This was an unannounced inspection was carried out on 23 October 2018. This meant the staff and provider did not know we would be visiting.

The Highlands is a ‘care home’. People in care homes receive accommodation, nursing and 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. The Highlands provides accommodation and personal care for up to 14 adults who have an acquired brain injury. It offers both permanent and short stay services. At the time of the inspection 10 people were using the service, of which two people were using the short-break service. Over the previous 12 months 20 people used the short break services.

Although, the service us registered to provide nursing care we were told that this had not been provided for at least a year. We wrote to the provider to ask if they would be removing nursing from their registration.

At our last inspection in January 2016 and the previous one in January 2014 we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The registered manager has been in post for over 12 years. 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.

Relatives told us the staff showed a genuine commitment to people and this had led to a broadening of people’s experiences and a real quality of life. They told us that this was the first time since their relative had started to receive care this had been the case.

People were at the core of the service and included in all discussions. They were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People said they were happy and felt safe. There were sufficient staff to support people and ensure they received their medicines in a safe and timely way. When new staff were appointed, thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support.

We found that care records detailed people’s needs but relevant information was not always incorporated into care plans. People who use sign language did not have communication books detailing the signs they used. The registered manager confirmed that this was an area the provider had identified and was addressing. Staff understood the principles of the Mental Capacity Act 2005 (MCA). The records demonstrated MCA compliance.

Risk assessments were carried out that identified risks to the person. People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. People had access to health care professionals to make sure they received appropriate care and treatment.

Staff received regular training, supervision and appraisal and they were supported in their role.

People received a varied and nutritional diet that met their preferences and dietary needs. The service provided home-made food and drinks which were adapted for different diets.

People were overwhelmingly positive about staff. Staff knew the people they were supporting well. Care was provided with patience and kindness and people’s privacy and dignity were respected. People were actively engaged in a range of activities and had opportunities to access the wider community.

People told us they di

This was an unannounced inspection carried out on 18 February 2016.

We last inspected The Highlands in January 2014. At that inspection we found the service was meeting all the legal requirements in force at the time.

The Highlands provides accommodation and personal care for up to 14 adults who have a learning disability or acquired brain injury. These numbers include people who may stay for a short break.

A registered manager was 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.

People said they were happy and felt safe. There were sufficient staff to support people and ensure they received their medicines in a safe and timely way. When new staff were appointed, thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support.

Risk assessments were carried out that identified risks to the person. People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. People had access to health care professionals to make sure they received appropriate care and treatment.

Staff received regular training, supervision and appraisal and they were supported in their role.

People were supported to be part of the local community. They were provided with opportunities to follow their interests and hobbies. People received a varied menu.

People were overwhelmingly positive about staff. Staff knew the people they were supporting well. Care was provided with patience and kindness and people’s privacy and dignity were respected.

The Highlands was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Records were in place as required by the Mental Capacity Act (MCA) 2005 to show best interest decision making when people were unable to make decisions themselves.

People we spoke with said they knew how to complain but they hadn’t needed to. Staff said the registered manager was supportive and approachable. People were consulted and asked their views about aspects of service provision.

We spoke to four members of staff who spoke positively and without prompt regarding local management, training and working conditions. We also spoke to three people who lived there who told us that they were happy in the home.

We spent time in the home observing people and staff and found evidence that people were treated as individuals and with respect. We also found evidence of this by reviewing procedures such as admissions assessments, mobility and nutrition assessments, care plans and questionnaires completed by people who used the service and external professionals.

We viewed five private rooms and all of the communal areas in the home and found a safe, inviting, well-maintained and friendly atmosphere throughout. There were two large, bright and airy communal lounges, a dining room and a well-kept landscaped garden and patio that was available for people to use for activities.

We reviewed the internal quality procedures with registered manager and found that there were no current complaints or safeguarding concerns.

We spoke to people who used the service and they told us that they thought the service was ‘fantastic’, there was ‘nothing to improve’ and that the staff ‘treat us with respect’. People who used the service also said they ‘get on well with staff’ and the food is ‘fantastic’.

They said that staff responded promptly and politely and that they had been asked about what help they needed when they started to use the service. They also said that they were consulted about any changes to their care.

People who used the service said that they had a care plan and that any changes in their care had been discussed with them. We were told that care was ‘excellent’ and ‘couldn’t be improved’. One person who used the service said he had ‘come on leaps and bounds’ because of the care he had received.

People we spoke to said they were confident that staff would address any concerns as soon as possible and they knew who to go to if they had any issues to discuss. People said they had been given a copy of the complaints procedure and that they would feel able to use it. We saw that there were leaflets and posters displayed throughout the building on how to make comments and complaints.