Archived: Highfield Manor Care Home

Updated 25 January 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 23 and 24 August 2016 and was unannounced. There were two inspectors and an inspection manager in the inspection team.

We met and spoke with all 18 people living at Highfield Manor Care Home. Because some people were living with dementia we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We spoke with three visiting relatives. We also spoke with the acting manager, deputy manager, a management consultant, the provider’s nominated individual from the management consultant and 10 staff. We have referred to the acting manager and management consultants as the ‘management team’ throughout the report.

We looked at four people’s care and support records and care monitoring records in detail, at monitoring records and specific elements of four other people’s care plans. We looked at all 18 people’s medication administration records and documents about how the service was managed. These included four staff recruitment files and the staff training overview record, audits, meeting minutes, maintenance records and quality assurance records.

Before our inspection, we reviewed all the information we held about the service. This included the information about incidents the acting manager and management consultants had notified us of and the monthly action plans from the acting manager and management consultants.

We contacted one commissioner and the local authority safeguarding team for an update on any outstanding safeguarding allegation investigations.

Following the inspection, the acting manager and management consultants sent us information we requested about staff training, policies, maintenance updates, and quality assurance audits.

We visited the home again on 31 August 2016 to pick up copies of documents we had requested that could not be sent to us electronically.

Updated 25 January 2017

This inspection took place on 23 and 24 August 2016 and was unannounced. This comprehensive inspection was carried out to review progress on meeting the regulations and shortfalls identified at previous inspections and to review the rating.

We last inspected Highfield Manor Care Home in April 2016. At this focused inspection we identified some improvement but we also found repeated shortfalls and breaches of the regulations. The home received an overall rating of Inadequate at the July 2015 and January 2016 inspections. The rating was not changed at the inspection in April 2016. This was because although there had been some improvements found at that inspection we did not have evidence that these had been sustained or embedded to enable us to change the ratings given.

Highfield Manor is registered to provide personal care for up to 46 people living with dementia. Nursing care is not provided. At this inspection there were 18 people living at the home.

There was not a registered manager at the 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.

The previous registered manager, who is also a director of the registered provider, cancelled their registration in August 2015. A management consultancy was appointed in January 2016 to oversee and manage the home until a new manager was registered. The new manager was appointed in May 2016 and has applied to be registered. They have been working alongside the management consultants who will continue to be responsible for the care provision at the home. The provider remains responsible for the ongoing purchasing, maintenance and safety of equipment and of the building.

For ease of reference we have referred to the new manager and management consultants as the ‘management team’ throughout the report.

At the comprehensive inspection in July 2015 the provider was placed into special measures by CQC. In addition to placing the service in special measures in July 2015 we imposed an urgent condition on the provider’s registration. This means further people cannot move into the home or return from hospital without agreement by CQC.

At the January and April 2016 inspections we found that there was not enough improvement in the service to take the provider out of special measures. At this inspection we identified improvements particularly in people’s experiences and the care they received from staff. However, due to the continued repeated breaches of the regulations relating to the safety of people, equipment and buildings we have rated the ‘Is this service Safe’ question as inadequate. This means although the service has made improvements and has an overall rating of ‘Requires Improvement’ the home remains in special measures. This is because the service has been rated Inadequate in any key question over two consecutive comprehensive inspections. 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.

We have requested the provider send us an action plan every month to tell us what action they have taken to meet all of the shortfalls identified at the previous inspections. Since April 2016 these have been provided by the management team. These action plans included information about the improvements we found at this inspection and progress on meeting the regulations.

At this inspection, people’s medicines were not consistently safely managed or stored. This was because medicines were not stored at a safe temperature and some specialist medicines were not recorded as required. One specialist medicine was out of date and the checking in medicine audit systems had not identified the shortfalls. The management team took action to address the medicines shortfalls.

There were fire safety shortfalls that had not been addressed by the provider when they were first identified. Following this inspection the provider arranged for the repairs to the emergency lighting to be made. In addition, action had not been taken in response to the works needed following a legionella risk assessment in 2015.

There was only one assisted bathroom out of four that was safe to use. There were some communal areas where the call bells were not working. Some carpets in communal areas were heavily stained and needed cleaning. Some areas of the home were very hot. This was first identified in July 2015 and there continued to be shortfalls in making suitable arrangements for safely cooling the home.

The shortfalls in the medicines management and ensuring the premises and equipment were safe for people, the cleanliness of some communal carpets, the high temperatures and the lack of ensuring equipment and the premises are properly maintained were breaches in the regulations.

The principles of the Mental Capacity Act 2005 were not consistently adhered to. This was because there were continued shortfalls in the recording of people’s consent, mental capacity assessments and decisions made in people’s best interests. Following the inspection the management team took action to address this repeated breach in the regulations. However, we have not yet been able to determine whether this action has been sufficient to meet the regulation.

Improvements had been made to the signage in the home but the building décor still was not suitable for people living with dementia and did not take into account national good practice such as that produced by the University of Stirling. There was a plan in place produced by the management consultants. However, the works and funding required were the responsibility of the provider. This remains an area for improvement.

The delays and lack of action by the provider to address and mitigate the risks to people and others and improve on shortfalls identified were also a breach of the regulations.

People and relatives told us they were safe and one person told us they now felt safe when they previously had not. People and relatives spoke highly of the caring qualities of staff and we observed positive and caring interactions from staff.

There were enough staff to meet people’s needs and this had a positive impact on people and the staff team. Staff were recruited safely. Staff were supported in their roles through training and supervision. Morale was good and staff recognised that they had worked hard under the guidance of the current management team to bring about the changes that were needed.

We found significant improvements in people’s experiences, the care and support they received and their wellbeing. People’s mealtime experiences were improved and there were enough staff to sit with and support people to eat in a relaxed atmosphere.

People’s individual care needs were met by staff who knew them well and were familiar with the care they needed. People had access to the healthcare they needed. There was an activities coordinator and there was a range of activities for people that was based on their preferences.

People’s needs were reassessed when their circumstances changed and care plans were updated and included all the information staff needed to be able to care for people.

People’s privacy and dignity was maintained and staff were respectful and caring towards people. People could receive visitors whenever they wished.

There was a caring, open culture. People, relatives and staff were kept informed of developments at the home and were consulted regarding how the home was run. There were regular meetings for relatives and staff. Staff felt well supported by the management team.

A quality assurance system was being introduced. The management team audited and reported back on various aspects of the running of the home. These fed in to an improvement plan. Actions had been taken by the management team, and improvements had been made to meet most of the regulations they were responsible for. We were not able to tell whether the improvements we found could be successfully embedded and sustained. We will review the impact of these improvements further at our next inspection.

Following previous inspections we considered the appropriate regulatory response to our findings of repeated shortfalls. We have taken action in response to these failings and have cancelled the providers registration with CQC.