Archived: Highpoint Lodge

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.

Highpoint Lodge is situated close to the centre of Wadebridge. It is a large detached property over two floors. The first floor being accessed by a stair lift. There are eleven rooms one of those being a double room. Of these six had en suite facilities. There is a large entrance hall, lounge and dining room on the ground floor. Bathrooms with adapted baths for people with poor mobility are in place on both floors. An additional toilet is situated on the ground floor. There is a sun lounge off the dining room. To the rear of the house is a garden area with parking to the side.

There were enough bathrooms including assisted baths on all floors. There were a range of aids and adaptations available to support people with limited mobility when required.

The atmosphere in the service on the day of the inspection was relaxing, friendly and calm. Staff responded promptly when people asked for help and support was provided at a relaxed pace. Throughout our inspection we observed staff providing support with respect and kindness. People told us they felt safe and comfortable living at Highpoint Lodge. Comments included, “I love it here. It’s very calm and relaxing”; “Staff are there at the push of a button. So kind and caring" and "Moving here has improved my quality of life. Yes it makes me feel a lot safer than when I was at home alone."

People’s risks were being managed effectively to ensure they were safe. Records showed where changes in people’s level of risk were. Care plans had been updated so staff knew how to manage those risks.

People received their medicines as prescribed. Systems and processes relating to the administration and storage of medicines helped ensure medicines were managed safely.

Care plans contained information about the person and what their individual needs were and how they would be met. Care planning was reviewed regularly and people’s changing needs were recorded. Daily notes were completed by staff responsible for peoples care.

People were treated with kindness, compassion and respect by staff who were sufficiently skilled to meet people’s needs. Necessary pre-employment checks had been completed. However some staff had worked at the service for a number of years and had not had a more up to date DBS check. We discussed this with the registered manager who agreed to act on this by gaining annual declarations from those staff members in order to demonstrate they remained safe to work with people who may be vulnerable. There were systems in place to provide new staff with appropriate induction training. Existing staff received regular training, supervision and annual performance appraisals.

Safeguarding procedures were in place and staff had a good understanding of how to identify and act on any allegations of abuse.

The manager used effective systems to record and report on, accidents and incidents and take action when required.

People received care and support that was responsive to their needs because staff had the information to support them. Staff supported people to access healthcare services. These included, Social Workers, Psychiatrists, General Practitioners (GP) and speech and language therapists (SALT).

People’s bedrooms were personalised to reflect their individual tastes and the service was well maintained.

The premises were regularly checked and maintained by the provider. Equipment and services used at Highpoint Lodge were regularly checked by competent people to ensure they were safe to use. It was clean and hygienic and a safe place for people to live.

Staff wore protective clothing such as gloves and aprons when needed and there were appropriate procedure in place to manage infection control risks

People's rights were protected because staff acted in accordance with the Mental Capacity Act 2005. The principles of the Deprivation of Liberty Safeguards were understood and applied correctly.

Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Where necessary staff monitored what people ate to help ensure they stayed healthy.

There was a complaints procedure which was made available to people on their admission to the home and their relatives. People we spoke with told us they were happy and had no complaints.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included regular audits, an annual survey, staff meetings and daily meetings with people living at the service.

Highpoint Lodge is a family run residential home that can accommodate up to 11 older people. On the day of our inspection 10 people were living at the service. The service is required to have a registered manager and there was one 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.

Care plans contained risk assessments which identified when people were at risk, for example from falls. Risk assessments were regularly reviewed and updated to reflect the current situation for the people they were about. Guidance for staff did not always contain detailed information on the action staff were directed to take when undertaking care.

Staff had received appropriate training to carry out their roles. However, refresher training in health and safety had not been provided in a timely way. Staff supervision processes were not taking place as stated in the service policy and there were inadequate records for staff supervisions.

Medicine Administration Records (MAR) were clear and accurate. This meant it was possible to establish how much medicine people were receiving and whether the amount of medicine in stock tallied with the amounts recorded.

The providers had oversight of the service and people. People and staff told us they were available and approachable. Staff told us, “I don’t think I would want to work anywhere else. It’s such a personal, family orientated home. Management were supported by a team of 10 carers. In addition the staff team included the second provider who acted as both the cook and maintenance person. There were clear lines of accountability and responsibility. There were sufficient numbers of staff to meet people's needs.

People and relatives told us they considered Highpoint Lodge to be a safe environment and that staff were skilled and competent. People, relatives, staff and professionals spoke of the service as having a 'family' feel and terms such as 'homely' and 'friendly' were frequently used. There was a relaxed and friendly atmosphere in the service. People chatted and joked together and with staff. One person told us, “This is a splendid place. I could not say a single bad thing about it. I am very well cared for here.”

Pre-employment checks such as Disclosure and Barring System (DBS) checks and references were carried out. New employees undertook an induction before starting work to help ensure they had the relevant knowledge and skills to care for people. Most training was regularly refreshed so staff had access to the most up to date information. However we found that certain training required by the service’s policy had not been carried out in a timely fashion.

The service had not made any applications for Deprivation of Liberty Safeguards (DoLS) authorisations to the local authority because no-one living at the service required this. Training for the Mental Capacity Act and the Deprivation of Liberty Safeguards (DoLS) was included in the induction process and in the list of training that required regular updating. The registered manager and staff demonstrated an understanding of the principles underpinning the legislation. For example, staff ensured people consented before giving personal care. Mental capacity assessments had been completed as required.

The premises were clean and odour free. People were able to use a shared lounge or stay in their rooms as they chose. Improvements to parts of the building were on-going, for example the outside of the building was being painted during our visit. Regular maintenance of the premises was carried out.

During our observations we saw staff help two people to mobilise. We also saw staff conversed with people when they were delivering personal care. We saw people talked to each other in the dining area. We saw staff spoke to people with respect.

We witnessed staff interactions with people which were positive. People told us staff answered call bells promptly. One person said the staff were 'polite and friendly'. Another person said, 'I am very happy here, no complaints'. People told us the food was good and they were offered choices. We were told visitors were welcome. One person said 'I can go to bed when I want, if I wanted to go out someone would take me'. Another person told us they were involved in the planning of their care.

We heard care workers ask people what they would like to do and they gave them ideas if people could not make a choice.

People who used the service were positive in their comments about the home and the staff. Comments made included 'The owners and staff are lovely, very kind and look after me well', 'there is always a choice of food and the food is good'. People told us they would feel able to go to the owners or staff if they had any concerns, and they said they felt confident the owners would resolve any issues.

We saw evidence and heard from staff how people who used the service were offered choices in how they spent their day. For example, people chose when they got up in the morning, where they spent their day, and what they wanted to eat. People's likes and dislikes were known and consent was sought routinely. For example, people were asked if they needed assistance to attend appointments.

We found that the care documentation did not always identify that people's care needs were consistently met.

People were protected from abuse and staff were trained and supported to carry out their roles.

The home was hygienic and clean, and on the day of our inspection free from odours. People we spoke with made positive comments about the environment, and said they liked their rooms.