Archived: Highstone Mews Care Home

Two adult social care inspectors carried out this inspection. The focus of the inspection was to answer five key questions: is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Highstone Mews is a residential care home which was providing care and support to 54 people at the time of our inspection. A number of people living at the home had dementia.

As part of the inspection we spoke with seven people who lived at the home, five members of staff, two relatives, the home manager and two senior managers'.

This was a follow up inspection to check that improvements had been made in the care and welfare of people who use the service and assessing and monitoring the quality of the service.

On our previous inspection on 12 May 2014 we observed one person who used the service being moved and handled by staff inappropriately and not in line with their plan of care. This meant care and treatment was not delivered in a way that was intended to promote people's welfare. Also records seen by us showed that not all of the shortfalls identified in the manager's audits had been addressed.

The manager of Highstone Mews submitted an action plan following our inspection which detailed the actions they intended to take in order to achieve compliance.

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were being cared for in an environment that was safe.

The majority of staff had been trained in moving and handling people safely. We observed staff using appropriate equipment in order to move people safely from wheelchairs into comfortable chairs.

One person who used the service told us, 'I have nothing to worry about here.'

We found risk assessments had been undertaken to identify any potential risk and the actions required to manage the risk. This meant that people were not put at unnecessary risk but also had access to choice and remained in control of decisions about their lives.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application should be made and how to submit one. This meant that people would be safeguarded.

Is the service effective?

Most people we spoke with said they were happy with the care they received and felt their needs were met. One person we spoke with had a number of concerns about their care. The person told us they were happy to discuss their concerns with the new home manager. The person and the home manager agreed to meet with each other on the day of the inspection.

Is the service caring?

At this inspection five people who used the service gave positive feedback about the care and support they received. They told us staff gave them support and assistance when they needed it. People told us, 'The staff here are very nice, always polite,' and 'I've only been here a few weeks but I'm settling in alright' and 'I'm well looked after, the staff are lovely.'

Two people told us, 'When I ask for assistance staff are always saying 'can you hang on a bit' and sometimes I wait for an hour,' and 'They're always short of staff and agency staff don't understand us.'

Two relatives told us, 'We are concerned the home is going downhill. Managers are coming and going and the atmosphere has changed. Some staff are lovely.'

Is the service responsive?

People's needs had been assessed before they moved into the home. Care plans included information about people's preferences, interests and diverse needs.

Is the service well-led?

At this inspection we found there were systems in place for auditing of the service. For example, medication, the environment, infection control, care plans and complaints.

We saw the home manager had carried out regular audits and where appropriate taken action so that the quality of the service was improved.

People who used the service told us they were asked for their feedback on the service they received and that they had filled in a 'customer satisfaction survey'.

We considered all the evidence against the outcomes we inspected to help 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?

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe. Safeguarding procedures were robust and staff understood their role in safeguarding the people they supported. People who lived in the home said, 'I feel safe and happy here' and 'Everybody looks out for me, so I'm safe.'

People were protected against the risks associated with the unsafe administration of medicines. At this inspection we observed staff dispense and administer medication to people safely.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. We saw evidence that applications that needed to be submitted had been so. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This meant that people would be safeguarded as required.

We observed one person who used the service being moved and handled by staff inappropriately and not in line with their plan of care. This meant care and treatment was not delivered in a way that was intended to promote people's welfare.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring the welfare and safety of people who use the service.

Is the service effective?

Care files we checked confirmed that initial assessments had been carried out by the staff at the home before people moved into the home. This was to ensure the home was able to effectively meet the needs of the people. People's health and care needs were assessed with them, and they were involved in the formulation of their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. One visitor confirmed they were able to see their relative in private and that visiting times were flexible.

Is the service caring?

At this inspection we found people were treated with respect and dignity by the staff. During our inspection we observed staff speaking with people who used the service in a friendly and caring way. We observed care and support was provided to people when requested. Three care workers we spoke with demonstrated a good understanding of people's needs and were able to give examples of how they promoted people's independence. Two care workers spoken with were not as skilled and confident in recognising the diversity, values and human rights of people who used the service.

People we spoke with told us staff were, "very nice" and "great." A relative said, 'I visit my family member nearly every day and the staff are very patient and caring. I have never seen anything here that worries or concerns me.'

Is the service responsive?

In January 2014 we carried out a scheduled inspection at Highstone Mews. We found concerns during our inspection that accurate and appropriate records were not being maintained.

Following the inspection the provider sent us an action plan stating the action they would take to ensure records were accurate and up to date.

At this inspection we found that in the main records were completed and up to date.

Staff told us the care and support provided was flexible to the person's needs and adjustments could be made where required. Staff said they informed the manager if they felt any change in people's needs was required and the support was then reviewed.

One relative told us their family member had recently become 'unhappy and anxious." They said staff had arranged for them to see their GP, who had reviewed their medication and they said their family member was now much more settled and content.

People were able to join in with a limited range of activities. A new activities worker had been employed and we observed the worker sitting with people and asking them what hobbies they enjoyed and what they liked to do socially. We saw staff spending time with people on a one to one basis and it was very evident that people enjoyed and benefitted from this.

People knew how to make a complaint if they were unhappy. All relatives spoken with said they had no worries or concerns about the home but if they did they could talk to any of the staff and they would listen and sort it out."

Is the service well-led?

The service worked in partnership with key organisations, including the local authority and safeguarding teams, to support care provision and service. We saw evidence the service had taken advice provided by other healthcare professionals so that the quality of the service would be improved.

The system in place to make sure the manager and staff learnt from events such as incidents, complaints, concerns and investigations was ineffective in practice. This increased the risk of harm to people and failed to ensure that lessons were learned from mistakes.

The service had a quality assurance system. Records seen by us showed that not all of the shortfalls identified in the manager's audits had been addressed. For example, an audit of the medication was completed each month. We found areas of concern which were identified in February 2014 had not been actioned. The audit for March and April 2014 repeated the actions required from February.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to quality assurance, and the improvements they will make to ensure actions identified when undertaking audits is completed.

We also looked at two other areas of concern that had been raised with us since the last inspection.

On this inspection we found that people's personal records and other records associated with the regulated activity were not always up to date and accurate.

People and staff spoke highly of the manager. Comments included, 'You can approach him for advice and help. He will come and help if needed.'

People and their family members told us people received appropriate care that met their needs. In the main, enough members of staff were available to meet those needs. Comments included, 'Staff are always there to help me. I'm happy here. I like my room, it's a nice size, just what I want. All the ladies [staff] are nice and I've no complaints.'

People were cared for in surroundings that supported their health and welfare. The environment was clean and people were protected from the risk of infection.

The service had quality checking systems to manage risks and assure the health, welfare and safety of people who received care.

The manager at the home is not registered with the Care Quality Commission, as required.

Before people were given any care or support, staff asked if they agree to it. Where people did not have capacity to agree to decisions, these had been made in accordance with legal requirements. For example, we saw staff offering choices to people who had dementia so that they could make decisions in their day to day care.

People did not always receive safe and appropriate care that met their needs. For example, on the dementia unit people did not start to have breakfast until 9:35am, when they had been washed and dressed and left sitting in the lounge waiting for breakfast.

On the dementia unit we observed there were not always enough members of staff on duty, which meant at times people were left without supervision, including those people at risk of falls.

The service had quality checking systems to manage risks and assure the health, welfare and safety of people who received care. These were ineffective in practice because improvements were being identified with no clear action plan about the action to be taken with timescales for those improvements.

People's personal records, including medical records were kept safe and confidential.

People experienced care, treatment and support that met their needs and protected their rights. We observed people being able to move freely around the home, engaging in conversation with staff, singing and being involved in a visit from a relative. We saw that staff had provided a doll to engage one person in 'nursing a baby'.

People were cared for in a clean, hygienic environment.

People were cared for by suitably qualified, skilled and experienced staff.

There was an effective complaints system available. Comments and complaints people made were responded to appropriately.