Highfield Care Home

Highfield Care Home is a 53-bed residential and nursing care service providing care, treatment and support, including end of life care and support for people living with dementia. On the days of our unannounced inspection on 25 and 26 June 2018 there were 49 people living at the service. Saffron suite was a specific part of the service which catered for people with a diagnosis of dementia.

The service had a registered manager who was present during the inspection. 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 last inspection of the service was conducted in July 2017 and we rated the service as, ‘Requires Improvement’ overall, and we found two breaches of the legal requirements. Equipment was not always maintained at the correct setting or regularly checked to make sure that it was working effectively. Care staff were not familiar with people’s needs and the care plans did not provide sufficient direction to staff.

At this inspection, we found that improvements had been made. We found that there were clearer systems in place to check on equipment and ensure that it was safe to use when needed. Risk assessments were in place to manage risks and reduce the likelihood of harm, however further work was needed to ensure consistency of practice in relation to some of the documentation and moving and handling.

The care plans were more detailed and informative, and provided clearer guidance to staff on people’s needs and their care preferences. Staff knew people well and there were effective handover systems in place to ensure that key information was communicated to those who were supporting individuals.

There were systems in place to review any accidents or incidents and to identify any learning or improvements needed. Staff received training on how to recognise abuse and we saw that concerns about individual’s wellbeing had been appropriately escalated to the relevant authorities.

There was enough staff available to meet people's needs. Staffing numbers had been calculated based on the needs of the people using the service. There were clear processes in place to check on staff suitability prior to them starting work at the service which included references and disclosure and barring checks.

New staff received training to ensure that they had the skills and knowledge they needed to meet people's needs. Additional training opportunities were made available to staff to update their knowledge and maintain their skills and competency.

People were supported to eat and drink and maintain a balanced diet. There were clear systems in place to monitor those individuals at risk of malnourishment.

People had good access to health care support which included access to the GP, optician, specialist nurses and dietician. The service worked with other organisations in a collaborative way.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People's ability to make decisions was assessed in line with the requirements of the Mental Capacity Act (MCA) 2005. Where appropriate Deprivation of Liberty Safeguard (DoLS) authorisations were in place to lawfully deprive people of their liberty for their own safety.

The environment was well maintained and comfortable. We have made a recommendation that further advice is sought on creating an environment that would further support people with dementia.

People looked well-groomed and were wearing communication aids such as spectacles and hearing aids. People told us that they were treated with dignity and their independence was promoted. There were systems in place to support people and their relatives to express their views about the quality of the service and suggestions were welcomed.

People had access to a range of interesting and stimulating activities which promoted their wellbeing.

There were systems in place to respond to people’s concerns and investigate them. We have made a recommendation about the management of complaints.

The registered manager was supported by a deputy manager and a clinical lead. Staff supervisions, appraisals and team meetings were used to reflect on practice and explore what could be done differently. The registered manager worked with other agencies including the local authority quality team to drive improvement at the service.

Quality assurance processes were in place, which provided the registered manager and provider with oversight of the service. Information was collated on a range of areas and analysis undertaken to identify patterns and manage risks. The providers representative visited the service on a regular basis and completed a report on the quality of care which set out actions and timescales for delivery.

The systems in place for the oversight of equipment and the management of risk were not effective. Clinical equipment was out of date and some of the mattresses which were in place to reduce the likelihood of skin damage were set incorrectly. This meant that people may not receive the pressure relieving support that they needed. Skin tears were not always analysed to identify the cause and the treatment plans were not clearly documented. This placed people at risk of inconsistent care.

We found that the service was supporting a number of individual’s who were at risk of falls and saw that the service had referred people appropriately to health professionals and had put specialist equipment such as alarms and crash mats in place to reduce the risk of injury. We were not assured that actions on repairs were always taken promptly and have asked that this is followed up.

Staffing levels were adequate but staff were not always effectively deployed. Checks were undertaken on staff suitability for the role prior to their employment.

Medicines were well managed and regular audits undertaken to check that people were receiving their medicines as prescribed by their GP.

Staff received training and guidance but best practice in areas such as understanding the needs of people living with dementia was not consistently implemented. The manager and staff had undertaken training in the Mental Capacity Act 2005 and understood their responsibilities.

People enjoyed the meals provided and we observed that they were well presented and appetising. The deployment of staffing however in the different parts of the service impacted on staff ability to support people with eating.

Peoples health needs were met and appropriate referrals made to health care professionals.

The environment was accessible and homely; however we have recommended that they review how they can enhance the independence and wellbeing of those individuals living in the specialist dementia unit.

People spoke positively about the support from staff. We saw caring interactions but also care which did not promote peoples dignity and was task based.

Care plans were not always accurate and did not provide staff with the guidance they needed to provide safe and personalised care.

People were supported to follow their interests and we observed excellent practice, however we have recommended that further efforts are made to engage with people living in dementia.

Complaints were investigated but processes could be strengthened to promote transparency and openness.

People and staff told us that the manager was approachable. We saw that the manager had requested feedback about the quality of the service from relatives and people who used the service. There were systems in place to ascertain staff views and reflect on practice such as through supervisions and staff meetings.

The registered manager and provider regularly audited different aspects of the service but we found that the audits had not identified some of the issues that we had found, including a lack of consistency across the service, which meant that they were not fully effective.

You can see what actions we told the provider to take at the back of the full version of the report.