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Highcliffe House Nursing Home Requires improvement

We are carrying out checks at Highcliffe House Nursing Home using our new way of inspecting services. We will publish a report when our check is complete.

Inspection Summary


Overall summary & rating

Requires improvement

Updated 20 April 2017

This inspection took place on the 8 and 15 March 2017 and was unannounced.

Highcliffe House Nursing Home is a 30 bed residential and nursing care service providing care, treatment and support, including end of life and care and support for people living with dementia. On the day of our inspection there were 20 people living at the service.

There was a registered manager who was also the registered provider. 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.

At our previous inspections in May, July and August 2016, we found evidence of major concerns in relation to the clinical oversight of the service, insufficient monitoring of people with complex nursing needs and the overall quality and safety monitoring of the service. The service was rated as ‘inadequate’.

We formally notified the provider of our escalating and significant concerns and placed a condition of the provider’s registration to stop them admitting any further people to their service. We notified our stakeholders which included the Local Safeguarding Authority and the Clinical Commissioning Group (CCG).

At this comprehensive inspection, we found that with the support provided to the service from the local authority and the CCG, improvements had been made.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

The provider had implemented systems to improve their quality and safety monitoring of the service including the clinical oversight of people with complex health care needs. However, further improvements were required in the monitoring of people at risk of malnutrition and wound management.

At two inspections carried out in the last year, May 2016 and August 2016 we found, ongoing concerns in relation to the management of people’s medicines. At this inspection we found significant improvement with the implementation of improved systems for auditing and response to medicine administration errors.

There were systems and processes in place to minimise the risk of abuse and staff had received training in protecting people from abuse. However, not all incidents and accidents had been recorded and investigated according to local safeguarding protocols and the provider’s safeguarding policy.

Whilst we found some improvements, further work was required to ensure that the care planning for people who presented with distressed behaviours and the monitoring of catheter care, skin tears and wounds was effective at mitigating the risks to people’s health, welfare and safety.

The service was clean and there were regular audits and systems in place to prevent the risk of cross infection. Environmental risk assessments had been updated to include regular safety checks of window restrictors, exposed pipework, bedrails and slip, trips and falls hazards.

Staff and the manager understood their roles and responsibilities with regards to the Mental Capacity Act 2005. Staff had received a variety of training relevant to their roles.

People’s nutritional needs were assessed and they were supported to eat and drink according to their dietary needs, choices, and preferences. People were supported to access ongoing healthcare support. There were systems in place to ensure important information about people’s health, welfare and safety needs were shared with the staff team.

People had access to clear information about how to raise concerns and complaints. There was a written procedure visible on noticeboards throughout the service . There was a suggestion box in the reception area, available to enable people to log any suggestions and concerns easily and anonymously if they chose. Annual surveys were carried out to ascertain the views of people and their relatives.

We observed some very caring interactions between staff and people living at the service. Relatives were positive about the improvements they had observed and in the culture of the staff group. Staff were observed to be kind and respectful in their approach towards people.

Auditing arrangements had been strengthened but further improvements were needed to the oversight of clinical care and accidents.

During this inspection we identified a number of 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 this report.

Inspection areas

Safe

Requires improvement

Updated 20 April 2017

The service was not consistently safe.

Staff had been provided with training and demonstrated their understanding of how to identify people at risk of abuse and the procedure for reporting concerns. However, not all incidents and accidents were recorded and investigated according to the local safeguarding protocols and the provider’s safeguarding policy.

We found improved systems in place for the management of people’s medicines and the auditing and evidence of actions in response to medicine administration errors.

People’s likelihood of harm was reduced because risks to people’s health, welfare and safety had been assessed and risk assessments produced to guide staff in how to mitigate these risks and keep people safe from harm.

The provider’s recruitment procedures demonstrated that they operated safe and effective systems.

Effective

Good

Updated 20 April 2017

The service was effective.

Staff and the manager understood their roles and responsibilities with regards to the Mental Capacity Act 2005.

People were supported to access ongoing healthcare support. There were systems in place to ensure important information about people’s health, welfare and safety needs were shared with the staff team.

People’s nutritional needs were assessed and they were supported to eat and drink according to their dietary needs and preferences.

Caring

Good

Updated 20 April 2017

The service was caring.

Staff were attentive and caring in their interactions with people.

People’s privacy and dignity was promoted and respected. Staff took account of people’s individual needs.

Wherever possible people were involved in making decisions about their care and their relatives were appropriately involved.

Responsive

Requires improvement

Updated 20 April 2017

The service was not consistently responsive.

Whilst we found some improvements at this inspection further work was required to ensure that the care planning for people who presented with distressed behaviours and the monitoring of catheter care, skin tears and wounds was effective at mitigating the risks to people’s health, welfare and safety.

People had access to clear information about how to raise concerns and complaints. There was a written procedure available throughout the service on notice boards. Annual surveys were carried out to ascertain the views of people and their relatives.

Well-led

Requires improvement

Updated 20 April 2017

The service was not sufficiently well led.

There were improved clinical and safety audits. However, we identified further improvements were required such as; the monitoring and investigation as to how injuries had been acquired, recording of accidents and incidents, wound management and weight monitoring.