Archived: Highfields Residential/ Dementia Care Home

Highfields Residential/Dementia Care Home accommodates 27 people in one adapted house. There were 16 people accommodated when we visited.

We found the following examples of good practice.

Adjustments had been introduced to support visits from people’s relatives and friends which included visits inside the home and using a visiting pod outside. All visits were on a pre-booked basis so staff could support safe visiting.

The provider had sufficient stock of Personal Protective Equipment (PPE) which was easily accessible to the staff. Staff had been provided with training in how to use and dispose of this safely.

The provider organised for people who used the service and staff to be COVID-19 tested in accordance with government guidance.

Admissions were only accepted following a pre-arranged and negative COVID-19 test. New admissions were supported to self-isolate in a designated bedroom before moving into their permanent bedroom.

Cleaning arrangements had been adjusted to support prevention of the spread of COVID-19 infection in the care home and future improvement was planned for the laundry area.

The service had ensured people’s health needs had continued to be assessed and met during the pandemic. People had been supported to access vaccination for COVID-19 and the Flu.

Highfields Residential/ Dementia Care Home is a residential care home providing personal and nursing care to 17 people aged 65 and over at the time of the inspection. The service can support up to 27 people in one adapted building.

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

We found improvements had been made to staff recruitment procedures to ensure suitable staff were recruited to care for people using the service.

People were protected from harm and abuse through the knowledge of staff and management. A new system to support people with taking their medicines was about to be introduced.

Staff were able to develop the knowledge and skills for their role through a programme of training and were supported through regular individual meetings and annual performance appraisals.

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.

People were treated with respect and kindness and their privacy and dignity was upheld. They were supported to maintain their independence and keep in contact with relatives.

People received personalised care and there were arrangements in place to respond to concerns or complaints from people using the service and their representatives. People were enabled to be involved in activities in the home and to enjoy occasional trips out.

The registered manager was accessible to people, their visitors and staff. People and their representatives were asked for their views about the care home. Quality monitoring systems were in place to ensure a consistent service was provided.

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 24 October 2017).

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.

Highfield Residential Home had 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 took place on the 20 and 22 June 2017 and was unannounced. This was a comprehensive inspection that was carried out to check whether the provider had made the improvements required as a result of our previous inspection on 20 and 23 May 2016. At the previous inspection we identified two breaches of the regulations relating to seeking people’s consent before providing care, the recording of information about people’s needs and the management of risks in the service. Following the inspection the provider sent us an action plan detailing how and by when they would meet the regulatory requirements.

At this inspection we found improvements had been made and the provider was meeting the requirements of the regulations.

We found improvements to how information about risks to people using the service and information about their needs were recorded. There were also improvements to how people’s consent to receiving care and support was assessed and recorded. The provider's quality monitoring systems were effective in monitoring and improving the quality and safety of the service provided. Some time was still needed to ensure appropriate pre-employment checks would always be completed in accordance with the provider’s recruitment processes in the registered manager’s absence.

People were protected from harm and abuse through the knowledge of staff and management. People’s medicines were safely managed. People received personalised care and there were arrangements in place to respond to concerns or complaints from people using the service and their representatives. People were treated with respect and kindness, their privacy and dignity was respected. They were supported to maintain their independence and keep in contact with relatives. People were enabled to be involved in activities in the home and to enjoy occasional trips out.

Staff were able to develop the knowledge and skills for their role through a programme of training and were supported through regular individual meetings and annual performance appraisals.

The registered manager was accessible to people, their visitors and staff. People and their representatives were asked for their views about Highfield Residential Home.

Highfield Residential Home is a care home for up to 27 older people. At the time of our inspection there were 14 people using the service.

Highfield Residential Home did not have a registered manager in post. The previous registered manager left their post in April 2015. 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.

Information about people’s needs and the management of risks were not always clearly or consistently recorded.

People had their prescribed medicines safely and on time. However the service needed to ensure there was sufficient guidance for staff on the administration of certain ‘as required’ medicines.

There was an inconsistent approach to assessing people’s mental capacity in relation to decisions about their care.

People were not fully protected against the employment of unsuitable staff. Health checks had not been made when staff were employed.

We heard positive comments about Highfield Residential Home from people and their relatives such as “very pleased with it” and “very nice”. A visitor appreciated the size of the home which they felt compared well to larger establishments.

Staff and management understood how to protect people from harm and abuse. People received personalised care and there were arrangements in place to respond to concerns or complaints from people using the service and their representatives. People were treated with respect and kindness, their privacy and dignity was respected. They were supported to maintain their independence and keep in contact with relatives. People were enabled to be involved in activities in the home and to enjoy occasional trips out of the home.

Staff were able to develop knowledge and skills for their role through a programme of training. However staff supervision sessions had not been taking place. The manager was accessible to people, their visitors and staff. People and their representatives were asked for their views about Highfield Residential Home. Regular audits checked areas of the service provided to identify if any improvement actions were needed.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We found some people were not adequately supported with their nutritional needs. In particular people who required individual support and monitoring. A thickening agent to help prevent one person choking on fluids was not available in the care home.

Although we received concerns about people’s beds being left with dirty bedding we did not find this was the case, beds we examined were made with clean bed clothes. There was a lack of guidance for staff in relation to the correct temperatures to wash laundry. We passed information about food storage issues to the local authority.

People did not always receive the support they needed to take part in activities of their choice.

Highfield Residential Home did not have a registered manager. A manager had recently been appointed although at the time of our inspection visit we had not received an application from them to be registered as manager for Highfield Residential 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.

Twenty five people lived in the home on the day of our inspection. We were given a tour of the home and spoke with five people who lived in the home. They told us they liked living at the home and staff were nice. We spoke with five members of staff. We read the care records of four people who lived in the home. We inspected the policies and procedures, the record of complaints and the safeguarding folder which included details of safeguarding referrals. We read the reports from quality monitoring visits. We observed staffs' interactions with people they were supporting.

A single adult social care inspector carried out the inspection. The focus of the inspection was to answer five questions: Is the service safe, effective, caring, responsive and well-led?

We found the service was safe.

Overall we found the service was safe but we found the management of medicines to be unsafe. We found inappropriate arrangements for the recording of medicines. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Staff told us they had received training about safeguarding vulnerable people. They told us they would report concerns immediately to a senior staff member or the manager. Policies, procedures and local guidelines were available for staff to follow. The policies read were dated 2010 and we found no evidence of policies being reviewed. The provider has been made aware of this.

We saw that staff had a good rapport and interacted well with the people living in the home. We saw that people freely approached members of staff when they wanted support.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS), which applies to care homes. The provider had policies and procedures in relation to the Mental Capacity Act (MCA).

We saw systems in place to ensure that the manager and staff learnt from accidents and complaints as well as comments received from people who used the service and their relatives.

Is the service effective?

People's health and care needs were assessed. However, we did not find evidence that people had been involved with their care plans. We saw involvement from external health professionals such as the community mental health team (CMHT).

We spoke with staff who told us that the induction training for their role had been thorough. They also told us they received regular meeting with their manager to discuss their personal development. The records we reviewed did not identify staff receiving annual appraisals. An appraisal evaluates staff's performance which is documented in their records. The manager confirmed they were aware of annual appraisals having not been completed.

We found the service was caring.

We spoke with staff, and observed the interactions they had with people. We found, without exception, that staff spoke kindly and demonstrated a good understanding of people's needs. Staff said they enjoyed working at the home as "each day was different."

During our visit we observed there was a relaxed atmosphere with people choosing where they wished to spend their time. We observed staff treating people with kindness and patience. Staff demonstrated they knew people's needs and ensured people were treated with privacy and dignity.

We saw people freely expressing what they wanted to do during the day, and they were supported by kind and reassuring staff. People told us staff were "very nice and friendly" and they "do the best they can."

We found the service was responsive.

People had their needs assessed on a regular basis and had been allocated a key worker. However, we found no evidence within the records read of key worker's involvement with people who used the service. A key worker is a designated member of care staff with specific responsibility for a named person who lives in the home.

Staff told us that some people had difficulty communicating although they understood what was said. Staff told us people were able to respond through various means which included the use of signs and gestures.

We found the service was well-led.

We saw that people were asked for their feedback. We saw the responses from people and found there were many positive responses for example, people said they liked their home. Suggestions for improvements included more day trips out into the community. This had resulted in additional hours being allocated to the activities co-ordinator and we saw days out scheduled on the activities planner.

The service's monitoring system was not fully effective and some shortfalls had not been identified and therefore addressed. A compliance action has been set in relation to this and the provider must tell us how they plan to improve. We observed good relationship between staff and management on the day of our visit. Staff were clear about their roles and responsibilities and told us they were supported by their manager.

We observed a member of staff checking whether people were enjoying their lunch and interacting with one person who did not always eat well to offer their favourite desserts as alternatives. The outcome was that they ate every mouthful of the dessert prepared for them. A staff member told us, "The food is excellent; we have got good cooks".

We saw that staff worked in accordance with the home's infection control policy when assisting with personal care and when handling food and drink. All the staff we spoke with were clear about how clinical waste and body fluid spillages should be managed.

There were effective recruitment and selection processes in place. The people and their relatives we spoke with at Highfield were complementary about the staff at the home. One family said, "They are all so helpful and friendly."

Effective systems were in place to manage risks and to monitor the quality of the service.

We found that consent was obtained from people before they received care. People also told us that they received enough help to meet their needs. We found the environment of the care home had been well maintained. When we looked at staff recruitment we found that some required checks had not been made before staff started work in the service. Although we did not ask people specific questions about staff recruitment, we did hear positive comments about the staff such as, 'friendly and helpful' and 'all so friendly'.

We found that the service had an effective complaints system and information about this was made available to people using the service.