff and management approachable, willing to listen to their views and opinions. They said that if they had any concerns they were able to speak with the registered manager.

People’s care records were clear and identified any risks and actions taken to reduce the risk and were regularly reviewed to ensure they continued to accurately reflect their needs. People had their medicines managed safely and people received their medicines in line with their prescription.

The registered manager showed a commitment to achieving the best for the people that lived there. A range of quality audits were completed regularly to ensure that good standards were maintained. Feedback from the people that lived there and their relatives were sought on a regular basis and any areas identified for action were acted upon.

We spent time in the lounge so that we could see how staff supported people. We also spoke with people living at the home, relatives and staff. We visited some people in their bedrooms. We also looked at care records to check that staff had clear written information about each person's needs.

People told us that they were well looked after at the home. They described staff as, "lovely and kind", "always thoughtful", and, "a tonic when you're feeling down". We saw that staff were caring and gentle in the way that they supported people. They made sure that people had time to indicate consent before carrying out any care or support. Records showed that staff understood the importance of ensuring that decisions were made in people's best interests.

The home had systems in place to ensure that people received their medicines safely.

People told us that they knew who to speak to if they had any concerns. They were confident that they would be listened to and that action would be taken.

We spent time at Highwell House talking with people who live at the home. Some people were not able to tell us their views, because they were living with dementia, so we spent time in the lounge watching how people spent their time. We saw that staff were kind and caring in their approach to people. People told us that staff were, "just lovely" and, "so very kind".

People told us that staff provided them with the care and support that they needed. We saw that staff took time to make sure people were comfortable and had everything they needed. People appeared well cared for, with clean clothing and neatly groomed hair and nails.

People said that they felt safe at the home. They knew who to talk to if they had any concerns. People said that they were confident that staff would sort out any issues. Staff knew how to report any concerns about people's safety and welfare.

People spoke highly of the staff at the home. Some people said that they sometimes had to wait for their call bells to be answered. One person said, "they're very busy and we could do with a few more of them". The provider had recently carried out a review of staffing levels and was due to be increasing the numbers of staff on duty during the day.

Records were stored securely and could easily be located when needed. Some records did not provide accurate or consistent information about people's care.

We spoke with people who lived at Highwell House, and they told us that they were happy at the home and that the staff looked after them well. Everyone we spoke with had positive things to say about the staff, such as “they’re all marvellous”, “they look after me really well” and “they’re very kind to me, very understanding”.

We saw that staff were treating people with respect and kindness. It was obvious that a great deal of thought had gone into making Highwell House as homely and friendly as possible. One person told us “I don’t think of it as a nursing home: it’s my home”.

People told us that they received a high standard of care and that they felt that the care was personalised to their individual needs and wishes. We saw evidence that people were involved in making choices and decisions about their care.

We saw that staff knew people well, and were aware of their likes and dislikes. There was a calm and cheerful atmosphere in the home, and people told us “it’s a happy home” and “I think that anyone who has to go into a home should come here”.