Highfield House Nursing Home

We found the following examples of good practice.

Safe arrangements were in place for all visitors to the home. These involved visitors to the home showing evidence of a negative rapid flow device (LFD) test and temperature checks.

Posters were on display throughout the home on the importance of regular hand washing / hand sanitisation, social distancing and the wearing of Personal Protective Equipment (PPE). These measures helped keep people using the service, staff and visitors stay safe.

Staff completed IPC training and were observed to be wearing the correct PPE and following best practice. The premises and equipment were visibly clean and regular cleaning schedules and audits were completed to monitor the IPC standards within the home.

Staff had access to enough supplies of PPE including facemasks, gloves and aprons and PPE stations were accessible throughout the home.

A programme of routine testing for was in place for all people using the service and staff. This meant swift action could be taken should anyone receive a positive result.

There was an up to date infection prevention and control (IPC) policy. Staff were regularly updated with any changes to government guidance and procedures to follow so they could keep themselves, people and visitors safe.

The inspection took place on 13 and 21 November 2018 and was unannounced.

Highfield House is a care home which provides accommodation for up to 46 people who have nursing and personal care needs, including people living with dementia. At the time of our inspection, there were 37 people living in the home.

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.

Individual risks to people were not always considered fully or recorded within people’s care documentation.

Arrangements were in place for the safe management of medicines. People received their medicines as prescribed. The home was clean and hygienic and staff followed best practice guidance to control the risk and spread of infection.

People felt safe living at Highfield House. Staff knew how to keep people safe and how to identify, prevent and report abuse. They engaged appropriately with the local safeguarding authority.

Thorough staff recruitment checks were carried out when a new staff member started working for the service. There were enough staff available to keep people safe at all times and staffing levels were monitored by the registered manager.

People’s needs were met by staff who were competent, trained and supported in their role. Staff received regular support from the provider and registered manager in order to carry out their responsibilities effectively.

People were supported to access healthcare services when needed. Staff made information available to other healthcare providers to help ensure continuity of care and supported communication between people and health professionals.

People were supported by staff with their nutritional and hydration needs. People were offered choice at mealtimes and menus contained a variety of nutrition and healthy foods. Where people had specific dietary requirements, this was well documented and staff were aware of how to meet these needs.

Staff were knowledgeable of the Mental Capacity Act 2005 and people’s rights were protected in line with the Act at all times. Where people were required to be deprived of their liberty, this was completed and recorded in an appropriate and timely manner.

People were cared for with kindness and compassion. Staff had developed positive relationships with people and their relatives and knew what mattered most to them.

Staff took action to protect people’s dignity and privacy at all times and encouraged people to be independent with all aspects of their daily routines where possible.

People had a clear, detailed and person-centred care plan in place, which guided staff on the most appropriate way to support them.

People had access to a range of activities based on their individual interests, including regular access to the community.

The service had a clear process in place to deal with complaints and we saw that concerns were dealt with in a timely and effective manner.

Staff took account of people’s end of life wishes and preferences. They supported people to remain comfortable and pain free.

People, their relatives, visitors and staff members commented positively on the leadership of the service and felt that the service was well-led. The provider was engaged with the running of the service and was approachable to people and staff.

There was an appropriate quality assurance system in place and where issues were identified, action had been taken promptly.

Staff were organised, motivated and worked well as a team. They enjoyed working at the home and told us they felt valued.

There was a registered manager in post. 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 inspection was unannounced and was carried out on 11 and 16 May 2016.

People and their families told us they felt the home was safe. Staff and the registered manager had received safeguarding training and were able to demonstrate an understanding of the provider’s safeguarding policy and explain the action they would take if they identified any concerns.

The risks relating to people’s health and welfare were assessed and these were recorded along with actions identified to reduce those risks in the least restrictive way. They were personalised and provided sufficient information to allow staff to protect people whilst promoting their independence.

People were supported by staff who had received an induction into the home and appropriate training, professional development and supervision to enable them to meet people’s individual needs. There were enough staff to meet people’s needs and to enable them to engage with people in a relaxed and unhurried manner.

There were suitable systems in place to ensure the safe storage and administration of medicines. Medicines were administered by staff who had received appropriate training and assessments. Healthcare professionals such as chiropodists, opticians, GPs and dentists were involved in people’s care when necessary.

Staff followed legislation designed to protect people’s rights and ensure decisions were the least restrictive and made in their best interests.

Staff developed caring and positive relationships with people and were sensitive to their individual choices and treated them with dignity and respect. People were encouraged to maintain relationships that were important to them.

People were supported to have enough to eat and drink. Mealtimes were a social event and staff supported people, when necessary in a patient and friendly manner.

People, and where appropriate their families, were involved in discussions about their care planning, which reflected their assessed needs. Each person had an allocated nurse and keyworker, who provided a focal point for that person and maintained contact with the important people in their lives.

There was an opportunity for families to become involved in developing the service and they were encouraged to provide feedback on the service provided both informally and through an annual questionnaire. They were also supported to raise complaints should they wish to.

People’s families told us they felt the home was well-led and were positive about the registered manager who understood the responsibilities of their role. Staff were aware of the provider’s vision and values, how they related to their work and spoke positively about the culture and management of the home.

There were systems in place to monitor quality and safety of the home provided. Accidents and incidents were monitored, analysed and remedial actions identified to reduce the risk of reoccurrence.

We had received information of concern about consent and restrictive practices, so we focussed our inspection on the standard of consent to care and treatment.

This is a summary of what we found:

We looked at five care plans and associated records of care and reviewed how people's consent to care was sought. We saw the plans had a consistent structure and included the necessary information to inform staff, as to the specific care people required. People's families or their representatives had been involved in the development of their plan, which were personalised to reflect their individual needs and their likes and dislikes.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find.

The service had a series of up to date policies and procedures to support and provide guidance to staff in respect of providing care and support to people with complex needs. These included areas such as, the Mental Capacity Act (MCA) and the Deprivation of Liberties Safeguards (DoLS).

Relevant staff had received MCA and DoLS training, which was refreshed on an annual basis. The manager confirmed that at the time of our inspection there was no one at the home who was subject to a DoLS authorisation.

We observed care and support being given in communal areas of the home and saw staff seeking consent before providing any care or support. We saw where consent was not given this was respected by staff and documented in the person's care plan.

A relative told us their relative had been seen prior to coming into the home and staff had taken details of their history and background to help them understand their relative's needs and their likes and dislikes. They said staff treated their relative with 'respect and caring' and 'always check if it is okay' before providing support or care.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led

This is a summary of what we found.

Is the service safe?

We found the service was safe. People were cared for by staff who were knowledgeable about their needs and had the skills to provide the support people required. We found the provider had an effective system in place to monitor and manage staffing levels to ensure there was enough qualified, skilled and experienced staff to meet people's needs. Everyone we spoke with said they were happy with the way their care needs were met. One person said staff 'made me very comfortable. The girls are lovely there is nothing they won't do for you'.

The staff we spoke with were clear about their role and responsibilities in respect of providing care and meeting people's needs.

People who use the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Staff were able to explain the different types of abuse and could say what they would do if concerns were raised or observed.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLs). Relevant staff had received training to enable them to understand when an application should be made. At the time of our inspection nobody in the home was subject to DoLs.

Is the service effective?

The care plans we looked at were personalised to reflect people's individual needs and their likes and dislikes. People, and the relatives, we spoke with told us they were happy with the care that had been delivered and their needs had been met.

Staff had received training to ensure they had the skills necessary to care for people. Staff told us about the care they were providing for specific people which matched information in the person's care plan.

Is the service caring?

People were supported by kind and attentive staff. People said they had no concerns over how they were treated and they felt their privacy and dignity were respected. The records we looked at showed staff took account of people's individual wishes and these were respected, when providing care.

People's wellbeing was enhanced through the availability of individual and group activities focussed on people's preferences, interests and diverse needs.

Is the service responsive?

There were arrangements in place to respond to short term staff absences, which were managed through the use of overtime and the provider's own bank staff.

Staff received specific training to meet the needs of people living at the home. This included Mental Capacity Act training and dementia awareness. Discussions with staff showed they were aware of how to use the training they had received for the benefit of people.

We saw there was an effective compliments and complaints policy in place, which was published in the service users' guide. The manager showed us their complaints file and told us they had not received any formal complaints during the last year. The people and visitors we spoke with told us they knew how to complain but had not needed to do so.

Is the service well-led?

There was a clear management structure. There were also procedures in place to monitor the quality of service provided with audits of care plans, medication administration records (MAR), accidents and incidents and infection control. Where an issue was identified remedial action was put in place.

An annual survey questionnaire was sent out to people, their friends and families seeking their views on the service provided. We saw the results of the latest survey, which was predominantly positive. An action plan had been created as a result of the feedback provided.

Staff attended regular supervision meetings in line with the home's staff supervision and appraisal policy. Each supervision meeting provided the opportunity for staff to raise and discuss any concerns.

We saw the home had an up to date safeguarding policy. We spoke with six members of staff, who all told us they had received safeguarding training and could say what they would do if concerns were raised or observed. One of the relatives we spoke with said 'I feel happy that mum is safe here and being well looked after'.

We saw all the necessary checks were completed prior to staff commencing work at the home and in addition, there was a process in place for checking the registration of nursing staff. We spoke with six members of staff, who all confirmed they had received induction training, which included a number of shifts shadowing an experienced member of staff. We found the provider had an effective quality assurance system in place and sought the views of the families who use the service through regular surveys.

We spoke with eight relatives and visitors the majority of whom were very happy with the care that was provided at the home. They told us that there was good communication and they were kept informed about any changes in their relatives' condition. We spoke with nine visiting health professionals, who were very positive regarding the care provided and confirmed that home followed their advice and guidelines.

We also spoke with six staff and confirmed that they had received appropriate training and were aware of the safeguarding policy and who to contact. They felt there were sufficient staff available to meet people's needs.