We recently received information of concern about the safety and welfare of people living in the home from two anonymous sources. We responded to this information by bringing forward the date of the home's scheduled inspection.We reviewed the evidence we obtained during our inspection and used this to answer our five key questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?
This is a summary of our findings. If you would like to see further evidence supporting this summary please read the full report.
Is the service safe?
There were detailed risk assessments in place that covered most aspects of people's daily lives and each of these had been completed specifically for the individual they referred to. The risk assessments we looked at were all up to date and had been regularly reviewed.
CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The registered manager advised us that one person living in Highfield Residential Care Home was currently subject to a restriction, as defined by the provider's Deprivation of Liberty Safeguards (DoLS) policy document, dated 2009.
We saw that an appropriate DoLS application had been made, which assured us that that relevant staff had been trained to understand when an application should be made, and how to submit one.
The provider had consistently notified CQC in respect of expected or unexpected deaths, accidents such as falls or injuries and Deprivation of Liberty Safeguard (DoLS) applications.
However, we identified three separate issues that had occurred in March 2014 but had not been reported to the Norfolk Safeguarding Team and CQC.
This meant that people who used the service were not fully protected from the risk of abuse because the provider did not always take reasonable steps to identify the possibility of abuse and prevent abuse from happening.
Is the service effective?
In the care plans we looked at, we saw that people had been assessed appropriately in respect of their mental capacity. We saw that where people were unable to make certain decisions for themselves, these had been made in their 'best interests' with the involvement of appropriate people such as their next of kin or representative.
Discussions held with the deputy manager and senior staff, plus records seen in daily reports and people's care records, identified those people who were at risk of falls. Risk assessments and guidance for staff on how to manage these identified risks were seen to be in place.
Is the service caring?
We did not have any concerns regarding the level of care that was being delivered by staff to people living in the home during this inspection. We observed that the staff were knowledgeable of people's needs and consistently interacted with people in a warm and friendly manner. We also observed some people engaging in friendly banter with staff and having a 'laugh and a joke'.
Observations, discussions and the care records we looked at provided a number of examples of good practice in a genuinely caring environment.
For people who were reliant on assistance to move from one place to another, we observed staff regularly interacting, checking if they were 'alright' and asking what they wanted to do or where they would like to be. For example, we heard one member of staff asking a person in their room if they would like to come through to the lounge. The person responded, 'No, I'm quite happy here thank you'. Later in the day we heard another person say, 'I'd like to go back to my room now.' In both instances we observed that the staff responded appropriately and respected each person's wishes.
Some of the comments and responses we received from people included: 'They're (staff) all very good here.' 'Marvellous dear, I couldn't wish for better.' And, 'Everybody's very kind ' I'm very well looked after thank you.'
Is the service responsive?
We spoke privately with the senior on duty, who gave us a full description of each person living in the home and their current needs. People's care records, observations and discussions with the deputy manager throughout the day, showed that the staff had good knowledge of people's needs.
For three people who required intensive care and support, we saw that all the records had been completed appropriately. For example, the records showed that people were consistently being assisted to change positions in bed, either two hourly or three hourly, depending on their identified need. This was to ensure pressure areas were relieved and reduce the risk of pressure sores developing.
We looked at the notes completed by the night staff between 10pm and 8am and saw regular interactions had taken place with people as required. For example, responding to people's call bells, assisting people to go to the toilet, providing personal care and turning people, as needed, to relieve pressure areas.
Is the service well led?
The provider delivered some in-house training for staff in areas such as infection control, safeguarding, dementia awareness, health and safety and the theoretical aspects of fire safety. They confirmed that the practical aspects of fire safety training were delivered by Norfolk Fire Service. Other mandatory training for areas such as first aid, moving and handling and medication was also delivered by appropriate external professionals.
Four members of staff said that they regularly received one-to-one support with their manager and felt well supported. They also said they were happy in in their work, felt confident and knew each of the people well that they supported. All four staff stated that they felt they received appropriate training for the work they carried out.
However, during this inspection, we identified concerns with regard to the provider's lack of action taken in respect of allegations of abuse. The provider had not responded appropriately to a recent allegation of abuse and they had failed to appropriately investigate the conduct of a person employed in the home, following an allegation of misconduct.