Archived: Highfield Care Home

Highfield Care Home is a care home set across two floors and is registered to provide accommodation and personal care for up 54 older people some of whom are living with dementia. At the time of our inspection 36 people were living at Highfield Care Home.

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

People were not always protected from the risk of harm. When people sustained unexplained bruises or skin tears these were not investigated or reported to external safeguarding authorities.

Lessons following incidents, accidents or complaints were not learnt. Information was not shared with staff, so the service had not improved the care that staff provided to people.

There were not always enough staff effectively deployed to meet people’s needs in a timely way. Staff had not received training to understand the needs of the people they supported, and their competency and skills were not assessed.

Staff did not always follow guidance from health and social care professionals when supporting people at risk of choking or at risk of developing pressure ulcers. People’s dignity was not always promoted.

People who developed pressure ulcers or who’s health needs changed were not always referred to health care professionals in a timely way. Staff were not always responsive to people’s changing needs to ensure that the care and support they provided to people was personalised.

The registered manager had not investigated or responded to complaints raised. The governance systems in place were not used effectively to identify and improve the service.

The provider failed to ensure that people received a good quality service in a personalised and safe way. People were not always 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.

People’s medicines were managed safely. People had been provided with activities and opportunities to pursue their hobbies and interests.

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 23 November 2018) and there were multiple breaches of regulation. 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 that the provider was still in breach of regulations. This service has been rated requires improvement for the last four consecutive inspections.

Enforcement

We have identified breaches in relation to safe care and treatment, staffing, complaints, dignity and governance systems at this inspection.

For requirement actions of enforcement which we are able to publish at the time of the report being published:

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Special Measures:

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 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.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the five key questions, Safe, Effective, Caring, Responsive and Well-led to good. At this inspection we found that not all the areas we previously found not meeting the required standards were improved.

Highfield Care Home 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 Care Home is a purpose-built care home and is registered to provide accommodation and personal care for up 54 older people some of whom are living with dementia. At the time of our inspection 42 people were living at Highfield Care Home.

There was a recently employed manager in post, however they were not registered at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

People we spoke with told us they felt safe in the home. Relatives told us they felt that the care people received was safe. However, we observed, during the inspection that staff did not always follow guidance given by health professionals for people who needed assistance with their meals because they were at risk of choking.

Risk assessments had been completed and were regularly reviewed. However, when staff completed risk assessment tools to ascertain the level of risk presented to people the scores were not added up correctly and were not consistently reflected in assessment of need care documents or care plans. This meant that there was a risk people did not have the appropriate measures in place to mitigate the identified risks.

People told us that there were less staff over weekends and on occasions they had to wait long period of times for staff to answer their call bells. This was confirmed by relatives who told us that at the weekends there was always a shortage of staff. Staff members we spoke with told us there were not enough staff deployed to meet people`s needs in a timely way. Our observations confirmed that staff were stretched and busy which led to some people`s support being carried out in a rush.

People told us staff were kind and caring and protected their dignity and privacy. Care plans were developed and were reflective of people`s likes, dislikes and preferences, however not all care plans we reviewed had been updated following a change in people`s needs. Care plans contained a high level of information that was not helpful for staff and it did not give sufficient guidance in how staff should meet people`s needs in a personalised way.

Where people were identified at risk of malnutrition or dehydration and required their food and fluid intake monitored, this had not been done effectively. Where people used their own mobility equipment risk assessments were not developed and assessments were not carried out by the provider to ensure the equipment was suitable and in good working order as well as used correctly by people.

Safe and effective recruitment practices were followed to ensure that staff working at the home were of good character and suitable for the roles they performed.

People received their medicines safely and had access to healthcare professionals such as GP’s, dentists, opticians and chiropodists when required.

Staff asked people for their consent before they carried out any care, however mental capacity assessments were not carried out consistently and best interest processes were not always followed. Where people had behaviours which challenged others there were no care plans developed to offer staff guidance on how to manage and prevent these behaviours.

People told us that the activity provision in the home could be improved with more outings and activities which were more suitable to their needs. We observed activities on the day of the inspection and found that people were not interested and motivated to engage with what was on offer.

People told us they would report their concerns to the office but due to recent management changes they did not know the manager or the person in charge to share their worries. Complaints were recorded and responded too, however not always following the providers complaint policy.

People and staff had been invited to regular meetings where they could raise any issues and discuss how they wanted to improve the service. We found that some requests resulted from these meetings were actioned, however there were actions discussed in several meetings were there was no action from the provider to address these.

There were a range of audits carried out by the deputy manager and the provider to look at the quality of the service they provided to people. We found that they identified areas which needed improving, however not all these areas resulted in improvement actions and rolled over from one audit to the other.

Some of the concerns we identified through this inspection had not been identified through the providers quality monitoring systems.

This is the third consecutive time the service has been rated Requires Improvement. You can see what action we told the provider to take at the back of the full version of the report.

Highfield Care Home provides nursing and personal care for up to 49 older people, some of whom were living with dementia. At the time of the inspection there were 47 people living in the home.

The registered manager recently left the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 provider had recently employed a manager who was not yet registered with CQC.

People and their relatives felt that the home and the care delivered met their needs. However we found that the care people received had not always promoted their safety regarding pressure care management and nutrition.

Care plans were not up to date and did not provide staff with sufficient guidance to meet people`s needs safely and effectively. People`s likes, dislikes and preferences regarding their care was not always captured in their care plan or considered by staff when delivering the care and support people needed. Care records were not always legible and easy to read.

People told us they felt staff protected their dignity and privacy, however we observed that some of the staff`s actions had a negative impact on people`s dignity.

Where potential risks to people’s health, well-being or safety had been identified, these were assessed however not regularly reviewed to take account of people’s changing needs and circumstances. Food and fluid monitoring charts were not completed effectively and for people who were losing significant amount of weight it was not clear what the staff were doing to promote good food and fluid intake.

People told us their call bells were answered in a timely way. The provider used a dependency tool to inform their staffing levels. However we observed that there were a high numbers of people with complex needs who may have benefitted from more time spent with them, however staff were not able to do this.

Safe and effective recruitment practices were followed to ensure that staff working at the home were of good character and suitable for the roles they performed.

People received their medicines safely and had access to healthcare professionals such as GP’s, dentists, opticians and chiropodists when required.

We found that staff obtained people’s consent before providing the day-to-day care they required however mental capacity assessments were not always carried out to establish if people had capacity to understand and take decisions regarding the care and support they received.

Staff were caring and attentive to people’s needs and interacted with people in a warm and respectful manner. People were given choices in such areas as food, activities and where they wanted to spend their time.

There were a variety of activities available in the home however a high number of people were cared for in their bedrooms and more one to one activities were needed to meet people`s social needs. The provider was in the process to recruit an additional activity staff to meet people`s needs.

People were encouraged and supported to raise concerns and the manager closely monitored and sought feedback about the services provided to identify areas for improvement.

The manager and the provider completed a range of quality audits to monitor the quality of the service provided however we found that these had not been effective in identifying the issues we found at this inspection.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, and the staff supporting them. We also spent time looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

There was no effective system in place to make sure that the manager and staff learnt from events such as accidents, incidents and investigations. This increased the risk of harm to people and failed to ensure that lessons were learnt from mistakes. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to learning from incidents and events that affect people's safety.

We found that people's records were not an accurate reflection of the care they were being provided with and did not accurately record the progress of treatments given. Records were also in places illegible and difficult to read. This meant people were at risk of receiving inappropriate or unsafe care because an accurate record had not been maintained. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to maintaining an accurate record for people who used the service.

Is the service effective?

People's health and care needs were assessed with them, but they were not always involved in writing their care plans. Some people were not aware of what was in their care plans. Some of the care plans had not been reviewed regularly. Care plans were therefore not able to support staff consistently to meet people's needs.

We looked at the support and professional development provided to the manager and staff. We found that the manager and staff had not received an appraisal of their development for over a year. In some circumstances this was in excess of five years. We found that staff had not all received training relevant to their role. We also noted that the manager had not received training in areas such as incident management and supporting staff. This put people at risk of being supported by staff without the appropriate skills.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing people's needs and involving people in planning their care.

Is the service caring?

People were supported by kind and attentive care and nursing staff. We saw that staff demonstrated patience and gave encouragement when supporting people. People were treated by staff in a dignified manner.

People's preferences, interests, and diverse needs had not always been recorded. Because of this care and support could not always be provided in accordance with people's wishes.

We asked the provider to tell us what they are going to do to meet the requirements of the law in relation to involving people in planning their care.

Is the service responsive?

We found that the service did not always respond to issues identified through their own monitoring systems. We found that care record audits identified the need for updating records with important information, however this had not been done.

People using the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey.

Is the service well led?

At the time of our inspection the manager had not applied to the Care Quality Commission for registration to manage Highfield Care Home. The manager has been in post for one year. We have informed the provider that we may take action against them unless they tell us how they are going to meet the requirements of the law in relation to having a registered manager in post.

The service had conducted a range of audits to ensure people received a safe level of quality care. However where these audits had identified shortfalls and the manager had not acted to remedy these.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to quality assurance, and the improvements they will make.

We found that people were asked for their consent about their care provision and that, where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

People's needs were assessed and care and treatment was planned and delivered to meet those individual needs. One person we spoke with told us, 'I get everything I need here.' Another person said, 'I need help all the time and the staff are really good.'

People who were at risk of developing pressure ulcers had appropriate care plans in place that were followed by the staff.

People's medicine was administered on time and according to their prescription. There were proper arrangements in place for storing and recording medicines.

There were enough staff on duty, including nursing staff, for each of the three shifts to meet people's needs.

Care plans and daily records were stored securely and could be readily accessed by staff. Care plans and records were fit for purpose and ensured people received safe and appropriate care.