Background to this inspection
Updated
8 October 2016
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 registered providers were 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 27, 28 July and 2 August 2016 and was unannounced. This meant the staff and the registered provider did not know we would be visiting. The inspection was carried out by two adult social care inspectors and a specialist pharmacy inspector.
Before we visited the home we checked the information we held about this location and the registered providers, for example, inspection history, safeguarding notifications and complaints. We also contacted professionals involved in caring for people who used the service, including commissioners, safeguarding and infection control staff. Ongoing monitoring of the service was taking place by service commissioners in order to check if the service improved in line with their contractual agreements.
During our inspection we spoke with five people who used the service and one relative. We spoke with two visiting district nurses and one visiting social worker. We looked at the personal care records of nine people who used the service and observed how people were being cared for.
We spoke with the registered manager, the two registered providers, three care staff and one housekeeping staff. We reviewed care planning records, staff training supervision records and looked at other records relating to the management of the service such as audits, policies and risk assessments.
Prior to this inspection we did not ask the providers to complete a Provider Information Return. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We used information given by the provider from other sources to inform our inspection.
Updated
8 October 2016
Highfield House Residential Home is registered with the Care Quality Commission (CQC) to provide personal care and accommodation for up to 25 people. The home is a detached, two storey, converted house set in its own grounds in a quiet residential area of Haswell, County Durham. On the first day of our inspection there were 9 people using the service, although this varied slightly during the inspection. The home comprised of 20 bedrooms on the ground floor and 5 bedrooms on the first floor. 10 bedrooms were en-suite. We saw that the accommodation included two lounges, a dining room, two bathrooms, a shower room, several communal toilets, a conservatory and an enclosed garden.
This inspection took place on 27, 28 July and 2 August 2016 and was unannounced. This meant the staff and the registered provider did not know we would be visiting.
At our last inspection of Highfield House Residential Home on 14, 19 and 27 January 2016 we reported that the registered providers had not made consistent improvements following previous inspections. The registered providers were in breach of the following:
Regulation 12 Safe care and treatment
Regulation 15 Premises and equipment
Regulation 17 Good governance
Regulation 18 Staffing
The overall rating for this service was ‘Inadequate’ and the service was placed in ‘Special measures’. This is where services are kept under review by CQC and if immediate action has not been taken to propose to cancel the registered provider’s registration of the service, the location will be inspected again within six months. The expectation is that registered providers found to have been providing inadequate care should have made significant improvements within this timeframe.
At this inspection we found significant improvements had not been made to meet these requirements and Highfield House Residential Home was inadequate in four of the five areas we inspected.
The home was not well run, operational procedures were disorganised and oversight by the registered providers was ineffective.
We found no evidence that a systematic approach to resolve previously identified regulatory requirements was now in place. The registered providers did not ensure that effective action had taken place following a CQC inspection in January 2016 and people using the service were found to be at risk, despite the home being placed in ‘Special Measures’ and enforcement actions taking place.
The registered providers did not act in a timely fashion to achieve compliance, meet service users’ needs and adequately protect them from receiving poor care.
We found that the registered providers did not operate effective systems and processes to assess and monitor the quality and safety of the services provided
Management monitoring of the home had failed to identify serious shortcomings in the quality and safety of services provided.
At the time of our inspection visit, the home had a registered manager in place. A registered manager is a person who has registered with CQC to manage the service. The manager had been registered with CQC since 26 August 2014. The homes statement of purpose stated that the registered manager was undertaking an undergraduate degree in care home management. However we did not find any evidence of the impact of this training in the management systems at the home.
Also the registered manager and registered providers who were undertaking the leadership role at the home did not demonstrate competent skills and knowledge were held in the areas that the home purports to specialise for example care of people with Dementia type illness.
There was no indication that there was any organised management process for decision making and effective communication of basic tasks involved in the running of the home was not in place.
Medication administration procedures and systems were not robust and did not protect people living at the home from risk associated with poor medicines management. Medicines that have a sedative effect were found to be used without guidance or sufficient agreed practice to safeguard and protect people living at the home.
We found arrangements for safe food production did not protect the health and wellbeing of people living at the home.
People at the home were at increased risk of harm because the registered providers had failed to make adequate plans to be used in the event of a fire and equipment was adequately maintained which increased the risk of a fire taking place.
We found the hot water delivery systems at the home did not protect people living there from injury from water that was too hot. During our inspection the registered providers put in place contingency arrangements to keep people safe.
We found arrangements to ensure control of infections at the home were not robust. Service users and staff at the home were not protected from the risk of water borne infections such as Legionella and actions to detect, prevent and control the spread of infections had not been completed. This showed that people living at the home were not protected from risks from their environment and arrangements to reduce these risks had not been taken.
This showed that people working and living at the home were exposed to unnecessary risk because the registered providers did not ensure that chemical products were used safely.
The registered providers had failed to ensure that some people’s dietary requirements were accurate before making substantial changes to their diet posing significant risks to people’s health and well-being.
We found that the physical environment throughout the home did not reflect best practice in dementia care. The provider had not considered best practice in the design and use of other areas of the home such as the kitchen
The registered providers and registered manager did not have sufficient understanding of the Mental Capacity Act 2005 (MCA) to ensure people’s rights were protected.
People who were living at the home were not being supported by staff who had been trained in their conditions. People may not always be protected from the risks of abuse because staff training in safeguarding was not up to date.
None of the staff or the registered manager had been trained in medicines management sufficient to update them on None of the staff or the registered manager had been trained in medicines management to update them in line with current NICE guidance, ‘Managing medicines in care homes.’
The staff took an interest in people and their relatives to provide individual personal care. However people were not always treated with dignity, their privacy was not always protected and the registered provider did not show respect for peoples personal possessions.
Arrangements to ensure timely care planning with other services did not take place and did not ensure the health safety and welfare of service users was promoted when they transferred to other services.
The registered provider had not taken steps to assess, monitor and mitigate the risks relating to the health, safety and welfare of people at the home.
We found changes to care planning arrangements had not been made or considered following significant incidents which put people at the home at risk from receiving inappropriate care.
During our inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered providers to take at the back of the full version of the report.