Hightown House

Updated 24 October 2019

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection was undertaken by one inspector.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats and specialist housing.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

We gave the service 48 hours’ notice of the inspection. This was because we needed to be sure that the provider or registered manager would be in the office to support the inspection.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with relatives of thirteen people who used the service about their experience of the care provided. We spoke with eleven members of staff including the provider, registered manager, scheme managers and support workers.

We reviewed a range of records. This included a sample of four people’s care records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We spoke with two professionals who regularly visit the service.

Updated 24 October 2019

About the service

Hightown House is a domiciliary care service based in Hemel Hempstead providing personal care and support services to adults living in their own homes across Hertfordshire, Buckinghamshire and Berkshire. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of this inspection 176 people were receiving the regulated activity of Personal Care.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for outcomes

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

People were safe and protected from the potential risks of abuse and avoidable harm. People were supported and encouraged to be as independent as possible following robust risk assessments. Where risks to people’s health, well-being or safety were identified staff were knowledgeable about these risks and knew how to respond safely. There were enough safely recruited, experienced, skilled and qualified staff deployed to meet people’s needs. Staff supported people to take their medicines in accordance with prescriber's instructions. Staff had received infection control training. Incidents and accidents were recorded, investigated and reviewed by the management team.

Staff received training and refresher updates in basic core areas as well as training specific to meet the needs of the people they supported. Relatives said staff were skilled and competent. Staff told us they felt listened to and supported by the management team. Staff supported people to eat a healthy, balanced diet. People had access to health and social care professionals relevant to their needs. Health professionals told us people received appropriate support from the service. Staff sought people’s consent to the care and support they received, together with that of their relatives or external advocates where appropriate.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People’s relatives complimented the staff team for the care and support provided. Staff had developed positive and caring relationships with people and were knowledgeable about their individual needs and personal circumstances. People and their relatives, where appropriate, were fully involved in the planning and reviews of their care and support. People were supported to access advocacy services to obtain independent advice and guidance relevant to their needs.

People received personalised care and support that took account of their preferences and personal circumstances. Staff told us the provider encouraged them to explore any aids to enable better communication with people. Staff helped and supported people to develop the skills and confidence necessary for them to live independently in their own homes. People enjoyed a varied and active social life according to their personal preferences with the encouragement and support of staff. Staff and management routinely sought and learnt from people’s experiences, concerns and complaints in a positive and responsive way.

At the previous inspection in 2016 we had found that local level audits had not always been completed and had not always identified areas of concern. At this inspection we found significant work had been undertaken to develop workflows for every aspect of the business which meant that shortfalls in performance were swiftly identified and addressed in a timely manner. The management team were clear about the provider’s values and the purpose of the services provided. Staff also understood these values. People’s relatives were positive about how the service was managed and the management team.

The registered manager and scheme managers were knowledgeable about the people who received support, their needs, personal circumstances and the relationships that were important to them. The provider routinely distributed quality survey forms to people, staff, relatives and health professionals. Health and social care professionals told us that the staff and management team were responsive to any comments and suggestions and were committed to working collaboratively with people, their families, specialists and professionals.

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 Good. (Published 29 September 2016)

Why we inspected

This was a planned inspection based on the previous rating.

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.