Archived: Highfield Care Home

There is a registered manager in place: 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.

We found there were enough staff to meet people’s needs and we observed staff providing timely, respectful care. Staff were familiar with people’s needs and provided personalised care around their individual needs.

We did not identify any hazards to people’s safety other than when people were mobilising and had the potential to fall. Staff did not stifle people’s independence but put things in place to reduce their risk of falls. We also found inadequate storage of large items of equipment which could potentially be a hazard.

We have made a recommendation about the management of risk.

Staff had a good understanding of safeguarding and what actions they should take if they suspected a person to be at risk of harm of abuse.

Staff recruitment was sufficiently robust to try and ensure only suitable staff were employed to work in care.

People received their medicines as prescribed and medicines were administered by staff who were trained to give them.

Staff induction and training could be improved upon to clearly show staff had achieved the necessary competencies.

Staff had a good understanding of legislation relating to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberties Safeguards (DoLS). The MCA ensures that, where people have been assessed as lacking capacity to make decisions for themselves, decisions are made in their best interests according to a structured process. DoLS ensure that people are not unlawfully deprived of their liberty and where restrictions are required to protect people and keep them safe, this is done in line with legislation.

People were supported to eat and drink and this was closely monitored to ensure it was adequate to people’s needs.

People’s health care needs were met by the staff and other health care professionals where appropriate. We observed care being provided which was appropriate to people’s needs, respectful and dignified. Staff supported people in a way they wanted to be supported and in consultation, gaining their consent before providing care.

Care plans were in place for people and demonstrated how they should receive their care in accordance with their needs and wishes. These were kept under regular review to ensure they accurately reflected people’s needs. Social activities were organised around people’s individual needs and helped to alleviate social isolation. However not everyone was seen to participate and it was clear that there was insufficient engagement for some people.

There was a robust complaints procedure and staff involved and consulted with people.

This was a well led service. Staff felt the manager listened and was responsive. They were adequately supported by a deputy and senior team of staff. Audits were in place to assess and monitor the standards of care and support provided to people using the service and to help identify and reduce risks. There were regular audits for record keeping, care and safety and maintenance of equipment. Action plans showed how the service resolved any service deficiencies.

It was clear there were a lot of changes occurring to improve the overall service delivery but we felt in order for these changes to be managed effectively staff needed to be adequately supported. The number of audits potentially could overwhelm the service.

The manager had good systems in place to assess people’s needs and ensure they were being met. However the organisation did not have an effective dependency tool to help demonstrate and ensure that staffing levels at the service were adequate for the needs of people using the service. We also felt that there had not been sufficient consideration of how many activity hours should be in place to ensure people received sufficient social stimulation. We have made a recommendation about this.

Quality audits were completed through head office, surveys were sent to people annually and results collated and sent to the managers. However we saw low response rates and felt this was not an effective means of engaging with the majority of people using the service many of whom had dementia. Across the whole service we saw poor evidence of active engagement with relatives and with the local community

We looked at five people's care records. Other records seen included: care plans and risk assessment reviews, the complaints and compliments log, the provider's medication policy and procedures, staff meeting minutes, staff training and supervision records, accidents and incidents log, health and safety audits, fire safety checks, maintenance logs, medication audits, internal monitoring and quality reports, water temperature checks, resident and relative's meeting minutes and satisfaction surveys from people who used the service.

We considered the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask; 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 what we found;

Is the service safe?

When we arrived at the service a member of staff asked to see our identification and asked us to sign in the visitor's book. This meant that appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access the service.

People told us they felt safe.

Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. While no applications had needed to be submitted, we saw that policies and procedures were in place if they should be needed. The deputy manager confirmed that relevant staff had been trained to understand when an application should be made and how to submit one. They also advised further training was being planned in this area to ensure delivery of best practice.

Records confirmed that staff were booked onto upcoming or had received training in safeguarding vulnerable adults from abuse, the Mental Capacity Act (MCA) 2005 and DoLS. This meant that staff were provided with the information that they needed to ensure that people's rights were protected.

Safeguarding procedures were robust. Staff understood their role in safeguarding the people they supported.

There were effective policies and procedures for managing risk. Staff understood and consistently followed them to protect people. Our discussions with staff showed that the staff were knowledgeable about people's individual needs and how they were met.

Records confirmed health and safety was checked in the service and regular medication audits were carried out.

Is the service effective?

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The records were regularly reviewed and updated which meant that staff were provided with up to date information about how people's needs were to be met.

Records showed that staff support was provided through training, supervision and appraisal.

Is the service caring?

People told us they were happy with the care they received and their needs were met. One person told us, 'I like it here, no complaints; they (staff) look after me really well. My only grumble is I wish my (relative) would visit me more often but that's nothing to do with this place. They (staff) know when I am a little down and gee me up and I keep busy. It's a nice place, very kind and caring staff.' Another person said, 'Staff are very attentive, especially the chef; how (chef) remembers what we all like and don't like is beyond me. It's thoughtful how they (chef) comes round every so often and takes the time to speak with us and check everything is ok. The staff in general are very approachable and quick to respond if you need anything. Yes I am very content, I like it here.'

Staff had a good understanding of the people's care and support needs and knew them well.

Staff interacted with people who used the service in a caring, respectful and professional manner.

Staff were skilled at responding to people who were not always able to express their needs verbally.

Is the service responsive?

People's care records showed that where concerns about their wellbeing had been identified the staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance from health and social care professionals, including a doctor, psychiatrist and social worker.

A healthcare professional visiting the service confirmed that staff were quick to respond if they had concerns about a person's health and wellbeing.

Is the service well-led?

Staff told us they were clear about their roles and responsibilities and were supported and trained to meet people's needs.

People's care records and risk assessments were accurate and up to date.

The provider had systems and procedures in place to monitor and assess the quality of the service provided. There were records to identify shortfalls in the service and how they had been addressed.

We looked at the outcomes from the last annual satisfaction survey which provided people with an opportunity to comment on the way the service was run. Feedback was positive. We saw that actions to address issues raised were either completed or in progress.

We saw five people's care recods. We saw that care plans were reviewed regularly and that people were involved in the reviews of their care. There were a number of activities organised in the service and these were tailored to the interests of people.

There was adequate equipment available to support people in their daily lives and this was regularly serviced and maintained.