Archived: Highland Mist Care Home

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

We previously inspected this service on 24 April and 1 May 2014. We issued warning notices in relation to the management of medicines and the assessing and monitoring of service provision at Highland Mist Care Home due to concerns we found at this inspection. We returned on July 3 2014 to look at the improvements which had been made in these areas. The home had outstanding compliance actions at this time and we were due to receive the home's action plan by 9 July 2014. On the 17 July 2014 we returned for a further visit to look at all areas of non-compliance as we had not received an action plan.

An adult social care inspector undertook the inspection and we spoke with three members of staff including the Registered Provider. We met with or spoke with all of the people living at the home and talked to staff about the care people received. We read five people's care plans and reviewed the staff recruitment and training process.

This is a summary of what we found.

Is the service safe?

The home had made enquiries about accessing safeguarding training from the local authority and were awaiting dates for staff to attend this. Staff had been given a workbook about safeguarding from an external training provider to work through over the next month. This training meant all staff would be more knowledgeable of the possible signs of abuse, how to protect people and how to report safeguarding issues.

Aspects of the home's cleanliness were monitored daily. However, on both days of our inspection the checks had not identified the lack of hand gel or paper towels in the downstairs toilet or upstairs bathroom. A shared towel was used which could increase the risk of cross infection at the home.

We saw improvements had been made to the management of medicines. However staff did not follow guidance in relation to the safe administration, storage and disposal of medicines. Medication administration charts were not fully completed and there was not a visible audit trail of all medicines coming in to and out of the home. This meant it was difficult to know from people's prescription charts whether they had received their medicine or not.

We saw that checks were in place to ensure the safety of the environment and staff and people at the home had recently undertaken fire training. This meant all people and staff living at Highland Mist would know how to leave the building safely in the event of an emergency. People at the home were being actively encouraged to use the signing in and out book so staff knew who was present within the home at all times in the event of an emergency.

We met one new employee during the first day of our inspection and found that robust checks had not been undertaken prior to their employment commencing. This meant safe recruitment practices had not been followed. On the second day of our inspection we found those staff who did not have Disclosure and Barring Service (DBS) checks had these in progress. These checks ensure all staff are of a good character prior to working in an unsupervised capacity with people at the home.

Is the service effective?

The home worked closely with the local mental health team to ensure people's needs were reviewed regularly. We heard staff discussing people's care on the telephone with health professionals and talking with mental health nurses when they visited. The staff at the home notified the mental health team of changes in people's presentation promptly. A local pharmacist had offered support to the home to improve aspects of medicine management and the Registered Provider was in the process of arranging medicines management refresher training.

We found staff had not completed essential training such as infection control. The provider showed us the training modules which had been purchased for staff to complete and a plan was underway to achieve this training. This meant staff would have the knowledge and skills to support their care work.

Is the service caring?

During our inspection we observed staff treating people with dignity and respect and offering additional support if they required this due to their mental health needs. The staff we spoke with knew people well, treated people kindly, and worked alongside them to support their recovery. Many people we met had built a life in the community due to the support offered from staff. Throughout our conversations with staff and particularly the Registered Provider, it was evident the home remained hopeful regarding people's recovery however challenging their needs were to staff.

Is the service responsive?

We saw mental health professionals visiting during our inspection. Staff shared relevant information about people's health, progress and upcoming appointments for example their reviews. We saw that the home had been liaising with the local pharmacist, people's psychiatrists and community nurses to ensure people's care was managed in a coordinated way with all of the professionals involved.

People at the home and staff had recently been sent questionnaires asking for their experiences of living at Highland Mist Care Home and the responses received were positive. Residents' meetings had recently been reintroduced. This meant people had the opportunity to share their views and experiences in a formal setting.

Is the service well-led?

Since our previous inspection the home had been working hard to improve many areas such as seeking people's views and medicine management but the quality auditing the home undertook required embedding into practice. We (the Care Quality Commission) had been informed of events regarding people's welfare. Statutory notifications had been sent to the CQC when required.

Improvement was required in relation to quality monitoring within the service. Although we found audits were occurring, they were not robust. Audits were not identifying the areas for improvement or the action needed to ensure all aspects of quality within the home were monitored. The Registered Provider had plans to conduct a thorough annual quality monitoring audit to monitor all areas.

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. The summary is based on our observations during the inspection, speaking with six people who lived in the home, six staff supporting them, and from looking at records. We also spoke with external healthcare professionals including a community mental health nurse.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they did not always feel treated with respect and dignity by all of the staff. The medication systems in use were not safe and meant some people had received medicines they were not prescribed. Recruitment practice had some good practice but not all staff had been checked as being safe to work with vulnerable people. Staff recruitment files showed us that the service had not undertaken appropriate checks. During our inspection we found incidents of physical and verbal aggression had not always been reported to the local safeguarding team and we found the home had failed to notify us of events relating to people's care and welfare.

We found people's care plans and risk assessments were not up to date and did not reflect people's current needs. We found the home had not identified environmental risks which could put people at risk.

The Registered Provider set the staff rotas. These did not reflect the numbers of staff on duty. We had concerns the numbers of staff on duty did not meet people's needs at all times.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager told us they had not needed to submit any applications. Proper policies and procedures were in place and the manager had liaised with the local DoLS team. The staff required training to understand when an application should be made, and how to submit one.

Is the service effective?

People who lived in the home told us they were sometimes happy with the care they received.

We spoke with staff who were able to tell us how they met people's care needs. We observed the care provided and spoke with the people who lived in the home. This gave us evidence that staff knew people well. People's health and care needs were assessed but records relating to the assessment and people's care were not in date. Regular care plan reviews were not carried out to ensure they reflected people's current needs.

We found people's comments were not always listened to and acted upon. Some people told us they found it hard to raise concerns with staff. There were not regular residents' meetings for people to be able to share their views of the service and people's views were not regularly sought through questionnaires.

Is the service caring?

People told us "The staff are reasonably kind but not all the time"; "I don't always feel treated with respect"; "When I was really poorly I didn't always get the support I needed"; "Some staff never gave up on me, I appreciated that."

People were mostly supported by kind and attentive staff. Some people told us that they found some staff uncaring, abrupt and rude. Feedback from people about the staff was varied. When speaking with the Registered Provider and some staff, it was clear that they genuinely cared for the people they supported.

Is the service responsive?

People's needs had been assessed before they moved into the home but their assessments were not always fully recorded. The service carried out an assessment to ensure it was able to meet people's needs. We were unable to see the complaints procedure on display and some people did not feel safe raising a complaint and said they would keep their concerns to themselves. Some people told us they felt able to speak to the manager or staff if they were unhappy about something but most people told us they felt things would not be properly investigated. The people we spoke with were not confident that the service would deal with any matters to their satisfaction.

Is the service well-led?

We were unable to see how people who lived in the home were encouraged to be involved in how the home was run. People told us that there used to be residents' meetings but these had stopped. People who lived in the home were not routinely asked about the quality of the service. People told us that they were not confident comments were listened to and acted upon. Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the quality assurance processes that were in place but we found these had not identified the areas of concern we found during the inspection. We found the Registered Manager was receptive to feedback following the inspection and committed to improving aspects of the service to ensure people's safety and welfare. We were made aware it had been a difficult year for the Registered Provider due to personal circumstances which had affected areas of the home's management.

You can see our judgements on the front page of this report.

People told us they thought the staff were "a nice bunch" and "very kind people". Each person we met told us that they were respected by staff. One person said "I stay in my room when I want, and they know it's what I want'.

Staff we met were able to tell us about how people's specific needs were met. Staff said they received good training that helped them support people as they liked.

The service had policies and procedures in place that maintained people's safety. Staff were knowledgeable about their safeguarding responsibilities and how they would respond to any concerns that may arise at any time. In addition, each person in the service told us they felt safe and confident to raise concerns if they had any.

The manager monitored quality by the use of audits, feedback from questionnaires and an effective system that identified complaints and acted upon them where necessary, to improve the service.

The provider of this service is currently registered as an individual. They told us during this inspection that they had recently registered as a company with Company House. We told them that this will need a complete new registration with the Care Quality Commission (CQC).

At this inspection we met five of the eight people who lived at the home and spoke with three of them. We also met three staff and the provider. The provider and one member of staff spoke with us in detail about the care provided.

People who lived at the home had varying mental health needs. Staff were able to tell us about how these needs were met. People we spoke with told us that they were supported to make their own decisions.

People told us they thought the staff were "good and kind" and "fine ' get on with everyone".

Records showed, and staff told us, that there were sufficient skilled and experienced staff on duty at all times. We saw that staff received appropriate training and professional development.

We found that people's personal records including medical records were accurate and fit for purpose.

The home was clean and tidy and there were no unpleasant smells.