Archived: Highfield Court

Highfield Court is a care home providing personal care to up to 59 people. The service provides support to people who have a learning disability and autistic people. Some people also have mental health needs. The accommodation is divided into 22 separate bungalows. Some people live alone, and others live in small groups. At the time of our inspection there were 39 people using the service.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessment and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

People’s experience of the service and what we found:

Right Support: People were not supported to receive their medicines in a safe way. People’s risks were not managed in a safe way. Systems and processes in place to safeguard people from the risk of abuse were not effective. People were not protected from the risk of infection. The provider did not ensure there were enough staff available. The provider had failed to ensure appropriate decision-specific mental capacity assessments were carried out. The service did not ensure staff had the skills, knowledge, and experience to deliver effective care and support. People’s needs were not always understood and supported. People were not always supported to develop and maintain relationships, follow their interests, or take part in activities that were relevant to them.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Right Care: People’s needs were not always assessed; care and support were not always delivered in line with current standards. The provider did not always support people to achieve effective outcomes. The provider did not always ensure the service worked effectively within and across organisations to deliver effective care, support, and treatment. People’s individual needs were not always met by the adaptation, design, and decoration of the premises. People were not always supported to eat and drink to maintain a balanced diet, although people told us they liked the food. People were not always supported to express their views and involved in decisions about their care. People were not always well supported and treated with respect by staff. People were not always supported as individuals or in line with their needs and preferences. People’s end of life care needs were not always assessed.

Right Culture: People were not always supported to express their views and involved in decisions about their care. People were supported by a service which was not safe. People were not routinely and consistently protected from risks and avoidable harm. While people were asked for feedback in resident meetings and through surveys, the provider’s response to feedback led to 1 person being excluded from communal activities. The registered manager understood when things went wrong it was their legal responsibility to be open and honest. However, we identified missed opportunities for learning by the provider and registered manager because quality checks were not always effective. People, and those important to them, could raise concerns and complaints.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 28 June 2022).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found the provider remained in breach of regulations.

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to further investigation by the CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of people’s risks. This inspection examined those risks.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to managing people’s risks and environmental risks, assessing people’s mental capacity, safe recruitment of staff, delivering person centred care, and the governance of the care home.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow Up

The overall rating for this service is ‘Inadequate’ and the service is in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

About the service

Highfield Court is a residential care home providing personal care to 42 people who have learning disabilities and autistic people. Some people also have mental health needs. The service can support up to 59 people. The accommodation is divided into 22 separate bungalows. Some people live alone and others live in small groups. People have the option of having their meals at the on-site bistro, or in their own homes. There are several communal buildings and large gardens and outside space within the grounds people can access for recreation or activities.

People’s experience of using this service and what we found

Right support

Highfield Court does not meet the current Right Support, Right Care, Right Culture guidance which says that residential care should usually be provided in small, local community-based units. However, people told us they spent time in their local communities. One person said, "There's a shop within walking distance, the closest town is Uttoxeter. I would get a taxi or staff take me." People also told us they benefited from the rural location.’

The provider had not always ensured people had maximum choice and control over their lives, as some people's capacity to make specific decisions had not been assessed and recorded. This meant staff may not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. However, staff knew people well and understood their histories and experiences.

People were supported to make decisions about their living arrangements and, where requested, people had been offered alternative accommodation on site. The COVID-19 pandemic had impacted on the way people chose to spend their time, but this had been recognised by the provider who had established on-site activities to support people's interests and well-being. Improvements had been made to ensure the model of care offered people more choice, control and independence.

Right care

People’s medicines were not managed safely. Some aspects of people's care, including sexuality and spirituality, had not always been considered. Despite this people received support from staff who were kind and compassionate. End of life care planning had not always been recorded.

Staff understood people's communication styles and responded quickly where people were distressed or raised concerns. Staff had received training in how to protect people from harm and knew how to report any concerns for people's safety.

Right culture

Language used to describe people and their behaviours was not always respectful and did not always reflect a positive ethos. Audits used to monitor the quality of care people received were not always effective in identifying and driving the required improvements. People had been involved in reviews of their care and were given opportunities to be involved in developing the service through the resident's forum.

The provider had appointed two newly registered managers. They had developed an action plan to address the areas of concern identified at the previous inspection. People knew who the registered managers were and felt confident to approach them.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 28 September 2021) and there were breaches of the regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found some improvements had been made, particularly in relation to person centred care, however the provider remained in breach of regulations.

The last rating for this service was requires improvement. The service remains rated requires improvement. This service has been rated requires improvement or inadequate for the last five consecutive inspections.

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support right care right culture and to follow up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

Prior to the inspection the provider notified us of a specific incident, following which a person using the service died. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

The information CQC received about the incident indicated concerns about the management of people with modified diets eating and drinking. This inspection examined those risks.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the Safe and Effective sections of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, the need for consent and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Highfield Court is a residential care home providing personal care to 44 people who have learning disabilities, autism and/or mental health needs. The service can support up to 59 people.

The accommodation is divided in to 23 separate bungalows. Some people live in small groups of between two and six and some people live alone. Some people had their meals in their bungalow while others had their meals in a bistro located on site. There was an activities area and large gardens people accessed.

People’s experience of using this service and what we found

People did not receive care which was personalised to their individual needs due to the model of care in place. We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support:

• The model of care in place did not offer people ordinary living opportunities.

Right care:

• People did not receive care which was personalised to their needs and actively promoted their independence.

Right culture:

• People’s individual needs were not always considered, and people were not always encouraged to have aspirations for the future.

The governance systems in place had improved since the last inspection. However, they were still not identifying all areas of concern meaning the provider could not always keep people safe. The guidance seen in some of the care plans did not reflect best practice.

The provider did act when it was highlighted something had gone wrong. The registered manager was described as approachable. People and the staff team told us complaints were now addressed at the time.

Risks to people’s safety were assessed but staff did not always complete records to confirm the mitigation strategies had been adopted. For example, ensuring people receive specific drinks throughout the day. People received their medicine as prescribed, but the medicine audits had not identified all the issues the management team needed to address.

Infection prevention control policies were in place to manage the impact of COVID-19, but the provider was yet to complete individual risk assessments and ensure cleaning records were completed.

People were supported by enough staff members although they did not know until the day who would be working with them. People's needs were assessed, and care plans were developed and reviewed on a regular basis. People did not have access to health action plans to support them in managing their health needs.

People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The provider engaged with people and the staff team to gather their views on the service and future activities. They also worked in partnership with external agencies to support people and the development of the service.

The environment was undergoing refurbishment. Rooms were being decorated and house hold appliances were being replaced.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 08 October 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found there were still breaches of the regulations in some areas but in other areas there had been enough improvement to remove previous breaches.

This service has been inspected four times since 2017. On one of those inspections the service was rated inadequate and on the other three inspections the service was rated as requires improvement.

Why we inspected

We carried out an unannounced focussed inspection of this service on 26 August 2020 and an unannounced comprehensive inspection of this service on 07 October 2019. Breaches of legal requirements were found at both these inspections. We imposed conditions on the provider as a result of these breaches and undertook this focused inspection to check they were meeting the conditions and to confirm they now met legal requirements. The provider had also submitted an application to CQC to have the conditions removed. This report only covers our findings in relation to the Key Questions Safe, Effective, Responsive and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained requires improvement.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Highfield Court on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to how people were protected from abuse and the level of person-centred care people received. We also found a breach with the overall governance of the service at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Highfield Court is a care home which provides accommodation with personal care to a maximum of 59 people aged 18 and over with a mental health condition, learning disability or autistic spectrum disorder. At the time of our inspection 46 people lived at the home.

Although registered with us as a care home, Highfield Court is made up of 22 bungalows, rather than one building. Nine bungalows were staffed 24 hours. The bungalows accommodated between one and six people on the day of our inspection visit. Three bungalows were empty. The site has a communal dining room where people can eat and staff cook meals in some of the bungalows.

People’s experience of using this service and what we found

Since our previous inspection, significant improvement had been made at the home. Feedback from people and staff was positive about the changes which had been made. Despite the improvements, there was still further improvement required and the home needs to demonstrate the improvements can be sustained.

Improvements to the management of medicines had been made since our previous inspection, but there was still further improvements needed to ensure they were administered safely.

People's fluid intake was not always monitored and timely action was not taken when people's fluid intake was low. People’s assessment of risk informed staff how care should be provided to the person to minimise the risks to them. However, staff did not always follow the care plans which had been put in place.

Despite the provider having effective infection prevention and control systems in place, staff did not always follow these. Not all staff wore their personal protective equipment correctly to help ensure the risk of infection was reduced.

Whilst some improvements had been made since the last inspection in relation to the governance of the home, the systems in place were not always effective in identifying and addressing quality concerns.

The provider’s oversight of staff practice still needed to improve. Because not all staff fulfilled their responsibilities, errors were not always picked up, such as incorrect daily records. Staff did not always take accountability to identify and report issues which they had been trained to do, such as reporting missing signatures on medicine administration records.

Staffing had improved since our previous inspection. This had impacted positively on the lives of the people who lived at Highfield Court. Because of the improvements to staffing people had a greater range of experiences and independence.

People were happy with the care and support they received and gave positive comments about the staff and management at the home.

The management team had made significant improvement in the culture of the home. People were involved and consulted in the running of the home and there was a more open culture than there had been at our previous inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was inadequate (published 28 January 2020) and there were multiple breaches of regulation. We imposed conditions onto the provider’s registration for Highfield Court.

This service has been in Special Measures since 17 December 2019. During this inspection the provider demonstrated improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a focussed inspection which looked at the key questions of safe and well-led.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Highfield Court on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and to hold providers to account where it is necessary for us to do so.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Highfield Court is a care home service providing personal care to 51 people aged 18 and over at the time of the inspection. The service can support up to 59 people with mental health, learning disability or autistic spectrum disorder.

Although registered as a care home service, Highfield Court is made up of 22 bungalows, rather than one building. The bungalows accommodated between one and six people on the day of our inspection visit.

The service was registered prior to Registering the Right Support and other best practice guidance was introduced regarding the design of care homes for people with a learning disability. The principles and values that underpin this guidance reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The service did not consistently apply the principles and values of Registering the Right Support and other best practice guidance. People using the service did not always receive planned person-centred support that is appropriate and inclusive for them. The layout and size of the home did not fully support these principles and values.

People’s experience of using this service and what we found

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the following reasons; lack of choice and control, limited independence, limited inclusion. For example people were not involved in reviewing their care. The layout of the service did not fully support people’s independence and being able to engage easily with staff.

Not all people felt safe living at the home or felt their belongings were secure. Information given to staff on how to manage risks to people did not always reflect people’s personalities or the reasons why they became anxious. Some people had poorly maintained bathrooms which would prevent them from being kept clean and hygienic. People’s medicines were not managed safely and the deployment of staff did not support people’s safety.

People did not always benefit from the use of best practice guidance in the delivery of their care. Although staff received training, they did not always have the relevant training to support people’s specific health needs.

People’s dignity was not always respected and they were not encouraged to be as independent as they could and wanted to be. People did not feel listened to because there were not enough staff to spend time with them.

People did not always receive care and support which was centred around them. People were not involved in reviewing their care plans or setting goals or aspirations for themselves. People had opportunities to take part in activities, but records did not show how staff encouraged them to pursue their interests or offered them alternatives.

The provider had systems in place to monitor the quality of service provided to people. However, these systems were ineffective to ensure sufficient improvements had been made since our last inspection visit. People’s care records were not always available and did not show how the service supported them to achieve positive outcomes by living at Highfield Court.

People had access to healthcare professionals and saw the GP when they needed to. The provider ensured equipment and utilities were checked to ensure they were safe to use. Staff felt supported by the management team and people’s care records were kept secure. People were supported by staff to eat and drink enough to promote their health. People had access to information in a format they could understand. People had the use of an activities centre and some were supported to produce a regular newsletter.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 16 October 2018). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to insufficient staffing levels, people’s consent to care and treatment not being obtained and the ineffective systems to monitor the quality of the service. We also identified that people were not protected from the risk of potential harm and the care provided was not person centred.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

At this inspection we found improvements had been made but more were needed and the provider was not meeting the regulations for governance arrangements. You can see what action we asked the provider to take at the end of this report.

Highfield Court 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.

Highfield Court accommodates up to 59 people in one adapted building. At the time of the inspection there were 53 people using the service. The location is currently registered; however, the location would no longer be registered under Registering the Right Support. Registering the Right Support has values which include choice, promotion of independence and inclusion. This is to ensure people with learning disabilities and autism using the service can live as ordinary a life as any citizen

There was a registered manager in post at the time of our inspection. 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.

Governance systems were not always effective in identifying concerns and driving improvements. There were insufficient staff and some staff did not have the skills to meet people’s needs safely. Risks to people were not always managed safely and documentation about people’s care was not consistently completed, including when people had an accident. People were not always protected from the risk of cross infection.

Staff had received training but further work was required to ensure staff competency was checked effectively. However, staff felt supported in their role. Improvements were needed to ensure the environment was suitable for people and that they received consistency with their care and support.

People were supported to have maximum choice and control of their lives and staff were aware of how to support them in the least restrictive way possible; the policies and systems in the service were supportive of this practice. However, documentation required some improvement.

People received support from staff that were caring. However, improvements were needed to make sure that this was consistent. People’s communication needs were planned but staff did not always follow these plans. People were respected but sometimes their right to privacy was not protected and they did not always receive care in a dignified manner.

People’s preferences were clearly documented and staff understood these. However, staff did not consistently follow the plans. People’s end of life wishes was documented. People were not always clear on how to make a complaint.

Staff were safely recruited. People were safeguarded from potential abuse. People were supported to meet their dietary needs. People were supported to take their prescribed medicines. People were supported to maintain their health and well-being.

Notifications were submitted as required and the registered manager understood their responsibilities. We found improvements were needed to how people were engaged in the service.

The location has previously been rated as Requires Improvement. At this inspection the provider had not made all the required improvements. We may consider enforcement action if there is a continued lack of improvement at our next inspection.

This inspection took place on 6 April 2017 and was unannounced. At the last inspection, the service was meeting the legal requirements and was rated as good.

Highfield Court provides accommodation and or personal care for up to 59 people in a complex of 23 bungalows. People living at the home have mental health needs and or a learning disability and receive varying levels of staff support dependent on their assessed needs. On the day of our inspection 54 people were living at the service.

There was a registered manager at the home. 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 registered manager was absent from the service on the day of our inspection. We were assisted by the service manager who manages another of the provider’s homes, which is located on the same site.

We found improvements were needed to ensure the registered manager and staff always followed the legal requirements to ensure people’s rights were protected when they lacked the capacity to make their own decisions. Action was also required to ensure the registered manager’s quality monitoring checks were effective in identifying shortfalls and making improvements where needed People were supported and encouraged to eat and drink enough to maintain a healthy diet but improvements were needed to ensure people were always supported to enjoy their mealtime experience.

People felt safe living at the home and their relatives were confident they were well cared for. If they had any concerns, they felt able to raise them with the staff and management team. Risks to people’s health and wellbeing were assessed and managed and staff understood their responsibilities to protect people from the risk of abuse. People received their medicines when they needed them. There were sufficient, suitably recruited staff to keep people safe and promote their wellbeing. Staff received training so they had the skills and knowledge to provide the support people needed.

Staff gained people’s consent before providing care and support and encouraged them to have choice over how they spent their day. Where people were restricted of their liberty in their best interests, for example to keep them safe, the provider had applied for the appropriate approval. People were able to access the support of other health professionals to maintain their day to day health needs.

People received personalised care and were offered opportunities to join in social and leisure activities. People were supported to maintain important relationships with friends and family and staff kept them informed of any changes. People’s care was reviewed to ensure it remained relevant and relatives were invited to be involved.

There was a relaxed, informal atmosphere at the home. People and their relatives were asked for their views on the service and this was acted on where possible. Staff felt supported by the provider and management team and were encouraged to give their views on the service to improve people’s experience of care.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We saw that people were dressed in individual styles of dress and people we spoke with told us they went shopping and chose their clothes. People told us they kept in close contact with family and friends and enjoyed spending time with people outside of the service. This meant people were supported to do the things they wanted to do.

Staff were compassionate to people's needs and respected decisions that they made, including how they wanted to spend their time, who they were supported by and how they chose to dress. One person told us, 'The staff are nice to work with. They are nice and polite.'

People received care and support from staff who received training for people's assessed needs. This meant the provider demonstrated they were responsive to individual changes to ensure they could continue to meet people's needs effectively.

We used a number of different methods to help us understand the experiences of people using the service, because some people had complex needs. This meant they were unable to tell us their experiences about the care and support they received.

People using the service had choices in all aspects of their daily living. We observed staff interacting and supporting people in a respectful and positive manner. We observed that people were comfortable with staff and there was a relaxed atmosphere within the homes.

We saw that the homes were clean and well maintained. We saw that people's bedrooms were personalised and had pictures and photos of them on the wall.

The registered provider carried out regular checks and maintenance work to ensure the properties were maintained and safe.

During our inspection we saw people using the service engaged in different activities and they were able to choose how they spent their time.

Some of the care records were not up to date and did not reflect the support and care that people wanted. This meant they were at risk of receiving care that did not meet their individual needs.