Archived: Highnam Hall

This inspection took place on 27 January 2015 and was unannounced. We last inspected the service on 18 October 2013. The home was meeting the regulations we inspected.

Highnam Hall is registered to provide residential care to 37 people some of whom are living with dementia. At the time of our inspection there were 31 people living at the home. The home had a registered manager. 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 the provider had breached Regulations 9, 12, 13 and 15 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.

Some people did not receive the care they required to maintain their wellbeing and ensure they were safe. This was because care had not been specifically planned and delivered to meet their individual needs. We saw that people were left unsupervised for long periods of time which meant staff were not always available to support people appropriately. Medicines were not always managed safely for people. Records relating to the administration and stock control of medicines had not been completed accurately placing people at risk of medicines errors. We also found the current audit systems in place at the home were ineffective in identifying gaps in medicines records.

The home did not have adequate emergency procedures in place. The exit route from the home in case of emergency was kept locked with a bolt. The route was also partially blocked potentially preventing people from leaving this area safely. Staff members said they did not know what individual assessments had taken place in relation to people’s evacuation support needs. Staff also told us they were not aware of any fire wardens in the home and who was in charge in an emergency. The home’s fire zone plan was out of date and did not reflect the changed usage of some rooms or the change in locations of the fire extinguishers. An action plan had been implemented, following an ‘unsatisfactory’ fire safety inspection, to improve fire safety in the home.

‘Deep cleans’ had not recently taken place which meant the home was not clean. For example, we saw that a rubbish bin in a bathroom was overflowing onto the floor, there was no soap or hand wash in the staff and visitor’s toilet and a bath had not been cleaned after use. We observed items of clothing had been discarded and left around the home. We noticed a strong odour of urine in one area of the home which had not been dealt with in a timely manner.

People we spoke with told us they felt safe living at the home. One person said, “Yes I feel safe. Safe with the staff, I trust them. And safe in the house too, it seems to be very well looked after.” Another person said, “I feel very safe here, nothing to worry about.” Staff took care when supporting people to ensure they were protected from risks.

The provider undertook a range of standard assessments to help protect people from a range of potential risks including poor nutrition and moving and handling. Although care plans also identified potential risks. These were not specific and did not identify the controls needed to manage the risk.

Staff had a good understanding of safeguarding and knew about the provider’s whistle blowing procedure. This included how to report their concerns. One member of care staff said, “Thankfully I’ve never had to use it [whistle blowing procedure] but I wouldn’t hesitate, I know how important it is and who it’s there to protect.” Safeguarding concerns had been logged and investigated appropriately.

Staff told us they sometimes felt under pressure due to repeated sickness within the staff team. One staff member said, “Staffing is usually fine but some people are very unreliable and there is a high level of sickness.” The registered manager had implemented an attendance improvement plan to try and address this problem. Staffing levels were analysed regularly to check there were enough staff to meet people’s needs. As a result of this analysis the start times for the morning shift had been staggered to help staff provide the support people needed.

The provider had recruitment procedures to check new staff were suitable to care for and support vulnerable adults. This included requesting and receiving references and disclosure and barring service (DBS) checks.

Incidents and accidents were reviewed every three months. However, the review was not effective in identifying clear learning or directions for staff to try and reduce future accidents.

Records confirmed staff training was mostly up to date. We saw that staff were also receiving regular supervision and appraisal. New staff completed an induction programme with more experienced staff supervising them until they were able to work independently.

The provider was following the requirements of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards. We found that where required, DoLS applications had been submitted to the local authority for authorisation. The registered manager told us all people where there were doubts about their capacity had DoLS authorisations in place. Staff had a good understanding of their responsibilities under the MCA. Staff told us they had received training in the MCA and DoLS.

Staff told us, and records confirmed, that they had not completed training relating to behaviour that challenged the service. They said some people occasionally had “challenging or aggressive outbursts.” One staff member said although they could use some de-escalation techniques to help reassure and calm the person, they had not been formally trained in this and so just had to, “do their best.”

People gave us mixed views about the meals they were given. One person said, “It’s okay I suppose. Breakfast is pretty routine. I like porridge but they never have anything to put in it so it’s very plain.” Another person said, “The food is delicious, I always look forward to mealtimes.” We saw people did not always experience a pleasant dining experience. For example, we observed little interaction between people and staff, staff not being attentive and examples of people not receiving the support they needed as staff were busy.

People had regular input from a range of healthcare professionals including specialist nurses, community nurses, GPs, dentists, opticians, dietitians and speech and language therapists.

We found improvements were required to ensure the service was appropriate to meet the needs of people living with dementia. For example, the home did not have a dedicated ‘dementia champion’ and detailed life histories had not been developed. Most staff had not completed specific training in dementia awareness and meaningful activities specifically for people living with dementia were not available. We have made a recommendation about this.

People gave us positive feedback about their care. One person said, “It is nice here. The staff are lovely.” Another person we spoke with said, “The staff work hard and are very kind. They’re very patient and never rush you.” We spent time observing people in communal areas of the home. We observed there was often a lack of staff in communal lounge areas which meant people were often not supervised and lacked attention from staff for long periods. We carried out an observation for 50 minutes in the downstairs communal lounge, using the Standard Observation Framework for Inspection (SOFI). We saw throughout the observation period the three people received little interaction from staff.

People had access to independent advice and assistance (advocacy) when they needed it. The registered manager confirmed most people living in the home had representation from either an independent advocate or a family member.

Staff had a good awareness of people’s needs including their likes and dislikes. Care records included some personalised information about each person including details of their next of kin, health professionals and a brief history about the person. Care plans included information about people’s personal hygiene needs, mobility and dietary intake. People had their needs assessed when they were admitted into the home and this information was used to develop care plans.

We heard mixed views about opportunities to take part in activities. One person said, “Not much goes on around here. Staff are nice but most of the time we just sit.” Another person said they were, “Not aware of any activities.” Another person said, “Sometimes it can be quite sociable. Especially at mealtimes people can get together and chat.” On one occasion a person said, “I am bored stiff.” Staff told us the lack of an activities coordinator had meant that activities were difficult to organise and plan.

There were opportunities for people, family members and visiting professionals to give their views about the care provided at the home. This included questionnaires and meetings with staff. We saw there was a system to log and investigate complaints. People did not raise any specific complaints with us during our inspection.

The home had a registered manager. People and staff said the home had a good atmosphere. One person said, “The staff are like my extended family, they’re so lovely.” The registered manager said staff could speak with her whenever they needed to. Staff also confirmed the manager was approachable. One staff member told us, “I know we’re short staffed but we’re here for the residents and nothing else. The manager supports us brilliantly and her door is always open or she’s always on the end of the phone. I’ve never felt that there’s a problem I can’t approach her about.”

The registered manager told us they regularly observed staff member’s care practice whilst walking around the home to ensure people were treated with dignity and respect. The quality of care plans was usually checked monthly and these checks were successful in identifying issues with care plans and ensuring action was taken. For example, checks had identified that one person required additional care plans to be developed. Other people needed particular documents signing to show their consent to receive care.

The registered manager undertook a six monthly quality audit. This included checks on supervision, health and safety, fire safety, care plan updates and staffing levels. The audit also included an analysis of complaints, safeguarding, accidents and incidents. The records showed that action was taken to prevent incidents happening in the future, such as changing staff shift times and raising awareness of issues at team meetings.