Highfields Nursing Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Peoples needs and rights were supported. People’s care and treatment was effective due to their health, care, well-being, and communication needs being assessed with them. People’s care plans are kept up to date with any assessments completed in a timely manner. Staff were aware people’s preferences and respected these in a person-centred way. People were aware of their rights around care and treatment. Staff showed a good knowledge of the mental capacity act, including capacity and consent. Staff were aware of how to support people living with fluctuating capacity.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and relatives told us that they were involved with planning their care. One person said “It’s great. I like it here. The staff leave me and check on me regularly, that’s how I like it. Because that’s what I want. I am aware of my care plan; I have been through it.” People were confident that their needs were understood by the staff team. Relatives who also care for people, told us that staff also understood their family members needs and how best to support them. One relative said, “They know when my family member is ready to do something. They know their personality. We work well together.”

Some staff told us they felt pressured regarding their capacity for reviewing and updating all care planning documents; to ensure these were kept updated with people’s changing needs. This was a task specifically allocated to clinical and senior staff, which along with ensuring people’s clinical needs were met and medicines management, staff felt could be challenging to fulfil at times. We shared this with the management team to look at a more robust way of ensuring this was effectively managed within the staff team moving forwards. The manager provided a detailed, clear action plan, with associated key performance indicators, which we were assured by. We saw staff had a good knowledge of how to support individual people’s needs, and what immediate action to take if the person’s needs appeared to have changed. We saw prompt referrals had been made to health and social care teams when required.

A range of national assessment tools were used, to understand people’s needs and how best to support them. For example, the malnutrition universal screening tool (MUST) was used for the management of weight loss and nutritional intake. Staff had access to documents on how to support people. Where people’s needs changed, these care planning documents were updated so staff understood people’s changes in needs. For example, where a person’s mobility had reduced, staff had made a referral to an external health team for occupational therapy input for equipment to support their needs. People’s communication needs were recorded and understood by staff. This allowed staff to communicate with people, to have a clear understanding of the person’s needs.

People and their relatives received information on their health conditions. This allowed them to be as healthy as possible. The service involved people and those important to them in regular meetings to ensure their health and social wellbeing needs were effectively met. We observed during our visit that management and staff knew people well and adjusted their practice and approach accordingly. A relative told us, “My family member moved here from another home and had been very underweight but has successfully put on weight since being here.”

Staff had a good knowledge of tools that the service used, and how they impacted the care given. For example, one staff member explained that a malnutrition risk tool identified how likely a person was to be malnourished. The care plan gave guidance for staff on how best to support this risk. The kitchen team understood the importance of ensuring a good nutritional intake for people was maintained. The cook explained how people requiring specific diets were monitored for their food and fluid intake. The cook explained, “Fresh vegetables are served every day, and a great deal of attention is given to fortifying food so that residents maintain their healthy weight.” Where people were being supported with modified or pureed diets, we saw this food was presented in an appetising way, to ensure people were encouraged to eat well and maintain a healthy weight. Staff understood how to work with external health and social care providers, to provide support in the most effective way.

Care plans followed national guidelines on how to support people most effectively. For example, we saw one person’s care plan which followed NICE guidelines for the management of diabetes. This indicated to staff the risks for this person related to their medicines, ensuring a good dietary and fluid intake and monitoring the persons skin and weight. People’s nutrition and hydration needs were supported in line with current standards. Staff had identified people at risk of weight loss and were monitoring how much food they were consuming. Where needed, staff had supported people to source additional weight gaining supplements. Some people at the service found it difficult to eat their food without assistance. This was due to their diagnosis of dementia. The kitchen staff had provided adapted plating and cutlery, and these alternatives had effectively supported these people to eat independently again.

One relative described how effectively the service worked in partnership with health and social care providers to support their family member. They told us, “Our family member came into the home and could no longer walk, because of poor care they had received beforehand. With advice from the Physiotherapist, and support from staff, they are now walking with a frame to the toilet.”

The management team described how they worked with health and social care teams to ensure the best outcomes for people living at Highfields Nursing Home. The service had a positive relationship with the nursing teams who visited daily and were confident in seeking their guidance and advice for people who required their support.

Partner feedback regarding the service seeking advice and guidance and implementing this to ensure the best outcomes for people was positive.

People received person centred care. We saw from review of records that people and their relatives had been involved in discussions around their care plans. Detailed life histories were included in care plans, and people’s preferences had been fully considered. Staff understood the importance of effective partnership working and ensuring people’s preferences were respected.

The feedback we received from people and their relatives indicated the service worked in partnership with external agencies to ensure that people received effective, timely care and support.

Staff members we spoke with told us about the positive relationships they had with external health and social care teams. One member of the management team said, “We have regular multi-disciplinary meetings with external teams regarding residents. It is important the person is considered at the centre of these. It is our role to ensure this is carried out. We are representing their wishes during these meetings if people are unable to express themselves.” Staff were competent with responding to falls experienced by people. Records showed staff members had acted appropriately following falls incidents at the service.

Referrals were made to external teams to help mitigate risks effectively. For example, people who had experienced falls and injuries had been referred to professionals for specialist input to help mitigate this risk. Where referrals had been made, these had been followed up in a timely manner by the service. This ensured people received safe and effective support.

People and their relatives were positive in their feedback regarding the support offered by the service to ensure people received safe, effective, person-centred support. A relative told us, “My family member lives with dementia. We have a pet dog at home, who they love and miss. The staff bought them a soft toy one to cuddle.” We saw this person enjoying their time with this toy, and staff talking kindly with the person about this during our visit. A relative told us, “We really wanted our family member to attend a family wedding. The manager, and a member of staff facilitated this by taking them along themselves. They had also taken a great deal of care to dress them smartly and do their hair for the day.” The service employed a therapy dog, who visited regularly to provide support and physical contact for people who experienced challenges with communication. For example, due to a diagnosis of dementia. All of the people and relatives told us about the positive impact visits from the therapy dog had on their wellbeing.

There was effective communication and co-ordination between the service and external health and social care teams. This ensured people achieved positive outcomes. For example, where people required review of equipment, we saw this had been actioned by the management team. Staff understood how to support people and their relationships. A staff member told us, “You have to want to be in the care profession. It is not for everybody. We should be classed as professionals; we are passionate about what we do. Everyone here works so hard to provide good care and high standards.”

Staff kept records on how they had supported people and at what time. However, we found a lack of consistency in these daily records for repositioning, equipment checks and personal care for some people. We found this was a documentation issue and had not impacted directly on people’s health and wellbeing or had caused any direct harm. The primary impact was on staff being unable to accurately and promptly review any changes required to a person’s needs. For example, where a persons’ skin management needs may require review by an external health care team. We raised our concerns with the management team, who implemented a change to the auditing processes in place for people’s repositioning, personal care and equipment checking records. We were assured by their robust response.

People were supported by staff in their best interests, and in the least restrictive way, to ensure their rights were upheld and their freedoms and wishes were respected by staff. One person said, “Everybody is very nice. They really look after me. I have my dignity here, no complaints.”

All of the staff we spoke with understood the importance of respecting people’s wishes and asking for consent prior to providing personal care. We observed staff knocking on people’s doors and waiting for a response prior to entering. People were addressed by their preferred names and pronouns by staff in a respectful manner.

The management team had ensured they were working withing the principles of the Mental Capacity Act 2005 (MCA). The MCA provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. We checked whether the service was working within the principles of the MCA, whether appropriate legal authorisations were in place when needed to deprive a person of their liberty, and whether any conditions relating to those authorisations were being met. We found the service was working within the principles of the MCA and if needed, appropriate legal authorisations were in place to deprive a person of their liberty. Any conditions related to Deprivation of Liberty Safeguard’s authorisations were being met.