United Response - 4 Highgate Park is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The service provides accommodation for up to four adults in one adapted building. The service does not provide nursing care, but specialises in supporting people who may be living with a learning disability or physical disability.

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.

The inspection took place on 14 December 2017 and 3 January 2018. The provider was given 48 hours’ notice of our inspection because we needed to make sure someone would be in the location when we visited. On the first day of our inspection, there were three people living at the service and four on the second day.

At the last inspection in October 2015, the service was rated ‘Good’. At this inspection, we found the service remained ‘Good’.

During our inspection, people who used the service told us they felt safe. The provider had safeguarding policies and procedures in place and staff understood their responsibility to safeguard the people they supported. We found the environment was clean and necessary health and safety checks were completed.

We found medicines were administered safely.

Staff ensured that people had enough to eat and drink and people had choice about their diet. We observed staff had established a rapport with the people they supported and treated people with dignity and respect. Staff received supervisions and appraisals and described feeling well supported by the registered manager. People 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.

We found care records were person-centred and contained detailed information about people’s lives. People’s support was regularly reviewed and records were updated when there had been a change in their needs.

We received very positive feedback, without exception, about the registered manager. The registered manager considered ways to adapt the environment and improve the support provided to people. The registered manager and provider had systems in place to monitor the quality of the service provided.

Further information is in the detailed findings below.

We undertook this announced inspection on the 7 October 2015. At the previous inspection, which took place on 9 April 2014 the service met all of the regulations that we assessed.

4 Highgate Park provides care for four adults with complex physical and learning disabilities. The home is about a mile from Harrogate town centre. The building is a single storey purpose built property which is fully adapted and accessible. The home has paved gardens with parking to the front of the property. At the time of this inspection there were four people living at the service.

There was a registered manager at this service. 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 told us they felt safe. Relatives and a friend we spoke with told us they felt their relatives were safe at Highgate Park. Staff knew the correct procedures to follow if they considered someone was at risk of harm or abuse. They received appropriate safeguarding training and there were policies and procedures to support them in their role.

Staff were recruited safely and there were sufficient staff to meet people’s needs. People who used the service, their relatives and staff members confirmed this.

Medicines were managed safely. Staff had received the appropriate training and we saw staff offered people explanation and reassurance when their medication was being administered.

Staff were supported and trained to help them deliver effective care. They had access to mandatory training, and staff told us they were supported to attend other courses which would be of benefit to their personal development and people who used the service.

People told us the food was good. We saw people had access to regular drinks, snacks and a varied and nutritious diet. If people were at risk of losing weight we saw plans were in place to manage this. People had good access to health care services and the service was committed to working in partnership with healthcare professionals.

People were provided with a range of activities in and outside the service which met their individual needs and interests. Individuals were also supported to maintain relationships with their relatives and friends.

The principles of the Mental Capacity Act (2005) were consistently followed by staff. Consent to care and treatment was sought. When people were unable to make informed decisions we saw a record of best interest decisions. There was a record of the person’s views and other relevant people in their life. The registered manager had a clear understanding of the Deprivation of Liberty Safeguards.

The service was well-led. Everyone we spoke with was full of praise for the registered manager. Staff morale was high and there was a strong sense of staff being committed to providing person centred care.

There were good auditing and monitoring systems in place to identify where improvements were required and the service had an action plan to address these.

We gathered evidence against the outcomes we inspected to help answer our five key questions. Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? We gathered information from people who lived at the home during our visit to the home.

Below is a summary of what we found. The summary is based on our observations during the inspection. We spoke with people who used the service. We also spoke with the staff that supported them and we looked at records the service held.

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

Is the service safe?

People we spoke with told us they always felt safe. We saw in care records that people’s complex health care needs were being met safely by staff at the service, with support from health care professionals.

People had been cared for in an environment that was safe, clean and hygienic. We found there were safe systems in place to ensure that people were protected against the risks of infection.

Equipment was well maintained and regularly serviced and all health and safety records were up to date. These checks meant that people were not placed at unnecessary risk.

Systems were in place to make sure that the manager and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduces the risks to people and helps the service to continually improve.

Staff knew about risk management plans and showed us examples of where they had followed them. People were not put at unnecessary risk but also had access to choice and remained in control of decisions about their care and lives.

We contacted the organisation and were provided with evidence regarding their recruitment process, as the manager was not on duty when we visited the home. Recruitment procedures were rigorous and thorough. No staff had been subject to disciplinary action. Policies and procedures were in place to make sure that unsafe practice could be identified and therefore people were protected.

Is the service effective?

People told us they felt their rights and dignity were always respected and that they were involved in how the service was run. Some people told us how they were involved in making sure that the organisation as a whole provided a good and effective service by volunteering to be ‘quality checkers’. (This meant that people receiving services run by the organisation, visited other services, for example a small home. They spoke to people who lived there to find out what it is like and if there were any areas that could be improved, to make life better). People we spoke with also told us that they did a report on their findings. Records we saw supported this. This makes sure that people who use services are involved and their views and input are valued.

People we spoke with told us that they were also involved and participated in the recruitment of new members of staff. We spoke with staff who confirmed that people living at Highgate Park had been involved with their interview process. This demonstrates that people living at the home are included in how the service is managed.

People’s health and care needs were assessed with them, and they were involved in developing their plans of care. People said that their care plans were up to date and reflected their current needs. Staff they were able to demonstrate a good understanding of people’s care and support needs and knew people very well. One person told us “I like being here.” Staff had received training to meet the needs of people they support in the community.

Is the service caring?

People were supported by kind attentive staff, they had time to be able to sit and talk with people. We saw that staff treated people with respect. This ensured that the service was effective and highly regarded by people living at the home and their relatives. People said “We are well looked after here.”

People using the service were asked for their views on a daily basis by staff and the providers. Relatives were also asked for their opinion and they felt welcomed and well informed. One relative said,” I am highly delighted with Highgate Park. I know that X is in such a lovely, secure, warm, friendly and loved environment.” When speaking with staff it was clear they genuinely cared for the people they supported. One staff said, “It does not feel like we are coming to work.”

Our observations of the care provided, discussions with people and records we looked at showed us that individual wishes for care and support were taken into account and respected.

Is the service responsive?

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes. People we spoke with told us they knew how to make a complaint if they were unhappy. They told us complaints would be investigated and action taken as necessary. People also told us there were ‘house meetings’ held each Sunday. Records we saw confirmed this. This ensured that people living at Highgate Park had the opportunity to share their views about the service, which were then taken into account.

Is the service well-led?

The service worked well with other health care professionals and services to make sure people received the care they needed in a joined up way.

The service had a quality assurance system, and records showed that identified problems and opportunities to change things for the better were addressed promptly. As a result the quality of the service was continuously improving.

Staff told us they were clear about their roles and responsibilities. They told us they enjoyed the work they did in supporting people to be as independent as possible. One staff member told us that it was about ‘making a difference’ to people’s lives and supporting them with their goals. Staff had a good understanding of the ethos of the service and quality assurance processes were in place.

People’s personal care records, and other records kept in the home, were accurate and complete.

When we visited the home there were three people in, as one person was attending an appointment. People we spoke with told us they were happy living at the home and that they were involved in all aspects of their care. One person said “It is ok living here I would recommend it.”

We saw from people's care plans that people were supported to live as independently as possible. The home had carried out an assessment of the needs of each person, and kept this under review, to enable appropriate care and support to be given.

People who lived at the home were protected from risks of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. The staff we spoke with had received training in safeguarding adults.

Records we looked at also confirmed that staff received good training in areas such as fire safety,moving and handling and first aid. Staff we spoke with told us that they received good support from their line manager.

The home had systems in place to make sure people were safely cared for. This included policies and procedures and quality monitoring systems.

We talked with two people who were in at the time when we visited the home. People we spoke with told us about the care they received and what it was like living at the home. People told us that they were well looked after and that they were happy with the care they received. Comments made to us during our visit included “Yes it is ok living here” and “Staff are very good they help me.”

We spoke with people about meals at the home. They told us that the food was good and that most people living at 4 Highgate Park continue to cook their own meals with support from staff. People we spoke with told us that they receive the necessary support from staff when they need it.

Everyone we spoke with said that if they were upset or had a complaint they would either speak to a member of staff or the manager of the home.

We spoke with the Local Authority Contracts Officer who informed us that they did not have any concerns about this service.

We were unable to communicate verbally with all the people who use the service, to find out their views and experiences. However, we spent time sitting with people and seeing how everyone interacted. We saw staff enabling people and providing support on an individualised basis. Care practices were of a high standard. One person said ‘its good here, staff are alright.’ Another person told us ‘I get bored sometimes but it is OK.’

Staff told us people received a good level of personalised care and people’s needs were always met. They said people get good support with their health and social care needs and other professionals were consulted when appropriate.

Staff told us about the different measures they have in place to check that people receive safe and effective care. They said they do daily, weekly, monthly and quarterly checks. Audits were carried out by staff and management at the service, and senior managers from United Response. ‘Inspections’ were also carried out by people using the service at other houses run by United Response, they give a ‘what we saw’ report and use this to identify good practice and advise on how practices can be improved. Two people told us about their ‘inspection’ work and how they were assisted to do it.

Staff gave positive comments about the manager. They said she was always available and spent a lot of time working directly with people who use the service and alongside staff, and was therefore very involved in what happened at the home. One member of staff said, 'we receive a good level of training on a regular basis.’