The Highlands

Updated 9 November 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

An adult social care inspector completed this inspection on 23 October 2018.

Before the inspection we looked at the Provider Information Return (PIR), which we had asked the provider to submit to us prior to the inspection. This is a form that asks the provider to give us some key information about the service, what the service does well and improvements they plan to make. We reviewed information we held about the service, including the notifications we had received from the provider. Notifications are reports about any changes, events or incidents the provider is legally obliged to send us within required timescales. We used the feedback we received to inform the planning of our inspection.

We contacted external healthcare professionals and the placing authority commissioners to gain their views of the service provided at the service.

Over the course of the inspection we met all the people who used the service and called four relatives. Some people who used the service had limited verbal communication skills but could show us what they liked and expressed their views about the care at the service. We spoke with the registered manager, the deputy manager, four support workers, an optician who regularly visits the service, a social worker and a community nurse.

We looked at three care records, two staff files, as well as records relating to the management of the service. We also looked around the service, including bedrooms (with people’s permission) all of the bathrooms and the communal areas.

Updated 9 November 2018

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 did not have any concerns about the service but knew how to raise a complaint if needed. Feedback on the service was encouraged in a range of ways and was positive.

People and staff told us that the registered manager and deputy manager were approachable. They and the staff team worked in collaboration with external agencies to provide good outcomes for people. Processes were in place to assess and monitor the quality of the service provided and drive improvement.

The registered manager had informed CQC of significant events in a timely way by submitting the required notifications. This meant we could check that appropriate action had been taken.