Archived: Highland Mist Care Home

Updated 2 March 2015

We carried out this inspection under the Health and Social Care Act 2008 as part of our regulatory functions, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014. 

The inspection took place on 4 November 2014 and 11 November 2014 and was unannounced. The last inspection was on 3 July 2014 and 17 July 2014. We identified breaches of the legal requirements at this inspection.

The inspection was undertaken by two inspectors for adult social care.

Prior to the inspection we reviewed the information we held about the service, previous inspection reports and the notifications we had received. A notification is information about important events which the service is required to send us by law. We spoke with commissioners and requested their feedback on the joint work they had been undertaking with the registered provider following our previous inspections this year.

Following the inspection we liaised with the commissioners of the service, the local safeguarding team and CQC registration colleagues. We also spoke with mental health professionals supporting people under the Care Programme Approach (CPA). This is a particular way of assessing, planning and reviewing someone's mental health care needs.

During the inspection we spoke with six of the seven people living at the home. The registered provider requested we did not speak with one person due to their mental health condition at the time of the inspection. We also contacted the local pharmacist and one person's doctor during the inspection to clarify aspects of their prescription.

We reviewed seven people's care files and records and spoke with the owner and registered provider about people's care. We spoke briefly with four care staff as they were required to support people due to staff sickness within the home. We examined seven people's medicine charts and talked to two staff about people's medicines. We observed staff interactions with people during the inspection.

We looked around the premises and in some people's bedrooms. We were unable to look at staff recruitment, staff rosters and training files as the keys were not available during our inspection, however, we spoke to staff about their training. We were unable to look at the accident / incident book as this was not available during the inspection on either day. We requested this on the first day of our inspection but on the second day of the inspection, a week later, this was still not available. We looked at the records which were available to us related to the management of the service including quality audits and policies. We requested the financial records and contracts of people but these were not available during the inspection.

Following the inspection we raised a safeguarding alert regarding medicine management and the management of people's money within the home.

Updated 2 March 2015

Highland Mist Care Home is a small care home providing support for up to eight people with mental health needs. At the time of the inspection seven people were living at the home.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection took place over two days, the 4 November 2014 and 11 November 2014.

In April and May 2014 we inspected the home and found people people's needs were not fully met. Aspects of people's care was not safe and they did not have their medicines as prescribed. We set compliance actions and two warning notices were issued relating to medicines management and quality assurance. These warned the provider we would take enforcement action if improvements were not made.

We inspected again in July 2014. We found that whilst there were some improvements, there remained concerns regarding staffing, safeguarding, medicine management and quality monitoring. Repeated compliance actions were made.

Following that inspection the provider wrote to us and told us of the improvements they were going to make. They told us they would make all the changes by November 2014.

During this unannounced inspection we found that not all of the providers action plan had been progressed. We found improvements started in July 2014 had not been sustained, particularly in medicine management and quality assurance. We found areas of improvement suggested at previous inspections such as ensuring people consented to their care and treatment and improved infection control practices, had not been actioned.  We also identified concerns with keeping people and their belongings safe, and continued problems with staffing levels and training to meet the needs of people at the home.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

The registered provider of this service was the manager and the owner of Highland Mist Care Home.

Due to unforeseen circumstances the registered provider was only available on the first day of the inspection. The person in charge during the second day of the inspection did not have the keys to the staff files so we were unable to review information related to staff training and support.

People's safety was compromised in a number of areas. This included the management of medicines and a lack of ongoing staff training. We found staffing levels were inadequate to support staff and people at the home with behaviour which at times could be challenging to the service.

Care plans were not always reflective of people's current needs. We found the home did not have essential information about people under supervised community treatment orders and were unsure whether some people were under current deprivation of liberty safeguards (DoLS). This is an authorised, legal restriction on a persons freedom to enable staff to care for a person in a safe way.

We were concerned the home had not reported incidents and accidents within the home to the commissioners, local safeguarding team and to CQC. We also had concerns about how people's money was managed within the home. Staff did not know the correct processes to report safeguarding concerns outside of the home.

Audits were in place to monitor medicine management, the environment and cleanliness but these had not been effective in identifying medicine management errors and had not identified the multiple concerns we found during the inspection.

Staff were kind, caring and knew people well. An example of this was the compassionate care they provided to one person receiving end of life care. Staff frequently went the extra mile to ensure people had support when they were unwell. However, low staffing levels at the home affected their ability to support people to integrate into the community, follow through on people's goals, and develop people's  external social contacts.